The patient came into the room looking embarrassed and a bit sheepish. He started to tell the tale of a drunken night out with his friends a couple of days ago. It turns out that he and his friends had been to the pub to celebrate a birthday, had a few too many beers and then on the way home starting daring each other to do increasingly daft things. “We’ve all been there!” When it came to the patients turn one of his friends picked up a big juicy slug from the floor and dared him to eat it… which in his inebriated state he promptly did.
 
The next morning, whilst nursing a hangover, the patient thought back to what he had done and started to wonder if this was such as sensible idea after all. A quick search on “Dr Google” and he was in a panic.
 
“You see Doc, I think I’ve got lung worm!” he exclaimed.
 
After recovering from the mental picture of the Harry Potter film where Ron Weasley’s curse “Slugulus Eructo” backfires and he starts coughing up giant slugs, the GP thought I know nothing about this. He tapped “lung worm” into his own computer and everything that came up was either to do with dogs… or Ron’s slug curse, apparently Ron’s plastic slugs were in chocolate sauce to make them more palatable! Anyway, not very helpful, time to call a Microbiologist he thought….

​“I think my patient has plague!” exclaimed the over excited junior doctor.
 
Knowing that plague had not been seen in the UK for 100 years this year the Microbiologist sighed, “Why do you think your patient has plague?” he asked.
 
“Because they have a rash and have been bitten by a rat” explained the junior doctor.
 
“Have they got a fever, headache and any swollen joints? Is the rash maculopapular?” asked the Microbiologist starting to take more of an interest, but not because they thought this might be plague.
 
“Yes!” said the junior doctor getting even more excited.
 
“This sounds like rat bite fever” said the Microbiologist “let’s get a joint fluid sample and then we can discuss treatment.”
 
“Oh, so you don’t think it’s plague then….” muttered the junior doctor.

The patient was in a right state! It took a while for the GP to calm them down enough to find out what was worrying them. Finally they were able to discover that the patient had returned a week ago from a trip snowboarding in Shiga Kogen in Japan (snow season is December – April), where he’d also visited Jigokudani or Snow Monkey Park. The patient reported he’d developed a headache earlier that evening and rushed to the out of hours GPs for help. He remembered not having a particular vaccine before he went because it was too expensive and then having since been on the internet and read 1/3 of patients with Japanese Encephalitis die, he was now convinced he had it and was going to die all because they had not had the vaccine.