From Scary Symptoms
Last January, Sara Bryant, 21, an interior design student in San Diego, thought she'd picked up a bug over the holidays. A petite powerhouse who often worked out hours a day, she thought she'd shake it off quickly. Instead, she kept feeling worse. "I had no energy," she recalls. "I was completely drained. Every joint ached. Even my skin hurt." Soon she became too weak to stay alone when her husband, Bradley, went to work."I had that 'mom sense' that something was really wrong," says Nancy Sunday, Sara's mother, who brought her ailing daughter to her home. On January 10, she took Sara to a doctor, who diagnosed a bad flu that had settled into her joints. He prescribed ibuprofen, but it didn't help. She was getting sicker and sicker.
You can't open a newspaper now without seeing scary stories about the possibility of a global pandemic of bird flu. And, yes, if the virus does mutate, allowing it to pass easily from person to person, that will be a frightening scenario. But that possibility is remote compared with the very real threats to your health found much closer to home. Influenza and pneumonia, for example, lead to 65,681 deaths and 1.5 million hospitalizations a year in the United States. They are among the many dangerous infectious diseases that can be contracted in the most innocuous-seeming ways: from petting an animal to spending time outdoors where mosquitoes and ticks hide; even a simple handshake could lead to something deadly.
Sara's fever persisted, and soon it became clear that her illness was serious. She had shaking chills. Her skin turned yellow. Every movement was excruciating. On January 14 Nancy, who'd never seen her daughter so sick, took her to another doctor, who immediately sent Sara to the emergency room at Scripps Mercy Hospital.
Not Just the Flu
"I knew something dramatic was going on, because she was in so much pain," says Alex Harrison, the medical resident who coordinated Sara's care. Her kidneys were failing. Her liver and gallbladder weren't working. Her extremities were swollen. A CT scan revealed lung damage. The diagnosis: a form of "walking" bacterial pneumonia. "But that didn't make sense, because her symptoms were so severe," says Dr. Harrison. Further tests revealed that as Sara's body was struggling to fight off this condition, a staph infection also invaded her bloodstream, which then triggered toxic shock syndrome.Things were getting worse. The next afternoon, Sara crashed. Her blood pressure plummeted, and she couldn't breathe. Organ after organ began to fail. "There was a high likelihood she would die," says Dr. Harrison. "We moved her to the ICU and put her on life support." A machine took over her breathing. IV poles, with feeding and drainage tubes dangling, circled her bed. She was on four different blood pressure medicines and three different antibiotics.
After three tense touch-and-go days in the ICU, Sara's blood pressure gradually began to rise. Her kidney and liver functions returned to normal. After ten days on a ventilator, she was finally able to breathe on her own. Heavily sedated, Sara had no memory of the fierce battle for her life.
Her body was so swollen from all the medications and fluids that she was almost unrecognizable. As the swelling subsided, doctors found abscesses, reservoirs of bacteria, deep within her legs, thighs and buttocks. "We needed to operate to remove the infection," explains Dr. Harrison. Nine times Sara, still too weak to walk, was anesthetized as surgeons drained the abscesses.
With daily physical therapy, Sara steadily regained strength. On February 26, after 43 days in the hospital, she went home to continue her recovery. After missing a semester of college, Sara is now back at Grossmont College, playing softball, volunteering with the mentally and physically disabled and working two part-time jobs. "She is a miracle," Dr. Harrison says. "Anyone who wasn't so young and fit and in perfect health would have died."
Perilous Pets
To many people, pets are like family -- but the increasing popularity of unusual species comes with danger. You might assume that "exotic" pets, such as rare birds, reptiles and furry prairie dogs, are safe if you get them from a certified breeder or pet store. But as one family discovered, some animals may carry a deadly virus.Like other three-year-olds, Schyan Kautzer of Dorchester, Wisconsin, occasionally had an unexplained fever. At first this one seemed like nothing serious, but on May 16, 2003, her temperature spiked to 103 degrees and stayed there. The usually buoyant girl seemed listless and weak. And when pus-filled blisters erupted on Schyan's skin, her mother, Tammy, 28, who keeps a menagerie of cats, dogs, goats and other animals on the family's 15-acre farm, thought about the cute little prairie dog she'd bought at a swap meet a few days before. One of its eyes had sealed shut, and it seemed sick. She'd warned Schyan not to play with it, but as the girl was putting the new pet into its cage, it nipped her right index finger and left hand.
A doctor at a local clinic said Schyan's bite wound was infected and prescribed antibiotics. By May 20, the blistering rash spread to Schyan's arms and scalp, then to other body parts. Her right eye, inflamed from rubbing, was swollen and runny. Two days later, the Kautzers drove 30 miles to Marshfield Clinic, which tested Schyan for every disease prairie dogs are known to carry. All came back negative. Meanwhile, the prairie dog that bit Schyan died. Fearing rabies, the vet sent its head to a state lab for testing; the results were negative. He also sent one of the animal's swollen lymph glands to Marshfield's pathology lab.
At the hospital, Tammy and her husband, Steve, kept a round-the-clock vigil in Schyan's room. "We cried," says Tammy. "And although I'm not a religious person, I prayed. The worst moment came when Schyan asked, 'Mommy, am I going to die?' Of course, I said no, but I was so afraid. All I could do was cry and sleep."
As dermatologist John Melski gently examined the virulent blisters on the girl's skin, he says, "All I knew for certain was that I didn't know what she had, so I had to keep looking." That meant a skin biopsy, and yet another painful needle poke. A pathology team, summoned on a Sunday afternoon, rushed to process the biopsy. By 9 p.m. they had eliminated a long list of possible suspects, including plague. "We strongly suspected a virus, but we didn't know which one," says Dr. Melski, who prescribed the antiviral drug acyclovir in the hope that it might help. The little girl also received fluids, breathing assistance, IV feeding and various medications to lower her temperature.
By May 26, Schyan was well enough to sit up in bed and eat. But the next day her mom came down with a fever, sweats and sore throat. She had the same telltale blisters clustered around a cat scratch that had allowed the virus to enter her. "She was delighted because we could do skin biopsies on her rather than on Schyan," saysm Dr. Melski. "I got more tissue to analyze with an electron microscope. That was the pivotal thing." On June 4 the high-tech images identified the pathogen as an orthopox virus, although they didn't know which one. Within days, pathologists at Marshfield and the federal Centers for Disease Control and Prevention pinpointed the culprit: monkeypox, a deadly but less contagious cousin of smallpox that had never been seen outside Africa.
"We live in a smaller, more dangerous world," says < Dr. Martin Blaser , president of the Infectious Diseases Society of America. "A disease like monkeypox or West Nile virus can jump from an obscure village in Africa halfway around the world in a matter of days or weeks." Medical detectives traced the outbreak to infected giant Gambian rats imported from Ghana, which had been kept in a cage adjacent to a group of prairie dogs.
"We were lucky," says Dr. Melski. "The only people who got sick (72 suspected cases in six Midwestern states) had direct contact with a prairie dog or someone who had skin lesions." Except for a damaged tear duct (from rubbing her eye while infected), Schyan recovered completely and went home on May 29. Both her parents, who developed milder symptoms, improved quickly. The family and their pets remained under quarantine for several weeks. Acting jointly, the CDC and the Food and Drug Administration banned the import of all rodents from < Africa as well as the sale and distribution of prairie dogs.
"In hindsight, we learned valuable lessons," says Dr. Melski. "Given the world we've created, you can't dismiss the threat of an infectious disease no one has ever seen before. It could happen anywhere any day. And yes, next time it could be worse."
Mystery Man
When flu-like symptoms appear out of nowhere, it may take detective work to identify possible suspects. In one man's case, no one knew the culprit until his wife recalled that he had recently spent a day on one of his favorite outdoor activities: fly-fishing. John Gray, a retired computer specialist at the Air Force Academy in Colorado Springs , wasn't feeling great in July 2003, but he wasn't going to let a cold or flu keep him from his sprawling family's annual reunion in < Tennessee. Tall and fit, he'd hardly been sick a day in his life. "My husband's full of charm," says his wife, Dorothy, "but he's also bullheaded."Despite John's fever and chills, on July 24 they started the 1,500-mile car trip east. But John felt worse with every passing mile. When they finally found an emergency room, doctors diagnosed an ear infection and prescribed an antibiotic. It all seemed pretty routine, and after a day's rest, the Grays pressed on to John's sister's home in Blountville, Tennessee.
But as more than 100 relatives gathered nearby, John stayed in bed with a high fever, nausea, vomiting and diarrhea. A red rash began spreading over his legs, upper chest and shoulders. He became increasingly disoriented and confused. Alarmed, his older sister, Jean Williams, drove the Grays to Wellmont Holston Valley Medical Center. "He was acting kind of goofy," says Robin Peavler, the emergency room physician who examined John. "His mental train kept going off the tracks." He looked for the usual suspects behind mental confusion, until a spinal tap signaled an infection in the brain or central nervous system. John was admitted to the hospital immediately. "I remember him looking at me and saying, 'I love you,' as if it was going to be the last time," Dorothy says.
Eventually he was diagnosed with encephalitis, an inflammation of the brain. Its cause was a mystery. Because the Grays came from < Colorado, the Tennessee team speculated John might have contracted Rocky Mountain spotted fever, a deadly infectious disease carried by ticks. "His wife tugged at my sleeve, saying, 'It wasn't a tick; it was a mosquito,' "says Rhonda Morgan, a clinical nurse specialist. While fly-fishing a few days before their trip, John had been bitten behind the ear by a mosquito, which he'd killed with a quick slap. "A light bulb went off in my head," recalls Morgan, who suggested a special blood test for West Nile virus, which mosquitoes transfer from infected birds to humans. The disease, once limited to Africa, first appeared in the United States in 1999.
As they waited for results, John's condition deteriorated. As his lungs filled with fluid, he struggled to breathe. A chest x-ray confirmed that he had an often fatal complication called adult respiratory distress syndrome. Unable to breathe on his own, he was put on a ventilator for 11 days. "I couldn't leave him," his wife recalls. Several days later the test results confirmed the first-ever case of West Nile virus in Tennessee. "At that point John was still in dire straits, but at least he wasn't getting worse," says Morgan.
After two weeks in the ICU, he was transferred, first to a less restrictive intensive-care room, next a general medical floor and then a rehabilitation facility. When he finally left the hospital, John had one goal: to return to Colorado. "A lot of people in Colorado got West Nile that summer, and most of the deaths were people over age 65," John observes. "I say I'm an answer to prayers. The congregations of all my brothers' and sisters' churches were praying for me. They're one of the reasons I'm here today."