This Medical Mysteries series is one of my favorites in the NYT, probably for the same reason I love P. D. James novels. The inscrutable condition (or crime) meets the rare, brilliant physician (or detective) with exceptionally broad experience and flawless recall. In the end, all works out well.
It’s compelling journalism (and crime literature). But it also makes me wonder how many patients come to the doctor(s) whose perception is slightly less acute, training is more pedestrian, or who missed the class on this condition in school. Not every detective is Inspector Dalgliesh, and many crimes remain unsolved.
The Hippocratic author of On Ancient Medicine observed, “bad and commonplace physicians, when they treat men who have no serious illness, in which case one may commit great mistakes without producing any formidable mischief (and such complaints occur much more frequently to men than dangerous ones): under these circumstances, when they commit mistakes, they do not expose themselves to ordinary men; but when they fall in with a great, a strong, and a dangerous disease, then their mistakes and want of skill are made apparent to all.”
1
What about acute histoplasmosis? At Peru we often see that disease after people explore caves since the spores of the fungus are found within bats (and also birds) feces. Where there bats in the shed? The man could have accidentally breathed de spores (same as the dog). The symptoms of this disease include flue-like symptoms, malaise, low-grade fever. Besides, these disease can also be treated by fluconazole (diflucan)
9
We see severe histoplasmosis here in Cincinnati at least a few times a year. Fluconazole is not the preferred treatment for histoplasmosis as it is inferior to Itraconazole. Those with mild disease do not require treatment. His presentation seemed more severe and seemed less likely to resolve with optimal treatment (ampho B or itra). Lastly, I don’t recall any of his imaging describing hilar adenopathy (I may have skimmed over it).
Blasto presents similar to Histo but is usually more severe and would more likely cause life threatening disease is untreated.
2
As i read the article i was more interested in the honey. While it was a quick part of the story honey, like rice, can have botulinum spores but then the dog would have had to have been exposed as well. Just out of curiosity his blood ox lvls wasn't mentioned. The broad spec would have temporarily eliminated the issue. This might be a reoccurring if the source of the illness is not determined.
1
Sounds like they’re both doing better.
The clinicians were right to not give the labs too much weight, though it’s curious given the severity of the symptoms described.
Obviously broad spectrum antibiotics like doxycycline and diflucan can treat a variety of infectious successfully, so it’s great we have those.
My first thought was leptospirosis, C. immitis, D. immitis, histoplasmosis (possibly).
However, it seems resolved now. Best of wishes to the family!!
3
I just watched the diagnosis series on Netflix and i think it is really good platform to help people. Being a veterinary student i thought of lyme disease and leptospirosis not fungal diseases beacuse immune system was intact
2
Having a beehive, shed, and a dog that can be off the leash sound like they might live in a more rural setting. Especially if they live in Central TX. I'm curious to know if there are any mass produced crops or fields around them that the farmers use pesticides or other chemicals to treat.
Another thought I had was lead poisoning. I believe it can affect animals as well. How old is this shed? Is it painted? Has the dog chewed, licked, or been around the paint?
Talking about immigrant doctors. Once I got an intestinal obstruction (3 days in a NYC Hospital) from eating a mango salad that was cut too close to the seed. The hairs that come from the seed are basically wood, cellulose. I knew from living in Venezuela and Colombia that they cut just the outer pulp to make smoothies and that they throw the seed in the blender and later they pass the mix to a strainer. Otherwise you get an intestinal obstruction for sure. If they get such in small towns they drink Coca Cola. It can deadly. I had to tell the doctors of such condition and the cause of it, they had no idea, gastroenterology students had no idea, nor the main doctor. They could have opened me like a lamb...In other tropical Countries, in Asia, that happens, google it..
7
Have histoplasmosis been looked into? This fungal infection comes from exposure to the fungal spores from bat feces being breathed in. I know this from experience from my cousin who had been infected from cleaning up bat feces from her work place. It can possibly be in the wood and you would not even know it. You can have this infection for years before getting a diagnosis. It's really knowing what to look for. I hope he gets tested for it because it really requires specific types of antifungals and antibiotics for a year to get rid of this type of infection. I wish him the very best.
Re: Rumination: Two thoughts: Rumination disorder is MOSTLY involuntary, but there does seem to be a component of release, i.e., the release of pressure, not only in the stomach but also emotional. These two components may be something that is learned, after the patient has an initially traumatic episode of vomiting. Some people "burp" repetitively but dont express food.
My second thought is that there is secondary gain for mother, here, and an obvious enmeshment between daughter and mother, some of which is understandable.I find it troublesome that mother continuously reinforces her daughter's belief that medicine is untrustworthy.
2
I was led to this article after watching the first episode of "Diagnosis" on Netflix. The idea of using social media and "crowd sourcing" ideas is wonderful, and we have been doing that more frequently in veterinary medicine as well. I was a little disappointed by Dr. Sanders comment that her favorite "non-medical" input was given by veterinarians. As a veterinarian, on a day to day basis I am a general practitioner, a neurologist, an anesthesiologist, a surgeon, an internist, and a cardiologist - sometimes before lunch. While I do not profess to be an expert in one particular field, I practice high quality medicine on a day to day basis. Calling input from a veterinarian "non-medical" is disrespectful to those that have completed intensive medical training and practice medicine daily. If more clinicians would seek input from veterinarians and vice/versa I firmly believe we would enhance the quality of medicine for everyone. I very much enjoy the collaborative efforts being brought about by the One Health movement, and encourage those unfamiliar with the movement to research it and its goals.
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@The Pet Dr.
I, a health care professional, have always been told that vets are smarter than the average doctor. They have to learn not one, but many, many anatomies, physiologies, drug selections, on and on and on. Also, it’s much harder to get into vet school than medical school.
Unfortunate perpetuation of a useless stereotype by the otherwise impeccable Dr. Sanders.
12
@The Pet Dr.
I was also led to this article after watching the first episode of "Diagnosis" on Netflix. As a veterinary technician, I was excited to see veterinarians offering their opinions. I was telling my husband during the episode, she should go to the vet! I have worked for some of the most amazing veterinarians and there have been times when I am at the doctor that I want to tell them, "forget it, I'll ask my veterinarian." I was also disappointed to hear Dr. Sanders refer to the advice of veterinarians as "non-medical". It is so frustrating that some people think veterinarians are not "real doctors". Veterinary technicians are also met with this same disregard when we offer our medical opinion as well. I very much enjoyed reading your response, and I completely agree with your statement about the One Health movement. I hope that you will to respond to these medical mysteries and offer your expertise regardless of the misguided opinion that you're not a "RD" (real doctor) because your experience as a DVM could save lives!
8
My two Lurchers have received yearly leptospirosis vaccines for the past several years. Vets here recommended it as there is too much of a chance of it being spread at off-leash areas and other parks and events that dogs frequent.
6
As an immigrant, isn’t it nice to see that another one brings talent to the US. Now what exactly have those people in Washington got against us ?
39
Lucky that the doctor was an immigrant.
27
Content aside, the title and illustrations remind me of the old Reader's Digest stories.
7
Modern humans stay/live indoors much more than in the last century. In fact, the farther back in time you go, the more time was spent outdoors and/or working in and around the soil. As time went forth from ancient to modern times, the lifespan of humans also lengthened. Statistically, one hypothesis is that time spent outdoors correlates inversely with human lifespan. Perhaps it's a marker for more exposure to bacteria and viruses ?
4
it's got to be valley fever. Here in Arizona plenty of people get it as well as dogs and horses. It will land people in the hospital for up to several weeks and is actually fatal to animals.
9
Chagas Disease also affects people and dogs. It has been found in that area and Texas A&M was asking for people to send them dead kissing bugs to test for the disease as they are carriers. I don't know the symptoms, but I have heard of dogs dying of Chagas Disease not far from there and it seems that young Labs are particularly susceptible, because they are curious about the bugs. I am glad both have recovered.
5
@mklitt
Chagas is nasty, but as I (imperfectly) recall, the harm is more longterm than immediate. (heart damage, intestinal damage).
For sure you don't want to encounter kissing bugs, and if you can have any tested that you encounter, that would be wise. (They nest in woodpiles, etc, but are happy to enter houses, esp older houses or adobes.).
Watch out for painless wounds in the face, looking like someone drilled you with a 1/16th to 1/8th drill bit sometime in the night. CDC has lots more info.
2
Maybe the author could have mentioned that neither raccoons nor possums are rodents.
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So was a convalescent antibody titer checked for these two pathogens? This would easily tell us if your hypothesis that he was tested too early to detect antibodies was correct.
8
This article left me hanging in the wind. It is unlikely the patient's dog would not have been vaccinated for lepto. The symptoms could easily have been caused by some environmental factor, including the prior use of banned chemicals or other substances by the original shed owner.
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@LH
Please remember that even the best vaccines are not 100% efficacious. They may markedly decrease the incidence of the infection but they almost never eliminate the disease entirely. In larger susceptible populations vaccination of the greater community also decreases the chances of contracting the disease even further by the so-called herd immunity.
3
hantavirus - spread by mice dogs also can get it but has high fatality
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@simon nutrient That's just what I thought - I was surprised that hanta was suggested.
3
Exactly.
1
@simon nutrient - Same thing came to mind, too. I knew someone who had gone to the 4 corners for an ultra-marathon and while visiting that part of the country came down with similar symptoms. Lethargy!
4
Dust masks - the sort sold in paint stores/departments - are useless. The narrow elastic band cannot hold the mask against the wearer's nose/mouth and so form a tight seal.
Our lungs are not efficient expellers of ultra-fine dust particles. Therefore, what is needed is an industrial respirator, with activated carbon filters. A respirator - rated for radioactive dusts - will keep-out most other dusts.
Viruses, though, are so small that only a sealed-system respirator - one that provides air from a tank - can provide proper protection.
Should an sneeze-transmissible, highly-lethal bird flu virus again evolve - akin to that which caused the end-World War I global influenza pandemic - do not waste time with surgical masks. Those are totally useless. Get a sealed-system respirator.
Using a shop vac to clean-up an area possibly contaminated with bioactive agents is foolhardy. A vacuum will disperse such agents. The best thing to do is to spray bleach on all surfaces. Bleach is a very efficient biocide. It kills bacteria and viruses. Ultraviolet light also is an effective biocide.
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@Jay E. Simkin - Sounds like the best thing to do is, "Work without a mask and hope for the best." Stay healthy before you get sick, eat right and get plenty of rest and exercise.
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@Jay E. Simkin
You answered a question I had. A practical question because I had been in an attic in an old house which was definitely contaminated with everything rodent, made allthe worse by the insulation which has collected decades' worth of dust and contaminants. Cleaning up a less filthy, but more moldy area, once gave me a severe sinus infection.
I guess "safe" means hiring people with the proper equipment to do the preliminary work.
1
Sounds like Hantavirus to me. Symptoms and signs are consistent and recovery period is about right. The primary host is the mouse. It is shed from mice in urine and transmission to humans occurs when mouse nests are disturbed kicking the virus up in the dust. But I'm not sure if dogs can get this.
27
Dogs can get it but don’t spread it to humans. Big outbreak in the Four Corners area of Arizona in early 90s.
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I remember that! Coincided with an unusually bountiful amount of pinon berries which kept the rodent population alive and well. The theory I recall had to do with their feces mixing in with soil and getting inhaled. Navajo elders told CDC investigators about an earlier outbreak in the 1940s I believe.
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@simon nutrient I thought of that also. Weren’t a lot of native Americans the ones who were infected?
2
lyme disease.
1
Very wise of the physician not to value lab tests above clinical judgment. There are always false negative (and false positive) lab results.
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Were antibodies for both diseases (leptospirosis and
coccidioidomycosis repeated a week or two after the first negative tests to see if antibodies had as would be expected in an active infection?
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This is a medical case which has nothing to do with immigration. Have we become too "woke?"
The article does not state that Dr Weeratunge was an immigrant, however even if she were, it is unlikely that her overseas experience contributed to her differential diagnoses. Infectious disease specialist do not have to travel the world to be good. Any ID expert is well aware of infectious agents which exist worldwide - that's why we have them .
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@A Doctor I would greatly prefer being seen by a doctor with clinical experience in settings where lab tests are not always available or reliable. Because a lot of medical advances are quite recent and geographically concentrated, the best older doctors and immigrant doctors can be really really good at seat of the pants diagnosis (of course, incompetence also can be found). My dad practiced medicine in rural PA for about 50 years, many of those alongside his father. He had hundred years of medical memory to consult. He was a great intuitive diagnostician in addition to being up on the latest lab protocols. That's the kind of doctor I want.
It isn't the origin of the knowledge, it is the breadth, and doctors who have only practiced medicine, especially specialized medicine, in the modern USA are often disadvantaged.
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@A Doctor
The doctor attended medical school in Sri Lanka. That suggests she is an immigrant. Not that there is anything wrong with that!
17
My experience working as an infectious disease nurse was that the docs who actually saw cases were much better prepared to diagnose and treat them. They were also valuable teachers of those doctors and nurses who, hopefully, will never see a case of polio or rabies. I learned about smallpox from Dr. D.A. Henderson - a heroic disease detective - who directed the effort to eradicate smallpox.
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San Marcos is northeast of San Antonio.
1
Why use the brand name Diflucan rather than the generic fluconazole?
23
This makes me think of George and Barbara Bush and their dog, Millie. All three developed autoimmune diseases. So strange. Not sure if in the Bushs' case the cause was ever proved definitively.
13
This is why my vet refused to let me bring my golden retriever puppy to NYC before she had her lepto vaccine. Yes, transmission is a low probability event, but the results can be dire. Vaccinate your dogs now!
29
Thank goodness for doctors from around the world, especially from other than the industrialized West!
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A wife smart enough to pay attention to an ailing dog, an MD with training abroad and open minded MD and DVM familiar with zoological pathogens are the trifecta here.
The fate of this gentleman and Annie are fascinating.
So are climate change, habitat loss and epidemiology.
MDs, DVMs, public health officials and climatologists are looking at these issues to be able to spot trends, mitigate causes and treat illnesses that affect humans, animals and our planet.
Anyone interested in this topic, can watch a discussion among experts at the Bronx Zoo, NYC Health Department and climate advocates to learn more here:
https://www.amcny.org/event/going-viral-one-health-day/
Congrats to all here for a happy ending here!
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Possibly tick-borne disease?
7
For me, the moral of the story is that an immigrant doctor found the cause and treated it! When will immigrant hating America understand what immigrants bring to this country? The doctor's knowledge was made of up of many different kinds of experience, some from Sri Lanka. I love that such a mixing of knowledge is possible in America and hate that some people are trying to undo that.
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@Shuchi Kapila
An immigrant surgeon saved my life. He is half Japanese, half Korean (and has a Chinese wife). For three years I dealt with baffling, scary symptoms. I went to my GP (born in India) because I thought it was my heart (I have a stent). He thought I was wrong, and he turned out to be right and connected me with the surgeon who knew what to do. I was born here, but my grandparents were immigrants. We're a country of immigrants, all of us, unless we are descendants of Native Americans. How is it that so many Americans don't understand our history?
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@Chrislav
I see an awful lot of the objection to immigrants being to those who aren't white. It's such a shame! The immigrant community has made enormous and vital contributions to our society. Including in medicine! US-based medical schools aren't the only good ones in the world, and we need to remember that.
I've noticed that vets are frequently the best diagnosticians -- perhaps because their patients don't tell them inaccurate or tangential information, and they have to diagnose from symptoms alone. This man and his dog were very lucky in his wife, vet, AND doctor -- they all contributed to this happy ending. I'm' so glad for them all!
22
@Iman Onymous That is not my experience. Often, you get what you expect. Be wary of cognitive bias.
8
This serves as a welcome warning to be careful and be aware when you're doing that kind of work.
15
The dog was not inoculated for lepto? What was the test result on the dog?
I also think the Sri Lanka connection is a red herring ... any physician could have made that connection, but good for her!
10
One thing jumps out at me here, and that is how superior this patient’s emergency and subsequent medical care was than what I would find at my local ER and hospital. I truly doubt that, had I presented with these symptoms, I would have been admitted to hospital here. Very frustrating.
The other thing that grabbed me was that it took a doctor from Sri Lanka to spot what others had missed. This points to the enormous contribution physicians from abroad bring to our domestic medical system. A recent Ethicist column addressed the question of whether patients’ possibly prejudice-based preferences for specific caregivers should be accommodated, and someone posted a disturbing comment saying foreign-trained physicians are less qualified than those trained here. I hope that person reads this article! A good doctor is one with a wide perspective. One who sees both horses and zebras, but also rodents. The more a doctor has seen, in training, the better. (I am often exposed to the waste of rodents and other wildlife, and have dogs, so this article freaked me out a bit.)
Even veterinarians are not always quick to spot leptospirosis, or the more common giardia. About 30 years ago, back when fewer people knew of these infections, I brought a sick dog to the vet and mentioned that the dog had been exposed to a dead seal on the beach. The vet happened to have worked with marine mammal rescue, so she immediately tested for lepto and giardia (both common in seals). Bingo!
80
I also have several anecdotal quotes from neighbors and friends who claim that they found South Asian trained doctors to be more compassionate and that they found very comforting during the high stress time.
23
It would be malpractice to not admit someone with high fever and low blood pressure—even in your sleepy little local emergency department.
8
As a veterinary internal medicine specialist for over 35 years I am stunned by this article. A man and his dog each get sick and go to the hospital. Neither get a diagnosis. Each recover, because of or more likely, in spite of treatments. The end. The point?
It was reported that Leptospirosis was the most likely diagnosis in spite of the tests being negative. The clinical signs were not consistent with leptospirosis which usually presents with renal and or hepatic issues and abnormal blood tests. Pulmonary lesions are extremely rare radiographically with leptospirosis. If this disease was truly a serious consideration, a follow up blood test for leptospirosis several days later would have confirmed or ruled out the disease with a high degree of reliability after the immune system has had time to respond. Relatively easy and inexpensive If this test was run, as it should have been, I’m shocked that the results were not reported in this article. If it wasn’t run, there are serious questions about the care given to both the dog and the man. Each patient was hospitalized for an extended period of time easily allowing the repeat of the leptospirosis test.
What was the point of this article?
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@Warren D, I just assumed that those tests were completed (I have had a dog treated for lepto). But your comment confirms my feeling that I should be treated by a good vet rather than the very rushed doctors I usually see.
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@Warren D
I don’t know the authors intent, but in comparing case articles I find the ones without an answer stimulate my inquisitiveness more than the ones that hand me the answer.
I was thinking this may have been septicemia plaque without bubos and that they should have tested the man and dog for Yersinia Pestis. Doxycycline Would have covered that as well, which is a good argument for empiric treatments.
24
@Joe it’s nice you enjoy articles that stimulate your mind, however it is not the job of a physician or veterinarian to entertain The issues in these cases were never resolved and at least some additional effort should have been exerted in trying to figure out what was going on. Any one of a large number of problems could have been at fault here. If these people had been given a diagnosis they would be possibly better able to prevent this problem from reoccurring. There was absolutely no evidence that the outdoor work associated with the wildlife had anything at all to do with their problems and perhaps there is an ongoing issue in their environment or some other cause they should be concerned about.
27
The DHL vaccine given to dogs specifically protects against leptospirosis - that's the "L". That makes it unlikely that leptospirosis was the cause of the dog's illness and casts some doubt on the human diagnosis.
22
@Cloudy Like a few others on this thread, I wonder whether hantavirus occurred to either the physician or the veterinarian.
2
The cause of the patient's illness seems to me much more likely to be acute histoplasmosis. The exposure, presentation and course are much more consistent than with coccidioidomycosis (which is likely far less common in that area of west Texas ) and even leptospirosis. I wonder if any tests for histoplasmosis were done?
16
@Neil Ampel, a Google search tells me that histoplasmosis is not common in Texas. Lepto is pretty common across the country, I believe.
Histoplasmosis was also my and my wife’s thought. It is common among certain types of workers. And the soil, rodents, and possibly bats in the vicinity seem to make this more of a horse than a zebra.
9
As I read this article I was on the edge of my seat to learn the outcome and hopefully a happy ending for the patient.
While I am glad for his recovery, I am left with the real life truth that so much of the mysteries of our bodies and their relationship on with the world is beyond the ken of science.
My daughter has several times been to the hospital for mystery ailments only to leave specialists mystified. Fortunately she is in great health today but my experience over the years has convinced me that our confidence in the medical establishment is overblown and that they are struggling in the dark almost as much as we are.
43
When I was cleaning out my basement in preparation for waterproofing and painting the stone-and-brick walls, I first shop-vacuumed what I could and then sprayed everything heavily with Clorox CleanUp. And then, wearing a mask, I wiped it all clean.
When we bought the house, we saw evidence of mice; and despite our having cats, two or three mice have ventured in over the course of twenty years.
It's always a good idea not to breathe in dust.
61
Quoting the advice from one of the discoverers of hantavirus: "When you go to clean your shed in the spring and see mice, bring a can of gas and a match"
There was no differential diagnosis and no cure; the patient survived with intensive supportive care, fluids and nutrients. Don't take either the danger of virus infections or the value of intensive care for granted, and don't ever imagine that the average american medical system has the capacity to identify infectious agents. There is only a very short list that may be tested for and everything else is "unknown". Why? Because there is no known treatment; go with intensive care if you want to survive.
79
Wow, what a tale, for both man and dog. Note to self - avoid ripping up old shed floors under which are all kinds of nests and skeletons! Or, if such a thing MUST be done, wear a mask or respirator, as other commenters have suggested. And don't let the dog supervise such activity, no matter how much she may want to :)
90
I find these mystery diagnoses stories fascinating. Thanks, NYT!
92
So...what was the causitive organism? No conclusion at all?
And of course, an N95-100 mask must be worn when digging, inhaling excavation "dust" in the air, etc.tc. That is only common sense...way too often lacking .
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@susan paul
Your "common sense" requires knowledge first. If a person doesn't know there is a risk from digging, s/he won't be in a position to have that "common sense". I'd guess few people know it.
4
Thankfully, DVMs now highly recommend Lepto vaccination for dogs here. I realize this wouldn’t have helped the beekeeper, just the loyal sidekick.
35
Cynthia, I agree wholeheartedly with your comment about the physician from Sri Lanka and couldn’t have said it better!
19
“There aren’t very many diseases that will affect both humans and animals.” Having worked in both human and animal medicine, it is frustrating how little human practitioners know about zoonotic diseases, which cause about 60 percent of all human diseases and 75 percent of all emerging infectious diseases. Leptospira would not likely be transmitted to the man from the dog, as he would have to ingest the urine. Lepto needs a moist environment to survive which seems unlikely in hot Texas. Coccidioides is common in Texas, but I assume the hospital ruled that out by doing a convalescent serology test. Both man and dog could have acquired hantavirus (from rodent urine and feces) or West Nile virus (quite prevalent in Texas in 2012), in which case the antibiotic and anti-fungal treatments had nothing to do with recovery. Not mentioned in the differential diagnosis are some more likely zoonotic bacteria which cause plague, tularemia, brucellosis, and Q fever. Yersinia pestis, Francisella tularensis, Brucella suis, and Coxiella burnetii are all very tiny bacteria which quite easily spread via aerosols. Breathing dust form the dead animal shed could yield any of these. The infectious dose is extremely small, as little as 10 bacteria wafting in the air. Rodents in Texas are known to carry some of these, and feral pigs can carry them too, especially Brucella. There are about 3 million feral pigs in Texas.
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@Dan Bradway “There aren’t very many diseases that will affect both humans and animals.”
Totally agree. I laughed out loud when I read this. (I suppose only a few zoonotics are covered by the USMLE.) There are so many possible candidates once you consider the soft- and hard-bodied ticks and fleas both the dog and patient might have been exposed to in the shed.
It's really problematic when clinicians don't know how much they don't know.
43
@Dan Bradway and Scientist
You're both being ridiculous. This was a local hospital, not the Mayo Clinic. Both the man and the dog stabilized quickly. Testing for all sorts of arcane pathogens when the patient is recovering, is a luxury with high cost and little upside, unless a swarm of unprotected curious scientists descend on the remains of the shed. He had an infection, for God's sake; he wasn't attacked by 3,000,000 feral pigs.
By the way, San Marcos is a tropical city on the San Marcos and Rio Blanco Rivers between Austin and San Antonio, both cities also on vigorously flowing rivers. It is not in desert West Texas, which I assume you know from TV.
18
@Mel Nice to know if you're not near the Mayo, you just better be really lucky.
They weren't going after the locals for not testing for every disease possible, it was regarding a statement that showed what appeared to be a rather large gap in their medical understanding. Maybe they should watch more tv?
4
It took a doctor here in Portugal three months to diagnose my fatigue as e coli which I had gotten in Turkey. I had no usual symptoms - just extreme fatigue.
Again, I have some type of fatigue, that started in Turkey. I'm now beginning tests to find out what it is. I just took the e coli cure and the fatigue is still present (but not as bad when it had combined with the e coli fatigue).
At nearly 70 years old, doctors first said it was related to ageing. Then to depression. But with antidepressants, it's not depression.
Not having a diagnosis causes depression. Having doctors find the correct diagnosis is not ever certain. Wish me luck....
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@Alice
Hi Alice, I suspect you have post-inflammatory fatigue. I had it for 6 months after acquiring gastroenteritis in the Dominican republic. The infectious organism is now gone, but the immune activation continues. Sometimes symptoms become chronic, as in post Lyme disease syndrome. I suspect you will improve. I hope you feel better.
24
@Alice
My sympathies, I hope you feel better soon.
3
Lucky for them they went to the right hospital, the hospital had hired such a Doctor, the Doctor applied to that hospital, the same illness half a world away, the dog also became ill, etc.
Lots of luck (or fate) involved. A super-natural force?
I wonder if the county issued an alert to wear an N100 mask when cleaning or "kicking up" dust.
I wonder if anyone looks at the county website for advise when cleaning around dust.
Well done Doctor. Congratulations.
96
My take-away from this article is non-pathological. My take-away is how fortunate the family was to have had a physician from Sri Lanka. And how fortunate we all are to be living in a nation of immigrants.
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@Cynthia K. Witter
Thank you for saying that. Yet another example of ways immigrants enrich the countries they immigrate to.
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@Cynthia K. Witter
This is a small world. All the more reason to try to get along and learn from all nations and cultures. I read that some opthalmology training programs in the US send the trainees to India for 3 months to learn to do cataract surgeries because the eye hospitals in India perform much larger number of such procedures. The physicians there have developed great skills both with training and the sheer volume of patients they treat. and the American physicians in training will get to observe and participate in many more cases during the 3 months than they would in the US.
42
@Cynthia K. Witter: Few people are complaining about immigrants; it's illegal immigrants which are the problem. In this article an Indian doctor made a diagnosis based on previous experience in India, but it turned out not to be the correct diagnosis.
5
Or hantavirus?
30
Another example that people with a wider exposure to training and experience are good for our society.
342
"The tests for both infections are based on measuring the antibodies made by the patient’s immune system to fight off the invader. Most likely they started looking for the infection before the immune system had really cranked up."
But shouldn't tests done later during the course of the illness and recovery (or even now) show whether or not antibodies to either of these diseases are present? Wouldn't that establish which, if either, organism caused the disease?
52
Convalescent paired serology.
4
@SML Likely the tests were done on the patient as he was followed by MDs during recovery. Dog likely doesn't have insurance, so I think the vet will presume that whatever organism(s) were the culprit for the man also infected the dog.
7
@SML My thought too about testing again.
Leptospirosis is a Nationally Notifiable Disease and should be reported to the CDC, so surely the patient should have been tested when convalescent to determine if they had Leptospirosis. Coccidioidomycosis (Valley Fever) is notifiable in most states, but not Texas.
35
This is truly an amazing and a frightening story!
27
What a remarkable story. How lucky that this family encountered such a knowledgeable doctor who had experience with two rare diseases.
222
And demonstrates again the contributions immigrants make to this country.
85
I suspect that if the man had worn an N95 or N100 dust mask while working on the shed he would have been protected. My family wear them when we work in the yard and generate dust.
163
And for the dog too.
17
Ever since the great wildfires of 2017-18, we keep a good supply of N95 masks and, yes. I have used them on occasion when digging in the garden's old, Roundup, DDT soil.
7