Stalking Microbes

In the early 1980s, a totally new and deadly illness visited itself upon a small number of citizens in the Charlottesville, Virginia area.  In the span of one month, five seriously ill people were infected with an organism causing an illness never previously described.  During the subsequent 20 years of my career I can say that the intensity of my focus on what was happening to those patients has never been exceeded.  The diagnosis rested on repeated questioning of patients whenever possible, otherwise inquiring of their family members and friends.  We attempted to trace their every move for the 2-3 week period prior to their illnesses.  Their common exposures were teased out of a myriad of facts, and combined with similarities in observed findings on physical examination, shared pathological and serological features, they formed the architecture of a new syndrome.  That process highlighted the best of scientific collaborations.

The faculty in the Infectious Diseases division at the University of Virginia at that time would spend three months on the inpatient services each year, two while leading the infectious disease consultations and one directing an internal medicine ward.  Our clinical team usually included a senior resident, two or three interns, and three medical students.  A few of us who particularly enjoyed managing acute illnesses chose to spend a month in the medical ICU.  In critical care units there were a limited number of patients, an intense experience with a close-knit critical care team with one-to-one nurse to patient care, a high level of excitement, and an opportunity to see complicated, acute infectious diseases.  With a limited number of patients we also had special opportunities to become more familiar with them and their worried families than was usual with a non ICU ward assignment.  In back-to-back assignments on the infectious diseases services and the medical ICU, an unusual cluster of patients with a new syndrome of illness came to our team’s attention.

A 41 year old woman who was a mother of five and a nursing student had been seen in the emergency room, and after an evaluation was discharged with a diagnosis of a viral syndrome, two days before I met her.  Subsequently, on admission to the hospital she complained of fever, severe headache, and remarkable difficulty holding her head up, nausea, and pain in her eyes when exposed to bright light (photophobia).  Whenever we see patients with unexplained fever, infectious diseases specialists ask about medications, exposures to ill contacts, travel history, insect bites, and exposure to animals.