Day Ten: Plague Studies

This morning, I finished writing notes on all the patients in the Low Acuity Unit and headed out to the Microbiology Lab. There, I met M, the UK ID Fellow. He gave me an enthusiastic greeting and then proceeded to put me to work. It turns out he has been working on a big Fever Study over the past year, the goal of which is to pinpoint associations between different clinical signs and common etiologies of fever at AHC.

So my first glorious task? Turns out he wanted me to scan an entire patient chart into the computer.

But to be fair, it wasn’t any old chart. It turned out to be that of a patient I had taken care of and discharged just a few days ago. This girl, barely 2 years of age, was Cambodia’s first confirmed case of plague. Yes, you read that right…Yersinia Pestis. Her total hospital course was 16 days, most of which was spent trying to figure out what was making her so ill.

There were over a hundred pages in her chart, which was filled with flowsheets, progress notes, lab sheets, culture results, and more. It was interesting to go through her initial presentation, which was fairly non-specific (high fevers, diarrhea and vomiting, lethargy) to about 24 hours later, when she became hypotensive, developed bloody diarrhea, and went into septic shock. She stayed in the ICU for a few days, requiring intubation and receiving multiple blood transfusions. At last, someone made the decision to test for Yersinia Pestis (which can cause sepsis), and sure enough, blood serologies came back positive. She was started on gentamicin and began improving just 24 hours after starting treatment. Fortunately, no one else in her family (or any one of her doctors) has gotten ill with the plague.

When I met the patient on day 13 of her hospital course, she was still with poor appetite and extreme lethargy—both of which are characteristic symptoms of septic plague. As I examined and wrote notes on her over the next 2 days, I saw her transform from a kid who could barely sit up to one that was alert, interactive, and absolutely charming. The picture above shows the patient on the day of discharge. It still brings a smile to my face to look at it.

In all, it took me about 3 hours to scan the patient’s entire chart. Curiously enough, it didn’t feel like too much work. As I took apart her chart and scanned in page after individual page, I felt like I was reliving her mysterious presentation, her rapid disease progression, and her dramatic recovery. I know that the Cambodian doctors are planning to write up her case, and that people from the Centers for Disease Control are following along with interest. Someday, her case will be important and well-known, especially in the infectious disease community. But for today, it was just me and her chart, unraveling her story bit by bit.