The Lost City of the Monkey God: A True Story(70)
I was still trying to decide whether I should go to NIH or not when the DNA analysis of Dave’s parasites came back. It showed he was infected with a species of leish parasite known as Leishmania braziliensis. This was bad news for Dave and the rest of us, because L. braziliensis causes the third, mucosal variety of the disease, and is considered to be one of the most difficult of all to cure.
Dr. Nash decided to begin Dave’s treatment immediately. He would use a drug called amphotericin B, administered by slow infusion. Doctors have nicknamed the drug “amphoterrible” because of its nasty side effects. It is considered a last resort, most commonly given to patients with fungal infections of the blood when other drugs have failed; most of these patients are extremely ill with AIDS.
Dr. Nash would give Dave and the rest of us a formulation of the drug called liposomal amphotericin. In this form, the toxic drug is encapsulated in microscopic spherules made of lipids (fats). This makes the drug safer, reducing some of the most dangerous side effects. But the lipid droplets can cause disturbing side effects of their own.
The length of treatment depends on how well the patient tolerates the drug and how quickly the ulcer begins to heal. The ideal course, which Dr. Nash had determined over many years of experience, was seven days—long enough to halt the disease but not so long as to harm the patient.
Shortly after Dave was diagnosed with leish, Tom Weinberg learned from the CDC that he, too, had the disease. Chris Fisher, Mark Adams, and Juan Carlos Fernández went to the NIH and were also diagnosed with it. All were treated except Juan Carlos; Dr. Nash recognized that his immune system appeared to be fighting it off and decided to delay treatment. It was the right decision, and Juan Carlos ended up leish-free without going through the rigors of amphotericin B.
From the UK we heard that Woody had contracted leish, as had Sully, despite bundling themselves up so scrupulously every evening. Sully was going to be treated at the Royal Centre for Defence Medicine at Birmingham Heartlands Hospital, while Woody was starting treatment at the Hospital for Tropical Diseases in London. Both would get a new drug, miltefosine. Word soon came back from Honduras that many Honduran members of the expedition had also fallen ill with leishmaniasis. These included Oscar Neil, the archaeologist; the commanding officer of the military contingent, Lt. Col. Oseguera; and nine soldiers.
When the news of our mini-epidemic began to spread among members of the expedition, accompanied by gruesome photos of weeping ulcers, it was hard not to think about the centuries-old legend and its oft-cited “curse of the monkey god.” All those flowers we chopped down! Gallows humor aside, though, many of us were privately aghast at having walked so blithely into that hot zone, and then having congratulated ourselves, prematurely, for emerging from the jungle unscathed. The jokes petered out quickly in the face of this dramatic disease, which had the potential to alter the course of each of our lives. This was deadly serious.
Because amphotericin is expensive and not available in Honduras, the Honduran members of the expedition were being treated with an older drug, a pentavalent antimonial compound. Antimony, a heavy metal, is directly below arsenic in the periodic table of elements and is similarly poisonous. This drug kills the parasite while sparing (one hopes) the patient. As bad as ampho B is, this one is worse: Even in the best scenarios it has dreadful side effects. We heard from Virgilio that Oscar, who had been bitten on the right side of his face, had almost died of the treatment and was recovering in seclusion in Mexico. He would have a nasty scar for life; he later grew a beard to cover it up and declined to speak of his experience or do any further work at T1.
After Dave was diagnosed with mucosal leish, I finally understood that I had to stop procrastinating and get treated. As bad as the treatment sounded, I wasn’t willing to take a chance with the disease itself, or with my face.
So finally, at the end of May, I called the NIH and set up an appointment for early June to get a biopsy and diagnosis. By this time my bug bite had turned into an oozing crater the size of a quarter, fiery red and disgusting to look at. It didn’t bother me; I’d had no more fevers and I felt fine. Dr. Nash said he doubted my fevers had been caused by the leish anyway; they were, he thought, coincidental viral infections, perhaps opportunistic because my immune system had been shaken up by leish, which hijacks white blood cells.
As my date approached, I heard that Dave’s treatment with liposomal amphotericin had gone very badly. He had suffered serious kidney damage and Dr. Nash had halted it after only two infusions. He remained hospitalized at the NIH under observation while the doctors debated what to do next.
CHAPTER 24
My head felt like it was in flames.
The National Institutes of Health occupies a verdant campus of several hundred acres in Bethesda, Maryland. I arrived alone on June 1, a gorgeous summer day, the smell of freshly cut grass drifting in the air, birdsong pouring from the trees. Sandals and jeans seemed to outnumber lab coats, and the place had the relaxed air of a college. As I walked up the drive toward the clinical center complex, I could hear from faraway a lone bugler playing taps.
I entered the center, and after wandering around more lost than I’d ever been in the jungle, I managed to find the patient processing area. There I signed paperwork agreeing to be studied, and a kindly nurse took thirteen vials of my blood. I met Dr. Ted Nash and my second doctor, Elise O’Connell, and was reassured by their warmth and professionalism.