Case 2: Derrick's Malaise
Synopsis: An epidemic caused by a fungus has begun in the U.S with potentially devasting effects on the corn crop. Derrick Hernandez and Maria Santini are graduate students studying the epidemic and crop improvement. An important resource in their studies is wild corn, teosinte, which may be resistant to the fungus. Teosinte grows in a few isolated locations in Central America. Maria, a geneticist, and Derrick, an ecologist, are headed south for their first field season. Maria went first to Mexico city to do some archival research on Zea at the Tiemplo Major. Derrick went first to Guatemala to another teosinte site. He'll join Maria and other researchers at the main teosinte site in the mountains of western Mexico, near the town of Durango.
Derrick's Malaise - Part 1:
Derrick waved goodbye to his father and got on the plane for Guatemala. It had been fun visiting the family in Houston, Texas despite the steamy heat so early this summer. His first season of field research was about to start and he was excited. He would have just two weeks to study the ecology of a new teosinte site in the valley of the Rio Huista before going on to Mexico where he would join up with Maria and the rest of the team.
Derrick loves field work. An early riser, Derrick would get up before dawn to be ready to head out at first light. As he had found in Texas, the mosquitoes were worst at dawn and dusk. He was so busy that he just splashed on some repellant, then ignored the mosquitos as best he could. At night, he faithfully used mosquito netting.
Two days after arriving in Mexico from Guatemala, Derrick felt like he had the flu. He climbed down the mountain (with Maria who was quite ill), to visit the doctor in Durango. After testing his blood, Dr. Stegnaro said, "You have malaria. It's caused by a protozooan."
"Oh, isn't that caused by Plasmodium?" Derrick asked. "I took the drugs the CDC recommended as protection against malaria. Wasn't that enough?"
"Well, there are several different kinds of Plasmodium, and sometimes people get malaria even if they've done everything right," Dr. Stegnaro replied. "Seems like we're seeing more and more of it recently." He prescribed sulfadoxine, an antimalarial drug, and Derrick left. Shrugging his shoulders, Dr. Stegnaro thought to himself, "Here's another case of malaria I have to report to the World Health Organization.'
After the malaria drugs took effect, Derrick was able to finish his field work in Mexico.
Derrick's Malaise - Part 2:
About a month after returning home, Derrick began to feel sick His roommate took him to the university clinic. It was the malaria. "How could I have these symptoms again?" Derrick asked the resident, Dr. Welty. "I know I finished my prescription."
"I'm not sure. We'll be needing a blood sample so we can analyze the bug causing you this trouble. In the meantime, let's try a different drug. I'm going to switch you to chloroquine," Dr. Welty suggested. "You know, malaria is the most common infectious disease in the world. I've got some contacts at CDC who may be interested in your case. May I share your records with them?" Derrick nodded.
Derrick's roommate asked, "Dr. Welty? Can I get malaria from Derrick?"
"You have nothing to worry about," the doctor replied, but Derrick's roommate wasn't entirely comfortable.
Derrick's Malaise Part 3:
Susan Welty glanced at the screen and clicked on the Send button. She had just replied to Steve Murphy who had identified her patient's parasite as P. falciparum. to let him know that Derrick had travelled through Houston, Guatemala, and northern Mexico during the estimated time of exposure to malaria. She copied Emily Chen at the CDC to describe the recurrence of malaria in her patient Derrick. She added a note to Andre Braun at WHO in Geneva as well to document the unusual case.
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