A Hidden Infection?
The doctors at South County werent sure what was going on, either. The patient felt sick: She was tired, her back was killing her and she felt weak all over. She looked sick too: pale and frail. On exam, her temperature was up and her blood pressure was down. She had a faint rash on much of her body, and she was confused. But her white-blood-cell count an indicator of infection wasnt elevated, and the doctors couldnt see any obvious source of infection. Blood tests showed no signs of the most common tick-borne diseases. A chest X-ray was normal. An ultrasound of her abdomen was, too. Blood was also analyzed to see if any bacteria would grow, and she was admitted to the hospital team, under the care of Caroline Jenckes, an experienced nurse practitioner.
Jenckes spent the next few days looking for an infection she was certain was there. She ordered an M.R.I. of the spine in search of an abscess, but found nothing. The patients gallbladder was carefully evaluated; inflammation can trigger a fever and pain that travels to the back. A couple of days in, a CT scan of the patients chest suggested the possibility of pneumonia. Dr. Fred Silverblatt, the infectious-disease doctor Jenckes consulted, didnt think the subtle findings could be the cause of her symptoms. And the patients fever was already coming down. Still, he agreed to start her on broad-spectrum antibiotics.
Finally the medical team saw what seemed significant evidence that the patient was getting better. Her fever came down, and her blood pressure returned to normal. Her back pain was subsiding.
From the sons perspective, his mother was not really recovering. He and his wife had been taking turns staying with her, day and night, and she was nothing like her old self; she still seemed quite sick. Despite the antibiotics, she remained tired, weak and practically speechless. The son called his sister in Maryland and older brother in Missouri to tell them that this might be the end, and the siblings hurried to their hometown.
The frail woman didnt open her eyes when her older son entered the room. He leaned close to give her a kiss and straighten her up in the bed. Did she have flying-squirrel fever, he asked lightly, referring to their effort the autumn before to rid her attic of the pesky rodents. Back then she told him how cute the big-eared babies were, creatures taken out of the attic by the exterminator on their way to relocation. He thought she smiled a bit at his joke, just a whisper of her usual good humor. But as he made the joke, he suddenly had a thought: Could those squirrels have anything to do with this strange illness that no one could figure out?
It was an odd thought but the kind of connection that inspired the son, so he found a computer in the hospital and searched online a bit. The first pages carried mostly ads for services to get rid of the pests. But then he found something: a short article from the Centers for Disease Control and Prevention linking flying squirrels with something called epidemic typhus. Further reading revealed that the symptoms of typhus fever, body aches, rash and confusion resembled those his mother had. But typhus was a rare infection. There had been fewer than 100 cases in the United States reported to the C.D.C. over the past 40 years.
Still, the son printed out the article and went in search of Caroline Jenckes. He explained that his mothers house had been infested with these animals. Jenckes was intrigued with the idea. Certainly all the studies theyd done to find the source of the womans symptoms had been unrevealing. She took the article to Silverblatt. It seemed to him a perfect fit: the symptoms, the exposure, the minimal response to the antibiotics. He read up a little more on the infection before starting the patient on the appropriate antibiotic doxycycline and sending her blood to the C.D.C. for confirmation.
Epidemic typhus is an old disease. Since the Middle Ages, periodic epidemics of this infection killed millions of people. Just after World War I, an outbreak in Russia killed three million. The infection is often transmitted through contact with a body louse. Modern sanitation has significantly reduced the incidence of both infection and carrier. In the United States, most cases of typhus have come from exposure to flying squirrels. Its not clear how the bacteria get from the rodents who harbor the bug to the humans they infect, but the louse once again plays a role. Squirrel lice do not tend to bite humans, so it is thought that exposure occurs when bacteria in lice excrement are inhaled.
After 24 hours on the new antibiotic, the woman was transferred to a rehabilitation facility. Within days she began to act more like herself. She was irritated that she had been placed on the floor designated for the sick and dying. She was certain, she explained to anyone who would listen, that this was not where she belonged. She says she didnt really start to get better until she moved to the floor for healthier patients.
After a few weeks she was well enough to go home. It took almost that long for the test results to come back confirming typhus. While she recovered, her children arranged for an exterminator to get rid of any squirrels that might have returned and to seal up any possible ports of re-entry.
Families are an essential source of information about patients and the world they live in. They dont usually make the diagnosis, but they can provide answers to questions doctors hadnt considered asking. In this case, the knowledge of this womans exposure and its associated infection may have saved her life. Untreated epidemic typhus can kill up to 30 percent of patients, and the very old are at the greatest risk.
All this happened three years ago. If you ask this woman now how shes doing, shell immediately inform you that shes just great because the more shes on her own, the better she feels.
Lisa Sanders, M.D., is a contributing writer for the magazine and the author of Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis. If you have a solved case to share with Dr. Sanders, write her at firstname.lastname@example.org.
Sign up for our newsletter to get the best of The New York Times Magazine delivered to your inbox every week.
A version of this article appears in print on June 25, 2017, on Page MM18 of the Sunday Magazine with the headline: Doctors in the hospital thought the 93-year-old woman was getting better. But her children thought she was dying. What was going on?.
- New theories emerge to explain dead rats washed up in Westport - RNZ - November 20th, 2019
- How to Get Rid of Mice, Rats, & Other Rodents in Your Shed - October 20th, 2019
- Patton Termite & Pest Control - Exterminator Services ... - October 4th, 2019
- Rodent identification guide | Western Exterminator - September 10th, 2019
- Exterminator Rodents - September 10th, 2019
- How do exterminators get rid of mice? - My Homey Home - September 8th, 2019
- Rodent Exterminator | Rodent Removal | Rodent Exterminators - May 29th, 2019
- Rodent Exterminators | Rodent Control & Removal | Allgood ... - May 24th, 2019
- Rodents | Boca Raton Termite Extermination, Pest Control ... - May 24th, 2019
- Pest Control Sacramento | Top Exterminators | Golden Hills ... - May 12th, 2019
- Mouse Exterminator Cost - Fixr.com - March 29th, 2019
- Rodent Control in Milwaukee County, WI | Rodent Exterminator - March 16th, 2019
- Beeline Pest Control - March 12th, 2019
- Exterminators Get Rid of Rodents Attic Crawlspace Rats ... - March 7th, 2019
- Pest Control Albuquerque | Exterminator Albuquerque NM - February 9th, 2019
- Seattle Commercial Rodent Control Exterminators for Rats ... - September 29th, 2018
- What Odors Do Rodents Like? | Pest Control and Bug ... - September 29th, 2018
- Anaheim Mice Control - Anaheim Pest Control Pros - September 29th, 2018
- Peoria Mice Control - Peoria Pest Control Pros - September 29th, 2018
- Norman Mice Control - Norman Pest Control Pros - September 29th, 2018
- Rodents - Southold Pest Control and Exterminator - July 28th, 2018
- Rodents - Manhasset Pest Control and Exterminator - June 7th, 2018
- Rodents In Memphis Tn | Rodents Exterminator - May 28th, 2018
- New Jersey Mice & Rodent Control | Exterminator For ... - April 23rd, 2018
- Mice, Rodent, and Rat Exterminator in Buffalo, NY - March 26th, 2018
- DIY Rodent Control & Traps | Rodent Extermination Products ... - March 9th, 2018
- Rodent Control Exterminator - Hitmen Termite & Pest Control - January 25th, 2018
- Exterminator does the dirty work for rodent-besieged ... - January 7th, 2018
- DIY Rodent Control, Traps, and Rodent Extermination ... - November 18th, 2017
- #1 Pest Control in Chicago, Illinois! Top Exterminator for ... - October 28th, 2017
- Local rat population surging - The Daily Post - September 5th, 2017
- Pest Control Exterminator in Buffalo, NY - ProStar Pest ... - August 29th, 2017
- Couple's horror as plague of rats infests their car and EATS the engine while their other motor is littered with ... - The Sun - August 26th, 2017
- Flea Control, Treatment, and Prevention - Victoria Advocate - August 7th, 2017
- The number of rat infestations in Leicester is going up - Leicester Mercury - August 4th, 2017
- Employees say Jacksonville International Airport has major rat infestation - ActionNewsJax.com - August 4th, 2017
- Creepy creature a mix between spider, scorpion; native to Arizona - ABC2 News - August 2nd, 2017
- Calling the Pied Piper: Rats invade Petaluma - Petaluma Argus Courier - July 31st, 2017
- Feral cats in demand | Calaveras County's Most Trusted News ... - Calaveras Enterprise - July 31st, 2017
- New York unveils $32-million fight vs rats - Inquirer.net - July 13th, 2017
- Mice seen as invading City Hall - Philly.com - Philly.com - July 13th, 2017
- Hartford residents speak out on unsafe, unhealthy living conditions ... - FOX 61 - July 12th, 2017
- North End Residents Organize Against Alleged Neglect By Landlord - Hartford Courant - July 11th, 2017
- Get Rid of Rodents | pest-control.com | pest-control.com - July 10th, 2017
- Dirty Dining: Alessi Bakery's rodent infestation evident by rodent ... - ABC Action News - July 8th, 2017
- From toilet bowls to car engines, rat sightings are up at Danforth and Woodbine - CBC.ca - July 3rd, 2017
- 'They were nesting in my underpants' - John Woodhouse on the city's rodent issues - Stoke Sentinel - July 2nd, 2017
- Dirty Dining: Bombay Grill Indian Cuisine shut down for 700+ rodent droppings in kitchen - ABC Action News - June 24th, 2017
- DNA from Egyptian mummies and Viking graves reveals how cats conquered the world - Popular Science - June 19th, 2017
- Philly nursing home has abysmal rating and rodents, too - Philly.com - June 12th, 2017
- Rat Mob! Rodents Swarm in Myanmar Villages - Live Science - June 8th, 2017
- Villagers fight back as rat hordes swarm Irrawaddy Delta's Ngapudaw - DVB (registration) - June 6th, 2017
- Minnesota sewer rats create nightmare for homeowner - THV 11 - June 6th, 2017
- My College Roommates Were Rats - The New Yorker - June 6th, 2017
- Thursday's best TV: Paula; The Truth About HIV; Jago: A Life ... - The Guardian - May 25th, 2017
- The Arizona Department of Economic Security Is Infested With Rats (Literally) - Phoenix New Times - May 20th, 2017
- MPI's Changes To Rodent Claim Policy Could Mean Lost Local Jobs ... - PembinaValleyOnline.com - May 1st, 2017
- Rodent Control and Removal Methods | Terminix - April 29th, 2017
- Long-time Atlanta restaurant fails second health inspection in seven months - WSB Atlanta - April 19th, 2017
- Burrowing rodents threaten Central Oregon canals - The Register-Guard - April 13th, 2017
- Former employee posts video of rats in Denison Little Caesar's - KXII-TV - April 13th, 2017
- San Francisco Cockroach Exterminator Bed Bug Rodent & Ant Pest Control Announced - MilTech - April 12th, 2017
- Digging rodents threaten canal safety in Central Oregon; Ground ... - Bend Bulletin - April 12th, 2017
- Rats! Infestation forces firefighters from Riverside South station ... - Ottawa Sun - April 3rd, 2017
- Exterminators tackle Riverside South fire station rats - Ottawa Citizen - April 3rd, 2017
- Massive amounts of trash are attracting rats and ruining this neighborhood - New York Post - April 3rd, 2017
- 'Swainsboro Apartments' Facing Major Rodent Problems That Are Going Unnoticed by Management - WJBF-TV - March 30th, 2017
- Gnawing costs force Manitoba Public Insurance to change rodent claim policy - Yahoo News - March 24th, 2017
- Gnawing costs force Manitoba Public Insurance to change rodent claim policy - Brandon Sun - March 23rd, 2017
- Rat Hunters in Paris Go on Strike to Demand Pay Raise - Heat Street - March 16th, 2017
- What killed owl at Forest Lawn? Maybe not what you think. - Buffalo News - March 5th, 2017
- What killed owl at Forest Lawn? Maybe not what you think. - The ... - Buffalo News - March 2nd, 2017
- Guardian Angels take up rat control as side gig - New York Post - March 2nd, 2017
- CIRCLING THE SQUARE: The Oscars were nothing compared to my squirrels - Wicked Local Danvers - March 2nd, 2017
- Tell me all you know about the rat! - Kokomo Herald (press release) - February 25th, 2017
- Don't bother petting these cats -- they're working - CBS News - February 24th, 2017
- 'The Cat That Changed America' premieres: Documentary stars Malibuites and local advocates - Malibu Surfside News (press release) (registration)... - February 21st, 2017
- College girls hailed for rat extermination genius - New York Post - February 17th, 2017
- Bed Bugs Found at Second DC Elementary School - NBC4 Washington - February 16th, 2017
- Paris fights rat infestation - WSYR - February 16th, 2017