September 16, 2024
Allison Berke
The following is an excerpt from Asimov Press.
Doctors in training are told that when they hear hoofbeats, they should think horses, not zebras; rare diseases are the exception, not the rule. Sometimes, though, novel diseases do emerge, and as COVID-19 demonstrated, they can surprise us. Identifying a new or unexpected pathogen quickly, particularly when it occurs in conjunction with other, more common illnesses, is a key challenge for doctors, researchers, and public health professionals concerned with disease preparedness and biosecurity.
Consider Alice, a 49-year-old woman (and hypothetical patient) who walked into a hospital in Puerto Rico with joint pain, a headache, nausea, and a low fever. She had recently traveled to Brazil to visit relatives and had felt achy for the past two months, beginning a few days after she returned. Painkillers and anti-inflammatories did not alleviate her symptoms. Her blood cell counts were low, but her hemoglobin was normal and a urine culture found no signs of a bacterial infection.
When doctors sequenced the DNA and RNA found in Alice’s blood and synovial fluid—the liquid that surrounds and lubricates joints—they found abnormally low levels of genes encoding iron-storing proteins and high levels of epidermal growth factor receptor RNA. The results suggested a dual infection; Chikungunya and Zika, both of which circulate in Brazil.
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