For days and days on end, doctors didn’t know exactly what kind of organism they were up against.
asserted
they → know → organism
The infection spreading through the 48-year-old Ontario woman was so aggressive, large parts of her heart were destroyed.
asserted
parts → spread → heart
But all the usual blood work, all the cultures for typical bacterial infections came back negative.
asserted
work → come → infections
Doctors couldn’t fully understand what was feeding the infection.
asserted
what → understand → infection
Until her sister wondered, could it be the rats?
uncertain
it → wonder → ?
The woman’s death last year, published in a new case report, is being described as the first reported fatal case of rat bite fever that defeated even the most advanced “Hail Mary” form of out-of-body heart and lung bypass.
asserted
that → publish → bypass
The case “was a bit of a conundrum,” said cardiologist and intensivist Dr. Craig Ainsworth, chief of critical care at Hamilton Health Sciences, and co-author of the report in JACC, the Journal of the American College of Cardiology.
asserted
Ainsworth → say → Cardiology
“Normally, when we have people with that degree of heart and heart valve infection, we usually get something in the blood work,” he said, typically one of the aggressive bugs “that do this sort of thing.
asserted
that → have → thing
In this case, everything was negative until weeks later, when valve tissue taken during the woman’s emergency heart surgery was sent for specialized DNA testing, which ultimately identified streptobacillus moniliformis, a bacterium found in the oral, nasal and respiratory tract secretions of rats.
asserted
which → take → rats
The bug can be transmitted to people via broken skin, bites or scratches, but also from close contact, without a bite or scratch, according to the U.S. Centers for Disease Control.
uncertain
bug → transmit → Control
It can also be spread through exposure to contaminated food or water.
asserted
It → spread → food
Diagnosis can be challenging: the organism is “fastidious, difficult to grow and has limited diagnostic tests available for early detection,” Ainsworth and colleagues wrote in the Sept. 16 edition of JACC Case Reports.
asserted
Ainsworth → grow → Reports
The woman ultimately died, despite being treated with the proper antibiotics.
asserted
woman → die → antibiotics
“We just guessed and happened to guess properly,” Ainsworth said, however, the infection was too far gone by the time she was transferred to his ICU.
asserted
she → guess → ICU
“It wasn’t obvious to us for days and days what we were actually treating.”
asserted
we → treat → what
Rat bite fever is a rare infection with an estimated mortality rate of up to 13 per cent if left untreated.
asserted
fever → estimate → cent
The disease often starts with vague symptoms such as fever, rash and generally just feeling unwell, which can delay people seeking medical attention.
asserted
which → start → attention
The woman was a bit of a “homebody” who kept to herself, Ainsworth said.
asserted
Ainsworth → keep → herself
She had some medical problems, including asthma and inflammatory bowel disease, and was a smoker.
asserted
She → have → asthma
After six to eight weeks of fatigue, lower back pain, facial flushing and peripheral numbness, the woman went to her local hospital’s emergency department, about 100 kilometres outside Hamilton.
asserted
woman → go → Hamilton
She described worsening diarrhea and fainting spells — spells owing to, in retrospect, “the infection eating into the electrical system of her heart,” Ainsworth said.
asserted
Ainsworth → describe → heart
Doctors suspected sepsis and started antibiotics, but while in emergency the woman suffered a cardiac arrest.
asserted
woman → suspect → arrest
The upper chambers of her heart were no longer communicating with the lower chambers, causing a dangerously slow heart rate.
asserted
chambers → communicate → rate
A temporary pacemaker was inserted.
asserted
pacemaker → insert → ?
Three days later, a special echocardiogram that involves guiding a thin tube down the throat to examine the heart from inside the esophagus revealed extensive infection of various parts of the heart and valves.
asserted
that → involve → heart
She was referred to a second hospital for urgent, complicated and prolonged heart surgery.
asserted
She → refer → surgery
Because of low oxygen levels, doctors couldn’t take the woman off the machine used to take over the function of her heart and lungs during surgery.
asserted
doctors → take → surgery
She was placed on ECMO, or extracorporeal membrane oxygenation, an advanced form of life support.
asserted
She → place → support
Her heart muscle continued to deteriorate, and the woman was transferred to Hamilton General Hospital, “still without a specific diagnosis or a bug,” Ainsworth said.
asserted
Ainsworth → continue → diagnosis
“By the time we received the call, she was at best a Hail Mary; she was very unwell,” he said.
asserted
he → receive → call
But because she was 48 and otherwise fairly healthy, they tried every measure they could.
uncertain
they → try → measure
“She just didn’t get any better,” Ainsworth said.
asserted
Ainsworth → get → ?
At one point her sister, from whom she was semi-estranged, remarked to Ainsworth, “You know, I just wonder if it’s related to the rats she has in her house.”
asserted
she → remark → house
“As a non-infectious disease doctor, I didn’t put two and two together,” he said.
asserted
he → put → two
“I thought it was like a guinea pig or a hamster, just a little more unusual.
asserted
it → think → pig
“But when we ultimately got this bug back from the DNA testing, it became clear that almost certainly this was related to her pet rats.”
asserted
this → get → rats
After several weeks in hospital, the woman succumbed to the infection.
asserted
woman → succumb → infection
Life support was withdrawn “given the unfortunate futility of what we were doing and her worsening, despite all the heroic interventions,” Ainsworth said.
asserted
Ainsworth → withdraw → interventions
It’s not clear if the rats were purchased or had infested her home.
asserted
rats → ’ → home
The sister said the rats seemed more like pets.
asserted
rats → say → pets
…and 21 more, not listed.
The Aporia
