Monsters Inside Me

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HOST VO

A high school senior falls victim to a veiled attacker.  

MARSHA GREINER VO/OC

It was an actual creature, a living creature in my eye.  

HOST VO

A doctor battles a deadly enemy that’s been hiding in his body for 60 years. 

YASMIN MEAH VO/OC

He looked awful.  He looked like he was on death’s door.

HOST VO

And a runner finds there’s no escape from a killer concealed in his blood.

RICK DIMICHELE OC/VO

I’m resigned to the fact that I have cancer.  

HOST VO

Three very different parasites that all use the same strategy to prey on their hosts.  They are cunning.  They are deceptive.  They are Masters Of Disguise.  

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HOST VO

Worms invisible to the human eye, insects thirsty for blood, microscopic amoeba, they might look harmless.  But, these are some of nature’s deadliest creatures.  They can hijack our bodies, disable our immune systems.  They are parasites.  But, to those infected, they are the Monsters Inside Me.

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HOST VO

Parasites survive by using other living organisms for food and shelter.  

DAN RISKIN VO/OC

Parasites have evolved to live in every kind of organism in every kind of environment on the entire planet.  All parasites face the same challenge.  They need to get into or onto a host and stay there long enough to reproduce.  One of the most successful strategies that parasites employ is deception.  

HOST VO

Some parasites are so well disguised it’s almost impossible to see them coming, as one teenager is about to find out.  August, 2008, Chicago.  16 year old Mallorie Greiner is at the end of her summer break.  

MALLORIE GREINER VO/OC

I like to do a lot of things.  I play alto saxophone in the band at school.  I like to go on the internet, like a lot of teenagers.  I like to play video games a lot.  I like to learn about sharks.  That’s something I kind of want to do when I’m older.  

HOST VO

She’s unaware that her carefree teenage life is about to change forever.  

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HOST VO

The night before her first day back at school, Mallorie has tickets to see her favorite boy band, The Jonas Brothers.  

MALLORIE GREINER VO/OC

I am going to sit off four rows from the catwalk to see Kevin and Joe Jonas.  And I am really excited about doing that.  But, I just want to go to my concert and have a good time.  

HOST VO

When the concert starts, the spectacular light show has an unexpected effect on Mallorie.  

MALLORIE GREINER VO/OC

The lights are bothering me at the concert.  It really feels like there is something in my eye, but in, in so much pain and it’s just very irritating and the light hurts it when any light gets into it.  And it just causes more pain. 

HOST VO

But, when the concert ends, the pain continues.  

MALLORIE GREINER VO/OC

My dad is driving me back home.  My eye is really starting to hurt at this point.  Of course, I am tired from everything that happened that night.  But, it’s just in a lot more pain.  I am putting my hand to my eye trying to relieve the pain somehow because the passing car lights are bothering me a lot. 

HOST VO

Mallorie goes to bed hoping that the problem will clear up on its own.  The next morning she wakes up to spend her first day as a senior.  

MALLORIE GREINER VO/OC

The eye was in so much more extreme pain than the night before.  And the sun is coming in from my blinds and it’s hurting it really, really bad.  I’d call out for my mom.  She comes running in to see if I’m okay.  The only thing I can do is just hold my eye.  And it hurt to the point where I was just almost on the floor.  

MARSHA GREINER VO/OC

She collapsed to the floor.  So I begin to try to help her to, to get dressed.  

MALLORIE GREINER VO/OC

My eye is looking extremely red, as red as a fire truck.  It looks totally bloodshot.  

HOST VO

Mallorie is in so much pain that she can’t wear her contact lenses and is forced to wear her glasses instead.  Concerned about her condition, Mallorie’s mother, Marsha, takes her to see a local ophthalmologist.  

MALLORIE GREINER VO/OC

He isn’t sure exactly what’s there.  He tells me it could be two things.  

MARSHA GREINER VO/OC

She could have some type of an eye infection or herpes.  

MALLORIE GREINER VO/OC

Either way, it was a bad situation.  

HOST VO

The herpes virus usually causes cold sores in the lips.  If a person touches a cold sore and then touches their eye, the virus can spread. 

MALLORIE GREINER VO/OC

All I’m thinking is how in the world did that get in my eye, and kind of almost laughing at that point, because I’m a teenager and, you know, that’s what I do. 

HOST VO

Ocular herpes might sound bad, but it can be easily treated with anti-viral eye drops.  The doctor is concerned that Mallorie has a more serious infection.  But, he can’t be sure.  So he refers her to a specialist.  

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Dr. Tu of the University of Illinois in Chicago is an expert in corneal diseases.  

DR. ELMER TU VO/OC

Well, Mallorie was sent into us basically to try to differentiate the infection she had in her cornea among a number of different disorders including ocular herpes.  It is very difficult to tell without special instrumentation and cultures exactly what’s going on.  

HOST VO

First, Dr. Tu takes photographs of the structures deep in Mallorie’s eye.  

MALLORIE GREINER VO/OC

This big machine looks into my eye and it brings up pictures on his computer.  So I’m able to look and see what it looks like and what’s been in my eye.  

HOST VO

The images confirm that Mallorie’s cornea is infected.  But, not with herpes.  To discover what the infection is, Dr. Tu must perform a delicate procedure called a corneal scraping.  Using a sterilized, metal spatula, Dr. Tu must scrape living cells from the surface of the cornea.  The technique requires a steady hand.  One false move and Mallorie could be blinded.  Mallorie’s father waits outside as he can’t bear to watch.  Her mother looks on helplessly.  

MARSHA GREINER OC/VO

My heart sunk, but I had to remind myself that I needed to be strong for her.  He had his burner on to sterilize his instrument.  And I’m thinking to myself, he’s not going to put that in her eye.  

MALLORIE GREINER VO/OC

At that point I’m just, is it going to hurt?  And he numbs my eye and he just takes this spatula and scrapes my eye.  

HOST VO

The samples are put on a slide and examined under a microscope.  

DR. ELMER TU VO/OC

After we attain the images it’s real-time, so I have the opportunity to show Mallorie and her parents exactly what’s going on.  

HOST VO

And there is a lot going on.

MARSHA GREINER VO/OC

On the eye surface, on the pictures, it looks like little white clumps of dots.  

HOST VO

These microscopic dots are about to change Mallorie’s life forever.  

HOST VO

Teenager Mallorie Greiner is about to find out exactly what is lurking in her eyeball.  

MARSHA GREINER VO/OC

He says that the dots are, in fact, a parasite that is living in my eye.  

HOST VO

The parasite is a vicious microscopic organism called Acanthamoeba.  

DR. ELMER TU VO

We were able to come back and tell her that definitively she did have the Acanthamoebic infection.  You can see that there are these bright white dots, which are really amoeba.  So these are active.  And these are actually the ones that are sort of moving around a bit and actively eating and doing different things in the cornea.  

DAN RISKIN VO/OC

The Acanthamoeba is a single celled organism that feeds on bacteria.  It can live almost anywhere it can find a food source.  And one of the places that bacteria naturally occur is in the human eye.   

DR. ELMER TU VO/OC

They have a way of penetrating the skin layer and then getting deeper into the cornea and, basically, setting up shop there.  So, they are basically, looking for a home and also for food.  

HOST VO

The amoeba secretes proteins that dissolve the surface of the cornea.  Once in the cornea, the parasite feeds on bacteria present in the eye.  But, bacteria aren’t their only food source.  The amoeba also feeds on corneal cells causing tissue damage and inflammation.  

DR. ELMER TU VO/OC

Patients can go on to needing corneal transplants and a certain percentage actually do lose their eye from the infection as well.  So it, it is a very serious disease.  

HOST VO

This parasitic infection is called Acanthamoeba keratitis.  The parasite can damage the eye so badly that Mallorie could lose her cornea, her sight, and eventually, the eyeball itself.

MALLORIE GREINER VO/OC

I felt kind of a little scared about it because of the fact that it was something living in my eye.  It was an actual creature that’s eating my eye.  

MARSHA GREINER VO/OC

The worst case scenario would be that she would lose her eyesight and, perhaps, need a cornea transplant.

HOST VO

So how did these parasites get into Mallorie’s eye? 

DR. ELMER TU VO/OC

Well, Acanthamoeba is really a remarkable organism.  It can survive in many different environments.  And it’s actually found both in water and soil.  They tend to hang around and live in contact lens cases and also on contact lens surfaces.  And so if you put that into the eye, the amoeba has access.  

HOST VO

Even a microscopic scratch from a contact lens can be enough for the Acanthamoeba to take hold.  The bad news for Mallorie is that killing this parasite is extremely difficult because the Acanthamoeba is a master of disguise.  

DAN RISKIN OC/VO

Acanthamoeba has two separate forms.  It can be active when it’s feeding and moving around and living off of its environment.  When the environment becomes hostile, an Acanthamoeba can go from its active feeding stage into a cyst where it’s very tough and protected and can wait for thing to get better.  The Acanthamoeba has a great strategy.  It can actually change its identity.  

DR. ELMER TU VO/OC

Well Acanthamoeba has the two forms.  And really when it’s challenged in any way, including medications, they have a tendency to honker down into these very thick walled cysts.  And it’s very difficult to get any medication to penetrate through them.  Those cysts are very hearty and very difficult to kill, and can live a very long time.  

HOST VO

The only way to kill the parasite is with a combination of powerful antiseptics.  One of them is the same chemical used to clean swimming pools.  Mallorie must adhere to a strict regime taking the medication as often as 12 times a day.  After three months, she starts to see a change in her condition.

MALLORIE GREINER VO/OC

It is gradually getting better.  I’m, mostly the pain I notice is getting a lot better.  There’s still a lot of light sensitivity.  But, it definitely has improved since I first started this.  

HOST VO

Mallorie has now been off the medication for three months and her current prognosis is very positive.

MALLORIE GREINER VO/OC

It is a really good feeling to be almost back to normal again.  I consider myself to be really lucky.  It was a really, it’s a really good feeling to be able to actually go outside and be able to do stuff again and not to have to sit inside in pain.  

HOST VO

Around 25 million people wear contact lenses in the U.S.  But, very few actually contract this parasite.  And fewer still lose their sight as a result.  People who don’t wear contact lenses can also get infected, especially if the corneais scratched.  To minimize the risk of catching the Acanthamoeba, keep contact lenses and lens cases clean and always visit an eye doctor if there’s a sudden onset of pain.

MALLORIE GREINER VO/OC

I really hope that no one else gets this because it is really a horrible experience to go through.

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DAN RISKIN OC

The Acanthamoeba’s ability to change its identity, to go into this cyst form and hide, is one of the reasons that it’s so successful and so difficult to treat.  But, Acanthamoeba isn’t the only parasite that knows how to conceal itself inside the human body.  Often times a parasite can be there for long periods of time totally undetected.  And by the time we figure out we have a parasite, it’s almost too late. 

HOST VO

When it comes to these masters of disguise, what you see isn’t always what you’ve got.  

HOST VO

October, 2007.  37 year old Yasmin Meah is a physician at Mount Sinai Hospital.  The patient she’s most worried about is her father, Dr. Mohammed Meah.  Mohammed has been diagnosed with colitis, or inflammation of the large intestine.  

YASMIN MEAH VO/OC

My dad suffered from this for years.  And really over in the past three or four years it really became much more pronounced.  It was approximately several weeks of abdominal pain, cramping, and profuse diarrhea that brought him to the attention of a gastroenterologist who took over his care. 

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The gastroenterologist…

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…treats Mohammed with steroids.  Steroids work by suppressing the body’s immune response and, thereby, reducing the inflammation.  But, three months later her father, Mohammed, is sicker than ever.  

YASMIN MEAH VO/OC

My mom called me on the phone feeling very desperate, telling me that he had not gotten out of bed in three days, and had not eaten anything.  At that point, I knew that there was something very, very significant going on that was not fully explained by his colitis.  And, at that point, I urged my mom to bring him to the hospital. 

HOST VO

At the hospital, Mohammed is put under the care of Dr. Eric Rosendorf.  

DR. ERIC ROSENDORF VO/OC

He, over about ten days, developed a worsening condition of his breathing, more shortness of breath.  He also developed abdominal discomfort where the abdomen was enlarging.  From that point, he became critically ill.  

YASMIN MEAH OC

He looked awful.  He looked like he was on death’s door.  

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HOST VO

The Acanthamoeba parasite can lead to blindness in humans.  What is the best way to avoid contracting the parasite?

a)  Always cook meat thoroughly

b)  Keep contact lenses clean.

c)  Drink only bottled water

HOST VO

Mohammed Meah is suffering from an inflammatory bowel disease.  But, instead of responding to treatment, his condition has rapidly worsened.  He is critically ill and his doctors are desperate to find out why.  Dr. Rosendorf believes the problem goes further than Mohammed’s large intestine.  The only way for the doctors to get a look at Mohammed’s intestine is to open him up.  

YASMIN MEAH VO/OC

A that point, he basically did what’s called the “peek and shriek.”  

HOST VO

When they perform the surgery, the doctors make a shocking discovery.

DR. ERIC ROSENDORF VO/OC

There was a clear abnormality.  

HOST VO

Mohammed’s small bowel is swollen to twice its normal size.  

YASMIN MEAH VO/OC

It was so swollen that he said it didn’t look like anything typical of what he’s seen before.  So he looked at it, took a few photos, and tucked it right back in.  

DR. ERIC ROSENDORF VO/OC

We had to decide to try to figure out why could he have this swelling of his small intestine? 

YASMIN MEAH VO/OC

My dad was now on a ventilator, but we were no closer to an answer than we were before.  

HOST VO

Mohammed is taken to the Intensive Care Unit.  His blood pressure is dangerously low, and he needs massive amount of oxygen to stay alive.  Yasmin persuades Dr. Rosendorf to perform a biopsy on her father’s bowel.  When the results come back, the doctors are stunned.  

YASMIN MEAH VO/OC

And I got a call from Eric Rosendorf.  And he said, you won’t believe it, but they found a worm. 

DR. ERIC ROSENDORF VO/OC

I was completely surprised.  We could see larvae in the biopsies.  

HOST VO

The biopsy reveals the Mohammed Meah’s bowels have become home to a parasitic worm called Strongyloides.  

DR. ERIC ROSENDORF VO/OC

I’ve never seen a case of Strongyloides prior to this.  I think it’s a once in a lifetime diagnosis.  

HOST VO

Dr. Rosendorf consults Mohammed’s daughter, who is shocked, but not surprised. 

YASMIN MEAH VO/OC

It was as if a light bulb went out.  And I thought, oh my gosh.  Of course it is.  This is, this completely makes sense.  Of course this is Strongyloides.

HOST VO

Strongyloides, also known as threadworm, is a parasitic worm that lives and hides in the small bowel. 

YASMIN MEAH VO/OC

This is one of those parasites that you learn in medical school.  And you learn about its elusive properties.  

DAN RISKIN VO/OC

Strongyloides is a perfect example of a parasite that is a master of disguise.  If it gets into a host with a healthy immune system, it can be totally undetected for years.  

HOST VO

This parasite can hide within the human host for years prior to discovery.  But, it also uses deception to get into the body.  

DR. ERIC ROSENDORF VO/OC

It has the ability to be free living in the soil, usually from a fecal contaminated soil.

HOST VO

Strongyloides larvae live and hide in soil that’s been contaminated by infected feces.  

DAN RISKIN VO/OC

The larvae have a great trick for finding a human host.  The larvae are attracted to a chemical called urocanic acid.  And urocanic acid is found on human skin and its highest concentrations are on the soles of the feet.  So, if a human’s walking around in bare feet on the soil, that’s how the parasite can find a human and get in. 

HOST VO

Once the parasite finds its way into a human host it can spread throughout the body. 

DR. ERIC ROSENDORF VO

And it burrows its way through the skin making its way into the small blood vessels.  And, eventually, it can enter into the lungs.  

HOST VO

From there, they climb up the bronchial tube and are swallowed back down into the gut.  In the small bowel, they molt twice and become adult, female worms.  The females thread themselves in and out of the lining of the small bowel causing inflammation.  Strongyloides is not native to America.  Where Mohammed contracted the parasite is a mystery. 

DR. ERIC ROSENDORF VO

It’s a unique worm that’s found endemically in tropical areas and subtropical areas of the world.  

HOST VO

Mohammed’s daughter has the answer.

YASMIN MEAH VO/OC

My dad grew up in a village in Chittagong, which is in Bangladesh.  And he was a farm boy, grew up on a farm.  He, like many other members of his family, walked around barefoot most of his early life.  

HOST VO

Mohammed probably picked up this parasite when he was a child living in Bangladesh.  But, why did this parasite only become a problem 60 years later?  The answer lies in the steroids Mohammed was given to treat his colitis.  Steroids reduce inflammation by suppressing the body’s own immune response.  But, instead of reducing the symptoms of the colitis, the steroids suppressed his immune system and allowed the parasitic worms to go on the rampage.  

DR. ERIC ROSENDORF OC/VO

Dr. Meah probably had the parasite at low levels in his system since his youth in Bangladesh.  And it wasn’t until he was on steroids that depressed or suppressed his immune system where the parasite was able to run rampant.  

HOST VO

The treatment for Mohammed’s colitis actually benefited the parasite.

DR. ERIC ROSENDORF VO/OC

We were trying to treat his colitis and, in fact, it is the steroid and the anti-inflammatory and imminent suppressive agents that were used to treat his colitis, which allowed the parasite to become such a burden and disseminate through his system.  

HOST VO

But, the relief at arriving at a diagnosis is short lived.  It soon becomes clear the worms have wreaked havoc throughout Mohammed’s body.  Strongyloides is a killer.  It can cause major tissue damage, acute respiratory failure, and eventually death.  

YASMIN MEAH VO/OC

Only ten percent of people with the infection will actually survive.  I realized at that point that despite all my relief at finding out a diagnosis, that his prognosis was actually pretty dismal.  

DR. ERIC ROSENDORF VO/OC

By burrowing its way through the intestines and causing inflammation of the lungs, he was really going through, what I would consider multi-organ system failure.  He was sick to the point that I thought he was going to die.  

HOST VO

Mohammed Meah is in critical condition.  A deadly parasite called Strongyloides is spreading through his body.  Dr. Rosendorf and his team must begin treatment right away to kill the parasite before it kills Mohammed.  

DR. ERIC ROSENDORF VO/OC

He was treated with, at that point, two antiparasitic agents.   One was ivermectin.  The other was albendazole.   

HOST VO

Ivermectin kills adult Strongyloides worms.  But, it doesn’t kill the larvae.  So, even if he survives this crisis, he’ll have to take the medicine for the rest of his life.  Mohammed takes the ivermectin for 14 days.  But, the medication may not be enough.

YASMIN MEAH VO/OC

Things were getting worse and it was fairly clear that the worm was causing more devastating effects than we could contain.  

HOST VO

His digestive system is so badly damaged that they decide to operate.

YASMIN MEAH VO/OC

At this point, it was pretty conclusive that he should probably get his colon removed.

HOST VO

The operation is complicated as the steroids Mohammed was given in the past make it harder for his body to heal.  But, to the relief of his family, the surgery is successful.  

YASMIN MEAH VO/OC

He came home and several months later he’s doing incredibly well. 

HOST VO

Against the odds, Mohammed survives the deadly infection.  

MOHAMMED MEAH VO/OC

I feel better right now.  I feel much stronger.  

YASMIN MEAH VO/OC

He remains on the ivermectin on a monthly basis and will continue to do so for the rest of his life.  

HOST VO

Mohammed knows that he survived thanks to his daughter and his doctors.  

MOHAMMED MEAH OC

I am grateful to all of them.  

DR. ERIC ROSENDORF VO/OC

I think it’s a miraculous story and a miraculous recovery.  I think he beat the odds.

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DAN RISKIN OC/VO

So the fact that Strongyloides can live for such a long period time inside the human body without the human ever knowing that it’s there is one of the things that makes it such a successful parasite.  When the immune system is down, that’s when the parasite can strike and that’s when it can be deadly.  

HOST VO

The best way to combat this parasite is prevention.  When visiting countries where the parasite is present, travelers should wear shoes at all times. 

DAN RISKIN VO/OC

If you’re a parasite, one of the big challenges you face is how to get to your host.  Now Strongyloides has a great strategy where they sit and wait for someone to walk by and then burrow into the foot.  Other parasites have a different strategy.  They conceal themselves inside the food that a host is going to eat and wait to be eaten.  Concealing yourself inside the food that your host is going to eat is a fantastic way to get inside your host.  And that strategy is used by countless parasites.  Raccoon roundworm gets into raccoons when raccoons eat infected rodents.  The rat lungworm gets into a rat when the rat eats an infected snail.  And one of the ways that humans get infected with parasites is when they eat infected fish.  

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HOST VO

At a research lab in Florida, Dr. Robert Overstreet wants to find out the extent of parasitic infections in fish on the gulf coast. 

PROF. ROBIN M. OVERSTREET VO/OC

There’s been a big change in diet.  People now eat a lot more fish.  With some of the new cuisines, they eat a lot of the fish raw.  Well, we’re going out and getting some of the fish that we see locally here both inshore and well off the islands to see which parasites are in which fish and how come they are.  

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PROF. ROBIN M. OVERSTREET VO/OC

It’s important to collect your own samples because we need to have living material to see whether they could possibly cause an infection in man. 

HOST VO

Fish common to the gulf coast include catfish, Wahoo, and bass.  And it’s not long before they catch something.  The team take the live specimens back to the lab to see what parasites they might be harboring.  Inside the guts of one of the fish, Rob finds what he’s looking for, a four inch parasitic worm called Uestrongylides ignotus.  It’s a parasite that can have many intermediate hosts.  It starts as an aquatic worm.  The worm is eaten by small fish, which in turn are eaten by a succession of larger fish.  When the infected fish are eaten by birds, the worms mature to egg laying adults.  If a human eats the fish raw, the consequences can be serious.  The worm can penetrate the abdominal cavity causing a life threatening condition called peritonitis.  Dr. Overstreet’s research reveals that in some populations up to 15 percent of the fish are infected with Uestrongylides.  

DAN RISKIN VO/OC

Eustrongylide is a parasite that literally uses its intermediate host as bait in order to get into its next host.  You might think that you’re only eating sushi, but you might actually be eating sushi plus parasites.  

PROF. ROBIN M. OVERSTREET VO/OC

The primary thing that, that we should remember is that if you cook your fish, shell fish or fin fish, you’re not going to get an infection.  On the other hand, I think most people like sushi or sashimi.  If you make your own, you should be careful.  You should be careful.  You should know which species of fish are more, you’re more likely to get an infection from.  And that’s one of the things that we’re trying to, to determine.  

DAN RISKIN VO/OC

These parasites disguise themselves inside the body of an intermediate host in order to sneak their way into the next host.  But, some parasites use disguise in a totally different way.  They actually conceal themselves inside the cells of their host’s body.  

HOST VO

Summer, 2007.  Rick DiMichele is a 55 year old fitness freak living in rural Massachusetts with his wife, Joan. 

RICK DIMICHELE VO/OC

I would call myself somewhat of a compulsive exerciser.  I work out pretty much every day.

JOAN DIMICHELE VO/OC

He’s always exercised.  He’s 160 pounds and he is all muscle. 

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HOST VO

One evening in July, Rick notices something unusual.  

RICK DIMICHELE VO/OC

It’s Friday night and I jump on my exercise bike and spend about 45 minutes to an hour on the bike.  When I jump off, I’m not feeling quite right.  I’m more fatigued than usual.  I feel like I have a fever.  Nothing serious, but I feel like I have a low grade fever.  And I’m thinking that this is something that’s going to go away on its own.

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HOST VO

But, the fever doesn’t go away.  

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RICK DIMICHELE VO/OC

Exactly one week later, I’m at work.  It’s a Friday.  All of a sudden what had been a low grade fever gets much worse.  I start feeling weak and tired from sweating.  The fever is increasing in intensity.  I leave work early and go home.  Joan, my wife, takes my temperature.  

JOAN DIMICHELE VO/OC

An adult with 103 temperature is not good.  He, obviously, is very sick.  

RICK DIMICHELE VO/OC

Going to the emergency room is something I won’t do unless it’s serious.  But, with 103 degree temperature I know something is really wrong.  

HOST VO

But, they have no idea just how monstrous Rick’s situation will become.  This is just the beginning.  

HOST VO

Fitness fanatic Rick DiMichele is suffering from a mysterious fever.  

RICK DIMICHELE VO/OC

So at the E.R., the doctor gives me a physical examination, takes my temperature, asks me some questions.

HOST VO

And, while he’s in the E.R. Rick notices another symptom. 

RICK DIMICHELE VO/OC

I’m also feeling a slight pain in my side, very slight.  When I take a deep breath, it gets a little bit worse.  

JOAN DIMICHELE VO/OC

I’m fearful it could be some kind of heart condition.

RICK DIMICHELE VO/OC

The doctor gives me an EKG just to make sure it isn’t my heart.  Once that’s ruled out we’re not really sure what this is. 

HOST VO

The doctors prescribe antibiotics and send Rick home.  

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RICK DIMICHELE VO

After returning from the E.R. for that weekend the symptoms basically intensify.  I’m having pretty severe chills.  I’m shaking at time uncontrollably.  

JOAN DIMICHELE VO/OC

He’s miserable.  He’s absolutely miserable.  

RICK DIMICHELE VO

I’m taking antibiotic and things are not getting any better. 

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HOST VO

The following day…

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…Rick makes an appointment with his primary care physician where he’s given a basic examination.  

RICK DIMICHELE VO/OC

We start asking the doctor questions about the symptoms.  And the doctor says it could be lymphoma, which is a type of cancer.

JOAN DIMICHELE OC

And that stops my heart.  

HOST VO

Lymphoma is a type of cancer that affects the lymphatic system.  Five percent of all cancer in humans is from lymphoma, and most strains are deadly.  

JOAN DIMICHELE VO/OC

It is a grim moment for both of us. 

RICK DIMICHELE VO/OC

I’m resigned to the fact that I have cancer. 

HOST VO

The doctor takes blood to test for cancer.  The results will be in at four p.m. the next day. 

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RICK DIMICHELE VO/OC

So, 4:00 rolls around.  I pick up the phone and call the doctor.  He informs me that the cancer markers came back negative, which is obviously good news.  

HOST VO

But the bad news is that his spleen is dangerously swollen.  And the doctor has no idea why.  

RICK DIMICHELE VO/OC

And he tells me my spleen is so large because something is happening with my red blood cells.  My primary care physician recommends that I see a blood specialist.  It really is a complete mystery.  I just can’t imagine what I might have. 

HOST VO

Two days later, Rick sees the hematologist.  

RICK DIMICHELE VO/OC

My wife and I walk into his office and sit down and he asks me some questions. 

JOAN DIMICHELE VO/OC

He takes multiple blood samples.  He does a lot of his own blood work in the office.  The doctor is very concerned about his blood count, which normally should be in the 40’s, is now down to 29.  And, states that he might consider transfusing him if it goes any lower.  

HOST VO

24 hours later they get the results.

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RICK DIMICHELE VO/OC

The doctor calls my wife and I in.  We sit down in front of him and he looks at me and he says, based on the blood analysis you’ve got Babesiosis.  

JOAN DIMICHELE VO/OC

The doctor tells us it’s Babesiosis.  And I had no idea what this is.

RICK DIMICHELE OC

I’d never heard of it before.  Never heard of Babesiosis before. 

HOST VO

Dr. Tim Lepore specializes in infectious diseases at the Nantucket Cottage Hospital in Massachusetts.  

DR. TIM LEPORE VO/OC

Babesiosis has the potential to be fatal.  The Babesia infects human red blood cells, causes them to breakdown.  In that process the patient typically goes through high fevers and chills, may have an enlarged spleen.  They may become very acutely ill and dangerously ill with it.  

DAN RISKIN OC/VO

Babesia parasites enter the bloodstream and then they hide in the red blood cells devouring them from the inside.  The parasite feeds inside the red blood cell, reproduces, and then bursts out into the bloodstream.  

RICK DIMICHELE OC/VO

The pain in my side is getting worse. 

JOAN DIMICHELE VO/OC

Having a temp of 103 around the clock for a week and a half, he’s feeling like crap. 

HOST VO

But, how did this parasite get into Rick’s bloodstream?

DR. TIM LEPORE OC

The Babesia organism is transmitted by a tick bite.  

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HOST VO

The tick is a tiny arachnid that lives in wooded areas.  It survives by sucking the blood of mammals.  Ironically, it’s Rick’s healthy lifestyle that indirectly causes his illness.

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RICK DIMICHELE VO/OC

I’m not sure where or how I got bitten by a tick, but most likely I got it in the woods.  I run several times a week in the woods.  And I probably brushed up against some grass and picked up the tick that way.  

HOST VO 

But, Rick isn’t the only person to have Babesiosis in this part of Massachusetts.  This deadly parasite is on the move and it’s infecting more and more people.  But, how and why it’s spreading across the country is a mystery.  

HOST VO

Inside 55 year old Rick DiMichele is a parasite that’s destroying his blood cells.  But, Rick isn’t the only one affected.  This parasite is on the move.  Dr. Thomas Mather is a Parasitologist at the University of Rhode Island.  He’s trying to understand how Babesiosis is spreading.  

DR. THOMAS MATHER VO/OC

35 years ago, Babesia was known from Nantucket Island.  Since then we’ve found it throughout the cape, down along the southern coast of New England.  To see the true spread I think it requires doing fieldwork.  

HOST VO

First, he heads to an area of New England that 30 years ago was free of the Babesia parasite.  There he begins collecting ticks. 

DR. THOMAS MATHER VO/OC

They’re really well adapted for latching on to hosts.  So, as we drag the cloth along the ground, the ticks hidden in the leaf litter will just latch onto the cloth.   

HOST VO

Dr. Mather and his team return the university lab to test the ticks for the Babesia parasite.

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HOST VO

To find the parasite, they must perform a genetic analysis.

DR. THOMAS MATHER VO/OC

And we’re looking specifically not for tick DNA but for Babesia DNA.  

HOST VO

They stain the tick specimens and expose them to a special UV light, which will identify the elusive Babesia parasite and the rate of infection. 

DR. THOMAS MATHER OC/VO

Each of these bright bands represents one positive tick for Babesia.  We would expect to see about a ten percent infection rate in ticks. 

HOST VO

But, in this area the results are very different.

DR. THOMAS MATHER VO/OC

It looks like we have seven positives out of 34, which is about 20, 20 percent.  It’s higher than we would have expected by eight to ten percent.

HOST VO

Dr. Mather’ experiment illustrates that the Babesia parasite is on the rise in New England.  But, how did it get there?  Ticks themselves can’t move very far.   But, they can hitch a ride on other animals which are much more mobile.  These parasites move into new regions by infecting mice.  When the mice migrate, they take the Babesia parasite with them. 

DR. THOMAS MATHER VO/OC

It can continue its move at a westward and a northward and a southern clip of about five or 15 miles every year.  I’m confident that over time, 20 years, 30 years that Babesia parasites will be far more common where ever black legged ticks are found.  And that’s going to present a much greater level of risk. 

HOST VO

In rural Massachusetts, Rick’s encounter with the Babesia parasite has thrown him into a life or death situation.  The parasites are literally eating his blood cells from within.  

DR. TIM LEPORE VO/OC

In a patient who is desperately ill with Babesiosis, there is the potential to die.  And you have to be aggressive about going after, finding it, and treating them.  

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RICK DIMICHELE VO

The doctor prescribes and antibiotic and an anti...  

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…parasitic that I’m on for ten days. 

HOST VO

Rick takes an antiparasitic medicine called atovaquone.  Once absorbed into the blood it prevents the parasite from feeding.  Unable to metabolize, the parasite starves to death.  With fewer damaged red blood cells to filter out, Rick’s overworked spleen gradually returns to normal.  

RICK DIMICHELE VO/OC

At that point, we’re just both jubilant because I’ve got a disease that’s treatable and I’m going to recover from.  Once I start treatment, the fever goes away almost immediately.  Very gradually, the other symptoms start to disappear.  Six or seven weeks after I start treatment I’m feeling normal.  

HOST VO

Now that Rick’s made a full recovery, he’s much more cautious. 

RICK DIMICHELE VO/OC

Now I am much more vigilant about checking for ticks, especially if I’ve been in wooded areas, or even out in the yard.  

JOAN DIMICHELE OC/VO

Having this happen to him, makes us appreciate every day.  You never know whether this is your last day.  It’s given us an appreciation for our lives, our family.  

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DAN RISKIN OC

The Babesia parasite is very difficult to detect because in a human body only around one percent of the red blood cells will be infected.  So, even with a blood smear you might not spot it. 

HOST VO

People infected with Babesiosis often show no symptoms.  But, when symptoms do occur, the disease can be fatal, especially in people who are older, or have weaker immune systems.  The best way to prevent getting Babesiosis is to avoid getting bitten by a tick.  In tick infested areas, wear pants and long sleeves, use insect repellant, and avoid tall grass.  

DAN RISKIN OC

It’s no accident that parasites are some of the most…

DAN RISKIN OC

…prolific and successful life forms on the planet.  

HOST VO

They are opportunistic killers that will stop at nothing to invade their next host, playing an elaborate game of hide and seek with our immune systems.  They are the unseen, unrecognized conquerors of the living world. 

DAN RISKIN VO/OC

Parasites are all around us.  But, for the most part, we have no idea that they are there because parasites are masters of disguise.  

HOST VO

For more disgusting parasites and their stomach-churning habits, visit our website, Animalplanet.com/monstersinsideme.   

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HOST VO

Dr. Bienvenido Castillo.  

DR. BIENVENIDO CASTILLO VO/OC

When I examined Mallorie, we first checked the vision and then I examine her in the slit lamp.  

HOST VO

The slit lamp combines a high intensity light source and a microscope.  It allows the doctor to see deep into the eye’s inter-structures.  

DR. BIENVENIDO CASTILLO OC

When you look at the slit lamp you get a magnified look of the cornea.  

HOST VO

The cornea is the transparent dome shaped layer, which covers the front part of the eye.  It protects the eye and helps it focus by refracting light.  A healthy cornea should be clear.  When viewed in the slit lamp, Mallorie’s cornea looks undamaged.  But, the retina suggests a common complaint.  

DR. BIENVENIDO CASTILLO VO/OC

In the beginning it presented as contract lens over wear.  What happens when you wear your contact lens or sleep with them too long is that it deprives the cornea of oxygen.  I see it quite often in the clinic.  And Mallorie presented that way.  

MALLORIE GREINER VO

He tells me to leave my contacts off for the time being.  But, he’s definitely concerned and wants me to come back and see him in a few days. 

HOST VO

As a precaution, Dr. Castillo gives Mallorie some antibiotic drops and suggests she take the day off school.  

MALLORIE GREINER VO/OC

Missing my first day as a senior is very disappointing because of the fact that there’s craziness going on.  I don’t get to see my friends that I’ve been wanting to see all summer.  So, it really stunk.  

HOST VO

Over the next few days, her eye sight deteriorates at an alarming rate.  

MALLORIE GREINER VO

My eye, at this point, is not improving.  It’s actually getting worse.  It’s very blurry and it’s very hard to see out of my eye.  

HOST VO

Four days later, Mallorie goes back for her follow-up visit.  

MALLORIE GREINER VO/OC

He takes a look at it with the regular light and then he puts the fluorescent drops in my eye and then he can take a look at it with a black light. 

HOST VO

Dr. Castillo uses a special dye called fluorescein, which highlights imperfections in the cornea.  

DR. BIENVENIDO CASTILLO VO/OC

Before the cornea appeared relatively clear with just some mild haziness.  And now she has some staining pattern with the fluorescein.  Although it is ill defined, it was not typical for contact lens over wear in that it’s gotten worse.  

HOST VO

This haziness could be a vital clue.

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JOAN DIMICHELE VO/OC

As a nurse, I’m spending a lot of time on the computer trying to find symptoms or an idea of what possibly could be wrong. 

HOST VO

While Joan tries to figure out what’s making Rick sick, another symptom hits him.

RICK DIMICHELE VO/OC

I’m starting to notice that my urine is darker than normal.  It doesn’t hurt to urinate, but it’s not something I’ve ever had before.  So I’m really getting concerned.

JOAN DIMICHELE OC/VO

Darkened urine could be kidney stone because he is complaining about pain in his side.  

RICK DIMICHELE VO/OC

When my wife mentions kidney stones or a kidney infection, I’m thinking this is treatable.  I’m hoping that her…

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…guess is correct. 

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RICK DIMICHELE VO/OC

He’s aware that I think this might be a kidney infection.  He comes out and he says, what’s the matter with you?  You’re not looking well.  He puts a hand to my side and he looks at me and he says, that’s not your kidney.  That’s your spleen.  He indicates that my spleen is enlarged.  And that’s why I have the pain.

HOST VO

The spleen is an organ that filters out dead blood cells.  An enlarged spleen can indicate serious medical complications.  

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JOAN DIMICHELE VO/OC

He looks at me and says your husband’s very, very sick.

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HOST VO

To investigate, Dr. Mather heads to a new location further north.  This time he’s not searching for ticks. The Babesia parasite reproduces using two hosts, the tick and the white footed mouse.  When the tick sucks blood from a white footed mouse, the Babesia parasite enters the mouse’s blood cells.  Once inside, the Babesia parasite clones itself.  When another tick bites the mouse, the Babesia parasite enters that tick and reproduces again, completing the life cycle. 

DR. THOMAS MATHER VO/OC

Knock him out so that they don’t feel anything when we take the blood sample.  And it will only take a few seconds.  Well, maybe a couple of minutes and this mouse is going to do fine.  She’s come to now.  It looks like she’s ready to go, go back home.  All right.  Let’s collect everything…

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…and it’s back to the tick mobile and to the lab.  

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HOST VO

At the lab, Dr. Mather examines each blood smear under the microscope looking for Babesia parasites.  

DR. THOMAS MATHER VO/OC

This is a typical form of the red blood cells that you would see in a, in a stained smear.  If there were parasites there, you’d actually see them.  There’s a Babesia parasite right there.  And, oh, there’s another one right there.  This is a mouse that is positive for Babesia.  One infected mouse in a new area will just probably serve to infect ticks, which will bite other mice and will spread the infection.