Monsters Inside Me

Outbreak

Episode Summary

A mysterious organism strikes a Midwest city, causing the worst parasitic outbreak in US history. In Chicago, doctors must track down a hidden killer that attacks students, and a flesh-eating monster terrorizes a Texas community.

Episode Notes

A mysterious organism strikes a Midwest city, causing the worst parasitic outbreak in US history. In Chicago, doctors must track down a hidden killer that attacks students, and a flesh-eating monster terrorizes a Texas community.

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Find episode transcripts here: https://monsters-inside-me.simplecast.com/episodes/outbreak

Episode Transcription

MUSIC IN

HOST VO
A deadly organism lurks all around us.  When it strikes it's the biggest parasitic outbreak ever recorded.  

PAUL NANNIS VO/OC
There were about 101 deaths.  We knew something besides the ordinary was going on.  

HOST VO
A hidden killer attacks a man's brain.  When others get the same symptoms doctors race against time to stop it.  

DR. STUART JOHNSON VO/OC
We are dealing with the largest outbreak of this particular parasite in the western hemisphere.

HOST VO
And a skin eating monster rages through a Texas community.  

DR. KENT AFTERGUT VO/OC
Clearly what we understood previously about where it was endemic may no longer be true.

HOST VO
Three very different parasites but they all have one thing in common:  when they enter a human population they get out of control cutting down victim after victim in a deadly outbreak.

MUSIC OUT
 
MUSIC IN

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.
 
MUSIC SEGUE

HOST VO
Parasites are among the oldest, most abundant organisms on the planet.  They survive by feeding off their living host and give almost nothing in return.  

DAN RISKIN VO/OC
For most parasites  survival depends on getting into or onto a host and a host is another organism that will give them food, shelter, and a place to reproduce.  The challenge is how to infect the host.  Some hide in the food that their host eat, others sit lurking in the environment waiting to be picked up, and some even hijack other organisms to deliver them to the host that they need to get to.  And when the most successful parasites make their way into a population and spread the result is an outbreak.
 
MUSIC SEGUE

HOST VO
April 2000, Chicago.  23 year old medical student Patrick Bradley is returning home from spring break. He doesn't know it but he is about to enter the nightmare world of parasitic infection.  

PATRICK BRADLEY VO/OC
I get back to Chicago.  I'm starting to feel that something's not exactly right especially on the backside of my body.  Like my neck's getting a little stiff and my back felt sore.

HOST VO
At first Patrick isn't really worried.

PATRICK BRADLEY VO
I'd played basketball the day before and I'm starting to think that maybe I need to hit the gym a little bit more often now because my back's really feeling sore.  

HOST VO
But as Patrick's symptoms increase it becomes clear, this is no sports injury.  
 
PATRICK BRADLEY VO
So as the week went on I started to feel worse and worse and the most distressing thing was this headache all of a sudden came on and it started out in like the kind of headache you'd have if you had a real bad 24 hour flu.

HOST VO
With the headaches only getting worse Patrick seeks medical attention.  
 
PATRICK BRADLEY VO
I went to see the doctor that I'd always gone to growing up and he suggested I take some pain killers to try to deal with the headache.

HOST VO
But the pain killers have no effect.

PATRICK BRADLEY VO
The headaches, just the most extreme headache bar none I’ve ever experienced in my life.  It was to the point where I, I really was almost wishing it would just be over.
 
MUSIC SEGUE

HOST VO
By now Patrick's pain is unbearable.  Unable to do the simplest things he goes to stay with his parents where his condition nosedives.  

PATRICK BRADLEY VO/OC
I had an episode where I was just laying on the couch with my head in my pillow with my eyes closed because that's really the only way I could even just like sort of tolerate breathing and all of a sudden I just like sat up and projectile vomited sort of out of The Exorcist.
 
MUSIC SEGUE

HOST VO
Shocked by their son's condition Patrick's parents rush him to the emergency room.  On call is Dr. Stuart Johnson.

DR. STUART JOHNSON VO
Patrick has come to the ER and is extremely distressed.  He has a headache that's been slowly building over the last several days.

PATRICK BRADLEY OC
When I first got into the emergency room the doctors were trying to get me to move my neck.

DR. STUART JOHNSON OC
Does that bother you?

PATRICK BRADLEY VO
Stiff.

DR. STUART JOHNSON OC
Okay.

PATRICK BRADLEY VO
And to describe my symptoms and the only thing I could utter is "headache, headache."  At this point I'm thinking that it's got to be some kind of meningitis because I can hardly move my neck.
 
HOST VO
And Dr. Johnson agrees.

DR. STUART JOHNSON VO
The suspicion is that he has meningitis.

MUSIC SEGUE

HOST VO
Meningitis is an inflammation of the lining of the brain.  It’s usually caused by a viral or bacterial infection.  In its bacterial form it's highly contagious and can be spread by coughs and sneezes.  Left untreated it's fatal.

DR. STUART JOHNSON VO/OC
The critical part of this is to discern whether this is a bacterial process or not.
 
HOST VO
To find out what is causing Patrick's meningitis they test his spinal fluid.  

PATRICK BRADLEY VO
They asked me to get into a fetal position and I was kind of grabbing my knees with my hands curled up in a ball and sort of exposing my backside and they stabbed me just below my spinal cord to collect some of the fluid that's around my brain and spinal cord.  

HOST VO
The liquid is collected in a tube called a manometer that measures the pressure of the spinal fluid.  The higher the pressure the greater the swelling in the brain.  

DR. STUART JOHNSON VO
It was amazing.  This, this pressure was rising above the first stem of the manometer and we watched the pressure go over the top of the tube.  I've never seen a cerebral spinal pressure to this degree.
 

MUSIC SEGUE

HOST VO
And when Dr. Johnson examines it he's amazed at what he sees.

DR. STUART JOHNSON VO
The surprising thing is the high percentage of a particular type of white cell in the cerebral spinal fluid.  Namely eosinophils.

HOST VO
Eosinophils are white blood cells produced by the body's immune system specifically to combat parasitic infections.  Patrick has meningitis but it isn't caused by a bacteria or a virus.  It's caused by one of the deadliest parasites on the planet.

DR. STUART JOHNSON VO
The most common cause of eosinophilic meningitis is infection with rat lungworm.

PATRICK BRADLEY VO
I remember Dr. Johnson telling us that I'd been infected with a parasitic worm and that that parasitic worm was in my brain.  I was shocked.  I was terrified.  

 
HOST VO
The rat lungworm is one of the most feared parasites on the planet.  Though rat lungworm cases have appeared in the continental U.S. most infections occur in Hawaii and other tropical islands.  So where did Patrick get it?  Patrick tells Dr. Johnson that he was part of a group of students that recently visited Jamaica.  When Dr. Johnson calls the other students he makes an alarming discovery.

DR. STUART JOHNSON VO
We have an additional nine students that have the very same symptoms.  This is not an isolated case.  This, this is an outbreak.  
 
HOST VO
Although it's not contagious, Dr. Johnson needs to find the source of the outbreak so that he can alert other potential victims.  

DR. STUART JOHNSON VO/OC
We are dealing with the largest outbreak of this particular parasite in the western hemisphere.  12 students.  All right.  We think, meet the case definition.  So it's very important that we get a handle on this as quickly as we can.
 
HOST VO
Dr. Johnson and his team start to question the sick students.

MUSIC SEGUE

DR. STUART JOHNSON VO/OC
A series of interviews were conducted asking where they've been, what they've eaten because we know this is a foodborne illness.

HOST VO
All the interviews point in one direction.  

DR. STUART JOHNSON VO
It was very apparent after a short period of time that one particular restaurant meal the night before they left Jamaica was highly implicated.  All the patients that were sick had eaten the Cesar salad.  

HOST VO
So what was wrong with the Cesar salad?  The answer lies in the rat lungworm life cycle.
 
MUSIC SEGUE

HOST VO
The adult worm lays its eggs inside the lungs of a rat.  The eggs hatch into larvae.  The larvae are coughed up from the rat's lungs and swallowed back into its stomach.  Then they are expelled in the rat's feces and are eaten by a second host, a slug or a snail.  When the snail is eaten by a rat the life cycle is repeated.  The most probable cause of the outbreak was that an infected slug or snail was accidentally chopped up in the unwashed lettuce.

PATRICK BRADLEY VO
In the Cesar salad on the unwashed lettuce were snails or slugs that had the worm inside it.
 
MUSIC SEGUE

HOST VO
Of all the sick students, Patrick's case is the most severe.  As he lies in agony in the hospital the parasitic worms chart a horrific course through his body.  The larvae hatch inside his stomach and then burrow into his bloodstream.  They travel in the blood to the edge of the brain.  Then they burst through the brain's defensive lining.  Inside the brain the larvae grow into adult worms.  But when the worms try to get back into the blood stream they get stuck and die in the brain lining causing it to swell.

DR. STUART JOHNSON VO/OC
The body's own immune system is attacking the worm and this is causing a huge inflammatory response in the covering of the brain.
 
DAN RISKIN OC/vo
In the case of the rat lungworm the infection is damaging the body in two ways.  First, the worms are burrowing through the body and that causes hemorrhaging and bleeding and tissue damage.  And second, your body is attacking these organisms and that causes swelling and that swelling can be a problem when it presses up against vital organs like the brain.  And that can be deadly.
 
MUSIC SEGUE

HOST VO
Patrick's immune system is working overtime to kill the worms but instead it's killing him.

PATRICK BRADLEY VO/OC
It was really getting to be a grim scenario.  The doctors were sort of running out of options.

HOST VO
And time is running out.  Not only is Patrick in imminent danger but the other students aren't far behind.
 
MUSIC OUT
 
MUSIC IN
 
MUSIC SEGUE

HOST VO
In Chicago, 23 year old medical student Patrick Bradley is one victim in a deadly outbreak.  A parasite called the rat lungworm has caused the lining of his brain to swell and press against his skull giving Patrick a severe case of meningitis.

DR. STUARD JOHNSON VO 
On the forefront of our mind is the thought that Patrick might die.  If we kill the larvae it might lead to increasing the inflammation.  

HOST VO 
Instead of fighting the worms the doctors must attack Patrick's own immune system.

DR. STUART JOHNSON VO/OC
It was controlling the immune response which was critical to managing his symptoms.
 
HOST VO
The doctors give Patrick a large dose of steroids to reduce the inflammation.

DR. STUART JOHNSON VO
The steroids tone down the immune response.  This was quite effective in decreasing his symptoms.

PATRICK BRADLEY VO/OC
I wasn't sure it was gonna work but I’m feeling so much relief. 
 
DR. STUART JOHNSON VO
The next morning when I walked in Patrick's room, it was like he had never been ill.  

HOST VO
After three weeks all the worms are dead and the steroid treatment has reduced the swelling in Patrick's brain.  Patrick and the other students are cured.  The outbreak is over.
 
HOST VO
Today Patrick is symptom free and refuses to let the experience hold him back.

PATRICK BRADLEY VO/OC
If I am every overseas again, I think I would be somewhat more cautious about what I would eat but I'm not gonna, you know, be scared.  I mean, look that would be like letting the worms win.
 
DAN RISKIN VO/OC
It's worth remembering that for a lot of these parasites that end up in the human brain, humans are not their target.  So when they do end up there it's a disaster for the parasite just as much as it's a disaster for the human.  The rat lungworm prefers rats or snails and slugs but when it does get into a human population that's when an outbreak occurs.
 
MUSIC SEGUE

HOST VO
Parasites like the rat lungworm thrive in places where sanitation is lacking but that doesn't mean that developed areas are parasite free.

DAN RISKIN VO/OC
In the developed world we've gotten so good at hygiene and sanitation that we almost forget that parasites are there.  But they are there and they're waiting and all it takes is one slip up and we've got an outbreak.  
 
MUSIC SEGUE

HOST VO
As one Midwestern city is about to find out.  

MUSIC SEGUE

HOST VO
1992 Milwaukee, Wisconsin.  Population 1.4 million.  Could one man's death be a sign of a disaster to come?  Danny Babb is caring for his longtime friend Jonathan Polarski.  
 
DANNY BABB VO/OC
Jonathan and I were inseparable.  I mean, we were closer than a brother.  

HOST VO
But later that summer Jonathan begins to get sick.  

DANNY BABB VO/OC
When I first started noticing the symptoms they started with night sweats and weight loss.

HOST VO
These symptoms don't come as a surprise.  In fact, both Danny and Jonathan have been preparing for this moment for some time.  

DANNY BABB VO
I had known he had AIDS for at least four years.
 
MUSIC SEGUE

HOST VO
With AIDS the body's immune system barely functions at all leaving it highly susceptible to infections.  

DANNY BABB VO
Initially I thought Jonathan's symptoms were due simply to having the AIDS virus until the other symptoms started to appear.  

HOST VO
By August what began as night sweats and weight loss becomes crippling stomach cramps and unrelenting diarrhea.  

DANNY BABB VO/OC
It was like he didn't have enough, even enough holes in his body to extract the waste.  And I started pressing him to try to get some, you know, some kind of professional assistance.  
 
MUSIC SEGUE

HOST VO
Jonathan agrees to go to the hospital.  After a few days the pain becomes unbearable.

DANNY BABB VO/OC
His whole body was turning to waste.  He grew hysterical about being touched.  He, he was in such severe pain.  He was praying, you know, to die. 

HOST VO 
Three days after being admitted to the hospital Jonathan's prayer is answered.

DANNY BABB VO/OC
He went into shock.  The pain was so severe.  I really knew then that we were waiting for the final moment.  

MUSIC OUT
 
MUSIC IN

HOST VO
On August 3rd, 1992, Jonathan Polarski dies.  At the time it seems that he is another victim of the AIS virus but the real killer is about to go on a rampage throughout the entire city.  
 
MUSIC SEGUE

HOST VO
The best way to avoid Lung Fluke is not to east which of the following? A) Unwashed vegetables, B) Raw fish, C) Undercooked crabs.  
 
MUSIC OUT
 
MUSIC IN
 
MUSIC SEGUE

HOST VO
The best way to avoid lung fluke is C, not to eat undercooked crabs.  The only way to kill the parasite is to cook an infected crab thoroughly.
 
MUSIC SEGUE

HOST VO
When AIDS patient Jonathan Polarski dies every one assumes his death is solely due to the HIV virus.  What they don't know is that the same parasite that killed Jonathan is about to launch an attack on the city,
 
HOST VO
April 1993.  Six months after Jonathan's death.  On the south side of Milwaukee infectious disease specialist Dr. Ian Gilson notices something strange in the HIV positive community.

DR. IAN GILSON OC/VO
We had a group of patients, maybe 20 to 25 patients who are were suppressed with AIDS who occupied more and more of our time because they were so sick and had such medical needs.  

HOST VO
And just like Jonathan all of Dr. Gilson's patients are suffering from crippling diarrhea. 

DR IAN GILSON VO/OC
We used standard anti-diarrhea medications.  We'd use things like Imodium and Lomotil and fluid and electrolyte replacement but it just didn't stop.

HOST VO
To make matters worse the number of extremely sick patients begins to increase.  
 

HOST VO
Dr. Gilson sends a report of his findings to the city of Milwaukee's health commissioner, Paul Nannis.  But Gilson is not the only one to raise the alarm.  

PAUL NANNIS VO/OC
We had set up a system where the health department were to receive lab results from a couple of local hospitals and we started to notice that that morning we were getting lots of lab reports of patients presenting cold, flu like symptoms.

HOST VO
But not all the new cases are HIV sufferers.  In fact most of them involve people who are otherwise perfectly healthy.  

MUSIC SEGUE

PAUL NANNIS VO/OC
We began to tally the number of folks that were anecdotally reported to us as ill and it started  out as hundreds.

MUSIC SEGUE

HOST VO
Nannis begins to suspect a city wide outbreak but of what?  

PAUL NANNIS VO/OC
As we began to see kind of the volume, the magnitude of the, of the reports that were coming in, we knew something besides the ordinary was going on.

 
MUSIC OUT

HOST VO
That evening Nannis and his team begin to map out where people are getting sick and they immediately see a pattern in one specific section of the city.  

PAUL NANNIS VO/OC
And we could see a concentration of illness on the south side.
 
HOST VO
The health department orders blood and stool samples to be taken from the sickest patients.

PAUL NANNIS VO/OC
Is there anything unusual about these samples?

HOST VO
The blood tests come back clear but tests on the stool samples reveal the culprit.  Each sample contains traces of a potentially deadly parasite.  Nannis can't believe what the lab technician is telling him.

MUSIC OUT

PAUL NANNIS VO
He looked at him and he saw in all eight of the samples...

MUSIC IN

PAUL NANNIS VO/OC
…that he had, he found cryptosporidium.
 
MUSIC SEGUE

HOST VO
Cryptosporidium is a highly infectious and potentially deadly parasite.  When ingested it attaches to the lining of the small bowel.  There it multiplies and attacks the intestine.  As the parasite spreads the body attempts to flush it out and this reaction results in diarrhea.  Nannis needs to act quickly to stem the outbreak and immediately turns his attention to the city's water supply.

MUSIC OUT

PAUL NANNIS VO/OC
We had a water plant.  One that served the north side of Milwaukee and one that served the south side of Milwaukee.
 
MUSIC SEGUE

HOST VO
But since the outbreak seems to be confined to one side of the city he zeros in on the prime suspect:  the south side's Howard Avenue Water Purification Plant.  

PAUL NANNIS VO/OC
We began to look at the records of water quality from the south side plant.  We noticed there was an incident, a spike in what we call turbidity.

HOST VO
Turbidity is a measure of the cloudiness or haziness of drinking water resulting from the presence of unwanted particles like dirt, chemicals, or parasites.  In Milwaukee, the spike in turbidity levels began three weeks earlier.  

PAUL NANNIS VO
We didn't know why but we at least knew it was the water plant.  Let's shut it down.  
 
HOST VO
Faced with the worst parasitic outbreak in U.S. history the city shuts down the south side water plant leaving half a million residents without running water.  But the move comes too late.  The parasite has already infected almost half the city's residents.

DR. IAN GILSON VO/OC
I think it was something like 400 to 500,000 people got the diarrhea in our urban area.  That's something like 40 percent of all people in the Milwaukee area.  
 
HOST VO
For most of the city's residents the symptoms caused by cryptosporidium are mild.  Doctors prescribe anti-diarrhea pills and after a week most victims recover.

DR. IAN GILSON VO
The vast majority of people who are not severely, I mean, you know, compromised, all, virtually all of them recovered.  

HOST VO
But for people with weakened immune systems the outlook is grim.  

DR. IAN GILSON VO
The ones who had extremely damaged immune systems found it very difficult to recover.
 
HOST VO
When confronted by a weakened immune system, cryptosporidium multiplies over and over again.  While some cryptosporidium is washed away, most of it stays and continues to multiply and line the stomach walls.  By lining the stomach walls cryptosporidium prevents the body from absorbing nutrients.  The constant diarrhea pushes the nutrients out of the body eventually causing malnutrition and death.

PAUL NANNIS VO/OC
There were about a hundred and one deaths and almost all of the patients that died had HIV or AIDS.  So this was a huge incidence for the HIV/AIDS community.  
 
HOST VO
While the shutdown on the water plant prevents any new cases, the health commissioner must still solve the most pressing question.

PAUL NANNIS OC
What was the cause?
 
HOST VO
Milwaukee's water purification plants rely on large doses of chlorine to clean the incoming water and make it drinkable but in this case the treatment isn't strong enough.

DAN RISKIN VO/OC
Cryptosporidium is an incredible parasite.  It is very tough so chlorine kills most stuff that gets into the water but not even chlorine can kill cryptosporidium.  
 

HOST VO
Cryptosporidium has a protective coating that allows it to withstand chlorine based cleaning systems and that's how it got into Milwaukee's drinking water.  On April 10th the city orders a thorough examination of the south side treatment plant but when they test the water in the plant the cryptosporidium is gone.  The turbidity levels are back to normal.  Nannis is stumped.

PAUL NANNIS VO/OC
By the time we had discovered that people were getting sick and that we identified the agent of infection as cryptosporidium we weren't able to find crypto in the water plant.

 
MUSIC SEGUE

HOST VO
By the next week there are no more new cases.  Nannis and his team are convinced that the parasitic cloud must have passed through the water system and is not completely gone.  

PAUL NANNIS VO/OC
Finally because we had consecutive clean readings from the lab that the water was clean we lifted the advisory and we knew at least we were over that stage.
 
HOST VO
For Milwaukee's south side residents life soon returns to normal but the biggest question still remains.  Where did the cryptosporidium come from?  For years following the 1993 outbreak no one knows until now.  One scientist believes he knows what caused the biggest parasitic outbreak in U.S. history.  
 
MUSIC OUT
 
MUSIC IN
 

MUSIC SEGUE

HOST VO
More than a decade after tainted water infected 400,000 Milwaukee residents with a killer parasite, the source of the infection remains a mystery.  For city health commissioner Paul Nannis the prime suspects have long been local cattle.

DAN RISKIN VO/OC
Cryptosporidium is extremely common in cattle so it's very plausible that runoff from a farm could carry cryptosporidium and put it into a water supply. 


PAUL NANNIS VO/OC
We had a lot of snow, a lot of runoff, a lot of runoff came from those dairy farms. 

 
HOST VO
The prevailing theory is that melting snow accelerated the runoff of contaminated cattle feces.  This could have caused a mass of cryptosporidium to flow into the rivers that feed the water system.  But one scientist has his doubts and keeps investigating and now 15 years later Dr. Ronald Fayer of the USDA believes he knows the real cause of the Milwaukee outbreak.

DR. RONALD FAYER VO/OC
Cryptosporidium, a few years ago, was considered a single species.

HOST VO
But new DNA based testing has shown that there are different species of cryptosporidium.  Fayer thinks this technology can help find the source of the Milwaukee outbreak.  Fortunately stool samples from the 1993 outbreaks still exist.

DR. RONALD FAYER VO/OC
Feces from humans that were infected with cryptosporidium were saved.
 
HOST VO
So Dr. Fayer and his team put the stool samples through the newly developed molecular test.  They are hoping to solve the mystery of American's deadliest parasitic outbreak once and for all.  The results are shocking.

DR. RONALD FAYER VO/OC
It was found that the molecular fingerprint matched a species called cryptosporidium hominis.

HOST VO
Cattle don't carry cryptosporidium hominis but humans do.  

DR. RONALD FAYER VO/OC
Cryptosporidium hominis is a species that is transmitted from human to human to human.  Cattle are not involved in that cycle.  So in effect we have found that humans were the source of human infection based on the molecular methods that became available after that time.
 
HOST VO
Using Dr. Fayer's findings one leading theory has emerged as to what cause the outbreak.  In late March 1993, an isolated sewage leak could have released a cloud of cryptosporidium infected human feces into the rivers that feed Milwaukee's water system.  The parasitic cloud would have caused the spike in turbidity at the south side plant before infecting the drinking water.  By early April when the turbidity levels had returned to normal and no further cases were reported the mass would have cleared the system.  Since 1993 Milwaukee has taken steps to insure a similar outbreak never happens again.

PAUL NANNIS VO/OC
The only agent that kills cryptosporidium is ozone and that lead to both of those plants being upgraded to an ozone cleaning process which leaves us today with the cleanest water in the country.
 
HOST VO
And 15 years after the death of his best friend Jonathan Danny Babb has a new mission in life:  keeping Milwaukee's residents safe.

DANNY BABB VO/OC
Iam now presently employed at the water plant and this has been one of my concerns that we put out the best water that we possibly can.  

HOST VO
While the Milwaukee incident highlighted the dangers of a mass parasitic outbreak and caused some states to take preventative action, cryptosporidium continues to threaten the water supplies in the U.S.  Ozone treatment reduces the amount of cryptosporidium in drinking water but it doesn't completely destroy all of it.  On average there are ten cryptosporidium parasites in every ten gallons of New York drinking water but at this concentration it rarely causes illness.

DAN RISKIN VO/OC
Part of the reason cryptosporidium is so successful is because it has a great strategy.  It uses water to get to its host.  By using water as a means of infection cryptosporidium is able to infect large populations very quickly.  They're able to spread through large geographic areas.  So water works well for cryptosporidium.  Some parasites use a different method.  They use animals to transport them to their next host.
 
MUSIC SEGUE

HOST VO
Weldon Hatch is a 59 year old delivery driver living 30 miles south of Dallas, Texas in the small town of Waxahachie.  

WELDON HATCH VO/OC
Waxahatchie's a rural town.  We've lived here 20 years.  I’m a Texas master naturalist so we do lots of projects out in the country all over north Texas.  I like being outside.  See things grow.  

HOST VO
But Weldon's life is about to become the center of a medical mystery.

WELDON HATCH VO/OC
The first thing I noticed in late November two very bright red spots on my back and they itched a little.  It was as painful probably a burn is when it's trying to heal and like something maybe piercing your skin.  Well at first thought it was an insect sting or a bite.
 
HOST VO
But after a few weeks the red marks are still there.

WELDON HATCH VO/OC
You could see the volume was increasing inside like a small balloon in, in your skin and they were rounded smooth, bright red.  I left it alone.  It was too unique and different to think about experimenting on.  So I didn't put anything on it.

HOST VO
But before long the sores become impossible to ignore.

WELDON HATCH VO
Being in the van or driving I'd have to sit sideways so I wouldn't lean against it.  I couldn't lay on my back.  I had to sleep on my side or my stomach because if you laid on your back you put too much weight and instantly pushed on them and it was very uncomfortable.
 

HOST VO
Four weeks after he first noticed the sores Weldon finally seeks medical attention.  Weldon's doctor tells him he has a bacterial infection and prescribes a two week course of antibiotics.

WELDON HATCH VO/OC
Yeah, that felt a good solution to me and a lot of times a prescription will work better than anything you can do at home so I felt good for it.

HOST VO
But two weeks later Weldon isn't feeling so good.  

 

WELDON HATCH OC/VO
I applied those things twice a day and they didn't do anything.  Being an intelligent doctor she decided it was beyond her scope of treatment and was wanting to refer it someone else that might know more.

HOST VO
Weldon's doctor refers him to a dermatologist in Dallas named Dr. Kent Aftergut

DR. KENT AFTERGUT VO/OC
When we first saw the non-healing sores our first thought that this was most likely something infectious such as atypical mycobacteria or other unusual bacteria.  If you’re not sure what it is or you wanna see what could be causing the problem one easy way to do it is to take a piece of the skin what we call a skin biopsy.

 
HOST VO
Dr. Clay Cockerell runs a dermatologic pathology lab in Dallas.  When he tests Weldon's skin sample he sees something odd.

DR. CLAY COCKERELL VO/OC
You see these cells that are very pale and they contain these little small round structures and then tend to line up around the periphery of these cells in almost kind of like a Ferris wheel.

HOST VO
The Ferris wheel shape is the trademark of a deadly flesh eating parasite.
 
MUSCI OUT
 
MUSIC IN
 
MUSIC SEGUE

HOST VO
Dallas, Texas.  Pathologist Dr. Clay Cockerell has found something unusual in Weldon Hatch's skin sample.  The Ferris wheel shaped cells are a sign that Weldon's skin is home to a flesh eating parasite.

DR. CLAY COCKERELL OC/VO
We were able to tell by looking at it that it was characteristic of leishmaniasis.

HOST VO
Leishmaniasis is a single celled protozoan parasite which attacks the skin.  It causes terrible sores that the body finds almost impossible to heal.  if the sores get infected the victim can die.

DAN RISKIN VO/OC
The leishmaniasis parasite is extremely successful because it can feed off of a whole bunch of different kinds of animals.  In fact, all it needs is something with skin.
 
HOST VO
Dr. Aftergut calls Weldon with the diagnosis.

WELDON HATCH OC/VO
Well, he called me up and just said we think it's this parasite and we're gonna determine how to treat it.  There was some anxiety to a little degree.
 

HOST VO
But the successful diagnosis creates another mystery.  More than 90 percent of the world's cases of leishmaniasis occur in the Middle East and Asia.  The remaining ten percent are in Latin America ranging from northern Argentina to northern Mexico.  So how did a man from the middle of Texas suddenly get this tropical skin parasite?

WELDON HATCH VO/OC
Well, one of the first questions that Dr. Aftergut had was had I been out of the country because it's not a common thing here so how did I get it?

HOST VO
But Weldon hasn't left the country in over 30 years. With no evidence of Weldon having traveled the doctors arrive at a chilling conclusion.

DR. KENT AFTERGUT VO/OC
So once we really talked to him a second time we became convinced that he had gotten it in the Dallas/ Fort Worth area.  We were very surprised and a little bit alarmed.  Clearly what we understood previously about leishmaniasis and where it was endemic may no longer be true. 

 HOST VO
Could a deadly flesh eating parasite be lurking just outside Dallas, Texas?  A city of six million people.

 
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HOST VO
Dr. Aftergut decides to raise his concerns at a conference of local dermatologists.

DR. KENT AFTERGUT VO/OC
Our patient was a very interesting case and I wanted to bring him to see if there were other cases.  And Dr. Cockerell was at that meeting and Dr. Cockerell said maybe we've seen a couple.  

HOST VO
Weldon's is not an isolated case.  Are the doctors looking at an outbreak?  

DR. CLAY COCKERELL VO/OC
We started calling out all the cases we've seen over the last few years.  It made us think that we really had something that was important.
 
HOST VO
The doctors put together a research team to discover if leishmaniasis is now endemic to northern Texas.  After extensive research the team uncovers 29 new cases of leishmaniasis in the north Texas area.  

DR. KENT AFTERGUT VO/OC
We contacted each patient and basically spoke with him and determined what exactly was their travel history and if they'd left the area.

HOST VO
To their amazement they discovered that nine of the victims like Weldon have never left the state.  Searching for a link the scientists plot each new case on a map.  

DR. KENT AFTERGUT VO/OC
Was it urban areas?  Was it suburban areas?  Was it people near a river, near a lake?   All those things we looked at.

DR. CLAY COCKERELL VO/OC
The only connection is where they really lived in this same general geographic area.  

HOST VO
The doctors' suspicions are confirmed.  The leishmaniasis parasite is loose in north Texas.
 
HOST VO
One man thinks he knows how the parasite is spreading.   Dr. Russell Raymond is an expert in leishmaniasis.

DR. RUSSELL RAYMOND OC
Rodents are a common reservoir of leishmaniasis in other parts of the world.  So, it's a natural place to start looking.
 
HOST VO
Dr. Raymond heads out into the countryside to trap wood rats.  

DR. RAYMOND RUSSELL VO/OC
This looks like a good place to put the traps.  You can see that the rodents have obviously been active in this area from eating on the cactus.  

HOST VO
Having chosen the spot he sets the traps and returns later to see what he's got. Dr. Raymond coaxes the rat into a mess cove to keep it still.  Using a skin punch he takes a tiny sample of the rat's ear.  With the skin sample in hand Dr. Raymond releases the rat.  
 

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HOST VO
Back in the lab Dr. Raymond prepares the skin samples.

DR. RUSSELL RAYMOND VO/OC
Here's that little piece of tissue biopsy that we took from the rodent's ear out in the field.

HOST VO
This test called a PCR will show if there is leishmaniasis DNA in the wood rat's skin sample.  

 

DR. RUSSELL RAYMOND VO/OC
Got the results.  Let's see if our rat was infected.  In this white band shows us an infected wood rat.

HOST VO
The test proved that the leishmaniasis parasite is being carried by wood rats but a piece of the puzzle is till missing.

DR. RUSSELL RAYMOND VO/OC
Now the wood rat doesn't transmit the parasite directly to humans.  There's an intermediate at play here and insects are very common transmitters of disease.

 
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HOST VO
But which insect is responsible for spreading the parasite?
 
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HOST VO
In Texas, Dr. Russell Raymond is on the trail of an insect that's transmitting the flesh eating parasite leishmaniasis.  He starts by making a house call at the den of a wood rat.  Dr. Raymond puts two traps into the den.  He hopes to snare the insects that are cohabitating with the wood rat.

DR. RUSSELL RAYMOND VO
What we'll do is place it in the nest opening so that when the insects come out they have to enter the trap.
 
HOST VO
In the lab Dr. Raymond examines his catch, a tiny insect known as the sand fly.  Sand flies are critical to the life of this parasite.  If the insect is infected the parasite will show up in the sand fly's mid gut.  

DR. RUSSELL RAYMOND OC
Okay and she is infected.  
 
HOST VO
The parasite multiplies in the mid gut of a sand fly.  When the fly bites a human the parasite enters the blood.  White blood cells attack the intruders but the parasite fights back and hijacks the white blood cells.  The parasite multiplies inside the white blood cells then bursts out and attacks the surrounding skin cells.  When a sand fly bites an infected human the cycle starts all over again.  

DAN RISKIN VO/OC
The sand fly is a key element for any outbreak of leishmaniasis.  A sand fly is about a third the size of a mosquito and it's extremely aggressive.  It will feed off of dogs, cows, horses, it doesn't care.  
 
DR. RUSSELL RAYMOND VO/OC
In Texas, humans become infected when they get in to that transmission cycle and the infected fly bites the human instead of another rat.
 
HOST VO
This is exactly how Weldon Hatch got leishmaniasis.  Weldon has now had the lesions on his back for over two months.  The best treatment is to surgically remove them.  In his office Dr. Aftergut cuts the lesions off Weldon's back.  

DR. KENT AFTERGUT VO/OC
We gave him an oral mediation called fluconazole that has been shown to have some activity against leishmaniasis just to be sure this wasn't gonna come back.  

HOST VO
The other eight patients in Texas were treated with drugs and underwent surgery.  They have all recovered.
 
HOST VO
Now that doctors in north Texas are aware of the leishmaniasis threat they can be on the lookout.

DR. KENT AFTERGUT VO/OC
It is something that patients and doctors need to be aware of.  When they see a non-healing sore it's important they consider leishmaniasis as part of the diagnosis.

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HOST VO
The best way to avoid sand fly bites is to use insect repellent and cover up at dusk and at dawn.

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HOST VO
Today, despite the risks involved Weldon Hatch is determined to continue the work that he loves.

WELDON HATCH VO/OC
Well, I'm out and about still.  I'm not gonna stay in the house.  So if I went in an area that had this fly I could go into it again and get stung again.  It's something to think about so you keep your insect spray handy.  
 
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DAN RISKIN VO/OC
12 million people in the world have leishmaniasis and every year one and a half million new people will get the disease. The leishmaniasis parasite is so good at infecting people because it’s picked a great way of getting to them and that's the sand fly.  Anytime you see an increase in the population of sand flies in an area...
 
 
 
DAN RISKIN OC
...you're going to get an increase in the number of leishmaniasis outbreaks.  

HOST VO
By sweeping through a human population leishmaniasis is only doing what all parasites are biologically driven to do:  reproduce and spread from host to host.

DAN RISKIN VO/OC
Whether it's by hitching a ride on an insect or moving through the water the ultimate goal of any parasite is to get to more hosts.  So while a parasitic outbreak is bad news for humans, it's a mark of how successful and how cunning the parasites are.
 
HOST VO
For more disgusting parasites and their stomach-churning habits, visit our website.  AnimalPlanet.com/monstersinsideme.  
 
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HOST VO
The night sweats and weight loss are consistent with the onset of AIDS.

DANNY BABB VO/OC
I mean these are universally known to be beginning of AIDS, full blown AIDS they call it when it actually starts, starts taking over the body.
 
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DANNY BABB OC/VO
I got razor blades.  Tried to shave him and this kind of thing and while I was just getting ready to shave him he set straight up, breathed his last, and then expired backwards.
 
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HOST VO
At first Gilson assumes a flu is going around and administers drugs to slow down the rate of diarrhea.
 
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HOST VO
Soon Gilson and head nurse Mary Busalogi are overwhelmed.

MARY BUSALOGI VO/OC
We were just, you know, grabbing at straws and trying to, to help and using experiences from other providers and other, other patients and just really winging it.  
 
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HOST VO
While the city's health commissioner tries to get a handle on what's going on in Milwaukee, Dr. Gilson's patients are getting sicker by the minute.  

DR. IAN GILSON VO/OC
Emotionally it was difficult because we're healers.  That's what we do and if you can't heal it's very frustrating and it's just the way these people were suffering was just almost beyond belief.  

MARY BUSALOGI VO/OC
I've been a nurse for, for more than 30 years and I still to this day have never experienced the helplessness and the feeling that I could not alleviate people's suffering in any way.  
 
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HOST VO
With each passing day the mass hysteria grows and hospitals all around the city overflow with new cases.  

DR. IAN GILSON VO/OC
We were starting to be overwhelmed.  Case after case was showing up.  People were really sick and we were scrambling to figure out what to do for them.

MARY BUSALOGI VO/OC
There was a lot of, a lot of fear and a lot of people wanting reassurance, wanting to, to know what can I do, what can I take, how do I know when will symptoms start.
 
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PAUL NANNIS VO/OC
There were less people in school.  There were less people in restaurants.  There were less people on the street.  Clearly there were less people at work.
 
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DAN RISKIN VO/OC
If you're immunal compromised it could be deadly.  Even though you might only ingest a few protozoans they can reproduce inside your gut so that eventually you're fighting an army of thousands of parasites.

 
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HOST VO
When Milwaukee's south side water filtration system is working correctly the water from the Milwaukee river enters an intake pipe at the treatment plant.  There the plant's cleaning system extracts unwanted debris from the water.  The clean water is then distributed through the city's pipes to the general public.  But Milwaukee's water filtration system is outdated.

PAUL NANNIS VO/OC
There have been improvements made to water plants around the country that hadn't been made in Milwaukee.  Again, this is not to cast blame.  We were producing great water for years and years and years but once we realized we actually had an agent of infection that breeched the water system there was significant upgrades made to the plant to be the most modern and efficient plant that we can, that we can have.
 
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HOST VO
But there's one feature of cryptosporidium that might explain its mysterious disappearance.  

PAUL NANNIS OC/VO
What we learned is that cryptosporidium flows in a bit of a mass through the water.  It, it flows in a bit of a clump.  

HOST VO
The cloud of cryptosporidium then floats down the river and enters the water intake pipe.  Without the proper chemicals to kill them the parasites are then distributed in the water to people's homes.  

PAUL NANNIS OC/VO
So we thought that it was likely that that mass of cryptosporidium that was pulled in from the intake pipe went through the water system and was dispersed to city residents.  It was pretty much gone. 


HOST VO
The city health department blames the outbreak on an isolated incident but as a precaution orders to boil water before drinking.

 
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DR. CLAY COCKERELL VO/OC
When you're diagnosing things under the microscope you kind of start noticing trends and say, you know, we saw a case of this maybe three or four months ago and then we saw another one and we, we got nine cases at that point.  We said, you know, maybe this is something we need to kind of look at a little bit more carefully.
 
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