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Strange Illnesses

Virus killer: Dr. Royce Johnson is chief infectious disease specialist at Kern Medical Center.

Kern County is a petri dish of cultures, people, and ideas. So naturally, when things in that petri dish start to mingle, you wind up with some interesting specimens.

Alright, alright, so it’s sort of odd to refer to people as specimens, and to call our county a petri dish, but when you’re talkin’ medicine and illness, it just makes sense.

One person who understands that is Dr. Royce Johnson. As the chair for the Department of Medicine and chief infectious disease specialist at Kern Medical Center he has been in a prime position to observe and treat many of the seemingly rare and altogether strange diseases that one might not expect to find in Kern County.

So open your mouth, say “ahh,” and get ready to digest some entertaining and educational information about some of the most prevalent and the most inconspicuous microbes roaming our area. Even some information on infections you thought you knew everything about.

When you think of thrush, you more than likely think of infants. But in fact adults can develop this fungal infection, known as oropharyngeal candidiasis. People with dentures and those who use inhaled corticosteroids are on the at-risk list. It occurs more frequently and more severely in people with weakened immune systems and is very uncommon in otherwise healthy people. Symptoms include painless, white patches in the mouth, redness and soreness of the inside of the mouth, or cracking at the corners of the mouth, known as angular cheilitis.

And while we all know about chicken pox, some of us aren’t as aware of shingles. Shingles is a painful skin rash caused by the varicella zoster virus, the same virus that causes chicken pox. After a person recovers from chicken pox, the virus stays in the body. Sometimes the virus can reappear years later, causing shingles, which usually starts as a rash on one side of the face or body. The rash blisters which scab after a few days. It usually clears within a few weeks. Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. Other symptoms of shingles can include fever, headache, chills, and upset stomach.

More people need to be aware of meningitis. It’s an infection of the fluid of a person’s spinal cord and the fluid that surrounds the brain and is usually caused by a viral or bacterial infection. High fever, headache, and stiff neck are common symptoms of meningitis in anyone over the age of two. Other symptoms may include nausea, vomiting, discomfort looking into bright lights, confusion, and sleepiness.

OK, OK, enough with the lecture, right? This isn’t a medical guide.

So while those might not seem that exotic, remember that infections come in all shapes and sizes, and it’s good to be on guard for any of them—even the ones you think you’d never get...like these bad boys.

“We have a broad range of infectious diseases,” Dr. Johnson explained. “We see lots of people traveling from abroad. Factor that in with where we are geographically [in a valley with farmland near mountains and a coast] and you’re going to see that range.”

While we might be well-versed in Valley Fever here in Bakersfield, Dr. Johnson still says many of his colleagues view this infection, known in the medical world as coccidioidomycosis, as a strange disease. And one that is fairly unique to our area.

“We see hundreds of patients a year with Valley Fever. In fact, Dr. Einstein [our local foremost authority on coccidioidomycosis] calls it ‘our fungus’,” Dr. Johnson laughed. So while not so strange to us, Valley Fever is a fairly uncommon diagnosis in other areas of the world and one that sees a lot of research.

But one disease that really tips the scales as strange is the plague. That’s right—we’re talking bubonic and pneumonic.

An adjunct Professor of Medicine at UCLA, Dr. Johnson relays information on new treatment options and disease patterns to physicians in Southern California.

Wait! you might be thinking. The last time you checked, we are not living 1340s Europe. True, but believe it or not, in the 30-plus years that Dr. Johnson has been working in Kern County, he has seen six or seven cases of plague. Relatively speaking, though, that’s not many. New Mexico sees many more cases than we do as human plague in the U.S. occurs in mostly scattered, rural areas with an average of 10 to 20 persons each year. In bubonic plague, the bacteria (commonly spread through fleas) causes the lymph glands to swell, called buboes, and can lead to pneumonic plague if the bacteria spreads to the lungs. Pneumonic plague affects the respiratory system and is contracted through airborne transmission (coughing, etc.).

“And it’s important to note that these cases of plague were endemic [the infection was contracted here].” It wasn’t brought into the county, nor did it spread. Rather, each case has been isolated.

“The last case I saw was over 20 years ago, and the gentleman who had it had been digging through garbage.”

Hear that? As long as you don’t make it a habit of digging through refuse, and you don’t have a flea for a best friend, it’s safe to say you should be plague-free.

Another strange illness that the general public seems to think is long gone is leprosy, but Dr. Johnson still treats a small number of patients each week with this illness [known also as Hansen’s disease]. The condition itself is a chronic disorder caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Leprosy primarily affects the peripheral nerves and mucosa of the upper respiratory tract, but most people recognize it by the lesions appearing on the skin of those affected.

“However, it’s not spreading,” he warned. “We’ve been treating the same patients each week and helping them manage this complicated disease. But have seen no new cases due to spreading.”

So while leprosy and the plague sure can make one wary, Dr. Johnson says he hears the most incredulous responses after people hear we still have tuberculosis (TB) cases showing up!

“I still hear the public ask ‘What? We still have that?’ But while it’s an ongoing problem, TB does not even rank in the top 20 causes of American [illness].”

Cysticerosis is even farther down on that list than TB, but we still see a number of cases here. Never mind the recent outbreak of Swine Flu, this tapeworm carried by pigs has a worse reputation.

“The main manifestation of cysticerosis is seizure,” Dr. Johnson explained. And humans get infected by eating the undercooked meat of a pig harboring the parasite (called Taenia solium) and its eggs or larvae. They travel to the brain and affect the nervous system of its host.

Then there’s brucellosis. Various brucella species affect sheep, goats, cattle, deer, elk, pigs, dogs, and several other animals. Humans become infected by coming in contact with animals or animal products that are contaminated with these bacteria, like unpasteurized cheese or milk.

Brucellosis can cause a range of symptoms that are similar to the flu and may include fever, sweats, headaches, back pains, and physical weakness. Severe infections of the central nervous systems or lining of the heart may occur.

“Brucellosis was common until the 1950s,” Dr. Johnson said, “but I’ll still see cases. Perhaps one a year.”

OK, one a year is nothing, right? With only around 100 cases diagnosed throughout the entire U.S. annually, it’s a fairly rare disease.

Now, before you decide to panic, remember that these are very isolated cases and many of them are in the more rural sections of the county...let’s not forget, one of our prime sources of income: agriculture. So it really shouldn’t come as that much of a shock that a majority of the illnesses infectious disease physicians like Dr. Johnson see spawn from contamination out on the farm.

But how do you tell the difference between a common flu and something that could be worse? What makes one fever different from the other? And should we all be worrying about catching diseases like listeria, malaria, or typhoid fever? The answer: no. Even if those exotic diseases have found their way to our city.

“But we can’t always diagnose everything,” Dr. Johnson said. “Many infections present alike. You get inflammation which leads to a fever, muscle ache, and headache.” Most people don’t know how to discern the difference and the body fights the infection alone. Thankfully, when we do encounter something presenting as more than your average flu, we have someone with an extensive background in infectious disease to recognize these microbes when they arrive.

“There was an employee at KMC who once fell ill after the big dust storm of 1977 in Kern County. She had recently been out of the country,” Dr. Johnson recalled.

“We thought she might have Ebola. Her temperature was as high as 106 degrees at one point. I got a hold of Carl Johnson [an internationally-known virologist who, at one point, worked for the Center for Disease Control] and told him, ‘I’m pretty sure it’s not Lassa Fever [another hemorrhagic virus].’

He said, ‘How do you know?’

Well, I told him I was going through the exact chapter he wrote on Lassa in his book.

Right away he said, ‘Oh, well...I’m revising that.’ ”

But Dr. Johnson was certainly ready to combat the invisible foe. And he remains so today, fighting for immune systems in our area.

Additional source: cdc.gov

Article appeared in our 26-2 Issue - June 2009