“The world is full of obvious things which nobody by any chance ever observes.”- Sherlock Holmes.
MRSA, and Rabies, and AIDS OH MY! The taboo of Infectious Disease, the sound of these serious medical conditions can make anyone shudder, but Infectious Disease is a commonly misconceived specialty. When asked what specialty MD I am, I answer “Infectious Disease.” Many people feel scared of the idea and respond, “thankfully, I’m not experiencing any infectious disease.” But, are you sure?
Infectious Disease is when an individual faces infection from infectious agents that can be viruses, microorganisms, bacteria, parasites, fungi, viroids, just to name a few. These agents compromise the host/individuals immune system, the body’s defense system. When the immune system is compromised the individual may suffer and experience multiple infections, illnesses and symptoms.
Individuals with chronic infections and reoccurring infections or conditions, as common as sinusitis infections, staff, prurigo nodularis, pneumonia, bronchitis, are likely under the infectious disease umbrella. I consider myself and ID colleagues as “Medical Detectives.” It is my job to gather all the facts and evidence of each case and identify why. If a person is having chronic sinusitis infections especially after surgery or treatment then I need to find and address the origin, and from there treat the problem. Many times, the chronic infections are not the diagnosis but the symptom or my “clue” to the root diagnosis. For years individuals seek medical help for these infections and find temporary treatment but the infection or another reoccurs. I have taken an excerpt written by a patient of mine that I diagnosed with Primary Immune Deficiency Disease.
“I literally can’t remember a time in my life when I felt well. Since about 4 years of age, my whole life has been spent in an endless cycle of coming down with an infection, being in the middle of an infection, recovering from an infection, and then coming down with another infection (often more than one infection at a time).
My life is a never-ending parade of sinusitis, bronchitis, urinary tract infections, pneumonia, MRSA, mono, cytomegalovirus, the flu – you name it, I’ve had it, and probably several times. Some years, I spent 10 months on antibiotics just to keep the severe infections at bay. In 23 years, I saw over 100 doctors and specialists in an effort to figure out why I was always ill and why I had a myriad of other symptoms like pain, fatigue, constant nausea, GI issues, and why I had to have surgery every couple of years to clear out some type of invasive infection. Despite the countless doctors and specialists, no one had any answers for me. I was misdiagnosed with everything from fibromyalgia to chronic mono. Finally when I was 27 years old, I was sent to an infectious disease specialist, Dr. Andrew Pugliese, because I had a sinus infection for over a year despite constant antibiotics.
My primary care doctor at the time knew something had to be wrong, but didn’t know what. Luckily, Dr. Pugliese knew what tests to run. He tested my blood levels of something called immunoglobulin (what your body produces to fight off infections and make antibodies) and he gave me a pneumonia vaccine to see if I mounted any response at all. The tests came back, and they showed that my immune globulin levels were extremely low, and I did not produce any antibodies to the vaccine. In just two weeks, I had the answer I had been searching for all my life. I was born with a dysfunctional immune system, a condition called Primary Immune Deficiency Disease – if life is a battlefield, I’m simply unarmed. “
The investigation is always ongoing until I properly identify the problem and effectively treat the patient. In this case, I started from the beginning by asking the questions, checking the records, and running all the tests. Every good detective takes every bit of information checks and rechecks even if the answer is seemingly obvious. ‘It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.’- Sherlock Holmes.
The problem lies within the immune system and that is where I start, testing the immunoglobulin levels! If the immunoglobulin levels are very low, then Watson we have an infectious disease! The immunoglobulin is what your body produces to fight off infection and make antibodies. Infectious Disease is an ongoing list of culprits from extremely serious to very common but as the deceive I always get my man!
-The Hound of the Baskervilles, Chapter 3: “The Problem”
-A Scandal in Bohemia