I have a fringe benefit most people only experience in their dreams.  My best friend, my across-the-street neighbor, my antiquing buddy, and beer drinking philosopher is also my PHYSICIAN.  As a parasitologist AND physiologist, I  often go off with him on some antiquing soiree only to end up discussing the intricacies of the renin-angiotensin reflex or some exotic case of parasitism.  I can never top him with one of my experiences, for he can routinely come back with an equally absurd happenstance. 

    He has doctored in Alabama, Virginia, and most recently in Pennsylvania.  He related to me an account of a Vietnamese immigrant who was being treated unsuccessfully for tuberculosis even though he didn’t prove positive in a tuberculin test.  He noticed that the immigrant had a brown-flecked sputum and realizing his country of origin, decided to look further.  In Southeast Asia, a delicacy is a dish called “drunken crab” which is marinated, but still raw crab, having been soaked overnight in wine.  The marination does not kill any parasites the crab may contain and is a significant epidemiological factor in the spread of Paragonomiasis.  The infectious organism is Paragonimus westermani though today, taxonomic splitters have created numerous other species.  A microscopic examination of the Vietnamese patient’s sputum revealed the presence of  egg capsules, recognizable as that of Paragonimus.  The patient survived.

     Another case involved preliminary lab tests preceding a multiple cardiac bypass.  The results included an unusually high level of eosinophils in the bloodstream.  As brilliant as thoracic surgeons are with their eye/hand mastery of dexterity, they often have left their diagnostics skills back in medical school.  In their concern for this unusual hematological find, they went back to their textbooks to look for a cause wanting to make sure they crossed all their T’s and dotted their I’s before surgery.  Look up eosinophilia and one diagnosis will suggest eosinophilic leukemia.  Look a little further and the reader will realize that eosinophilic leukemia is rare but eosinophilia is more commonly associated with a helminth infections.  Common causes include trichinosis, schistosomiasis, and strongyloidiasis.  My physician friend looked beyond the remote eosinophilic leukemia and requested a stool examination.  The lab tech immediately recognized egg capsules and  larvae which proved to be of Strongyloides stercoralis.  As an afterthought, the docs realized the patient had intermittent colitis for which a cause had never been identified.  Strongyloidiasis is often difficult to diagnose.  Case solved……and the bypass surgery was successful as well. 

    The most unbelievable of his experiences however, involved a sewer worker in Virginia.  This particular worker went to the emergency room with a severe case of shortness of breath and pneumonia-like symptoms.  After a chest X-ray followed up by blood tests ruled out pneumonia, my physician friend looked further and diagnosed (correctly) a case of leptospirosis.  This is caused by a bacterium which is tangential to my expertise and this website’s direction, but I thought this factual account was compelling enough to include.   Leptospirosis is a rodent parasite which occasionally infects humans exposed to rat urine.  The trencherman in question and his co-workers followed a daily routine at lunch.  After leaving the ditch, they would go to a nearby picnic table, unwrap their lunches, and then proceed across the street to a soda machine to get a drink.  When they returned, the workman in this case, discovered a rat was about to begin munching on his sandwich.  He ran to the picnic table and startled the rat which proceeded to urinate on his sandwich.  Hungry as he was, and accustomed to less than sanitary lunchroom facilities, he cut away the part of the sandwich he thought the rat urinated on.  Apparently, his dissection of the sandwich was incomplete.