Sometimes, when medical students or young doctors don’t pursue a diagnosis or treatment as aggressively as I feel the situation dictates, I find myself repeating an old mantra. “You’re not scared enough,” I tell them, “You’re not scared enough …yet.” Fear during the practice of medicine is a learned behavior. Take care of patients long enough, and we soon learn that there are some evil diseases out there, waiting silently to raise their ugly heads to leave death, destruction, and disability in their wake.
These are just 10 of my favorites, selected because a) They will either kill you, maim you, or cause such pain that you will wish you were dead; b) They are transmitted in seemingly innocent ways; and c) There is either no cure or, by the time they are diagnosed, it’s too late.
So, these are my nominations for the Top 10 Scariest Diseases. Happy Halloween!
Let’s start by learning a new word: bräŋ-kō-lə-ˈthī-ə-səs. Literally, “lung stones.” Live here in the Delta long enough, and your chest X-ray will develop the tiny, calcified spots of pulmonary histoplasmosis, which local radiologists call “Memphis lung.” Histoplasma is a fungus. The dry spores, when inhaled by healthy individuals, cause little areas of local inflammation, that over time, become calcified.
Occasionally, though, the fungal spores are captured by a lymph node, doing what lymph nodes are supposed to do by mopping up any foreign invaders. This time, though, the spores grow and then calcify within the lymph node and can erode out into the nearest structure. Get a calcified stone into an airway, and you’re coughing up stones, much to the disbelief of an inexperienced ER physician. Have one erode into the giant pulmonary artery and… Well, you get the picture. Life can be tough here in the Delta.
This one starts with a small, painless ulcer on your private parts. After that, it just goes away. Except that it doesn’t. Instead, it goes into hiding and silently morphs through a series of stages during which you may or may not notice a wide range of symptoms. In fact, syphilis has been called “the great imitator” for its potential to affect literally every body system in almost every way imaginable. And the effects are irreversible.
Several years ago, I took care of an older gentleman who sat at the foot of his hospital bed and barked loudly at anyone who dared enter his room. Yes, “barked.” Like a dog. He even growled if anyone attempted to get too close, but he was friendly if you gave him food. We performed a lumbar puncture (spinal tap) and diagnosed neurosyphilis. I don’t want it.
Straight from the Old Testament comes one of the most ancient of curses, Hansen’s disease or Leprosy. The unique Mycobacteria prefers body parts cooler than the rest, so faces, noses, fingers, and feet are all at risk for nerve damage and auto-amputation. Yup, your things just kind of, uh, rot off. More common in places like India or Brazil, some studies suggest that Leprosy might be grossly under-reported. That’s a problem since the disease is probably spread by coughing or sneezing.
Oh, and you’d better leave those poor armadillos alone. Contact with the adorable, armored handbags has been reported in some infections.
Here’s a trade secret: tetanus is caused by an organism found in the soil that only grows without oxygen. So, when you step on an old rusty nail sticking up from the ground, it’s not the rust that we’re concerned with. Instead, it’s the inoculation of the soil bacteria deep into your foot where it can multiply. And when it does? Tetanus causes intensely painful spasms of the muscles, from paralysis of the chewing muscles (“lockjaw”) to the torturous backward arching of the head, neck, and spine known as opisthotonus.
As horrible as it is, tetanus is preventable with a booster vaccination at least every ten years. This is why, even though you cut yourself with that nice, shiny kitchen knife, we use it as an opportunity to ask if you’re up-to-date on your tetanus shot. No rust required.
Honestly, I titled this one “Ebola” just to get your attention, but I don’t find Ebola particularly scary, mainly because I don’t intend to visit the jungles of the Congo anytime soon. The group of diseases known as “hemorrhagic fevers,” however, also includes Dengue, known throughout the Caribbean as “break-bone” fever. The Dengue virus is transmitted by mosquitos, and symptoms range from the typical fever, headache, joint pain, and rash to bone marrow collapse, shock, and copious bleeding from all the usual places.
Not scared yet? How about this: the severity of symptoms appears to depend on which one of the four Dengue virus types you’ve been infected with. Get lucky while visiting the Caribbean and grab one of the “good” serotypes. You’ll probably recover (I did). Vacation next time in Mexico and get a second, different serotype? Some experts predict that you’re more likely to convert to hemorrhagic symptoms. No mas, gracias.
Here’s a great idea: let’s pretty much eliminate from the entire planet a deadly disease that is ridiculously easy to spread and likely responsible, at least in part, for the near-total extermination of America’s indigenous peoples. But let’s keep a couple of test tubes full of the causative virus in the ‘fridge…just in case. “Just in case” of what? In case some Napoleonic dictator needs to eliminate entire nations?
All the pox viruses appear to be spread by respiratory droplets and can cause fever, headache, and pustules. Smallpox adds the risk of blindness, pneumonia, brain infections, and -ahem- painful inflammation of one’s “man parts.” We should clean out the refrigerator.
Move over Atticus Finch, rabies is no longer the exclusive purview of southern gothic. The viral infection, carried in the saliva of diseased animals, gives you a little time to consider getting treated just before the painful throat spasms make even the thought of drinking any water truly terrifying, and you start attacking and biting your neighbors. And, while we still see rabies in some wild species like bats, raccoons, skunks, and foxes here in the States, the greatest risks fall to big-hearted overseas travelers who can’t resist reaching out to help that sickly puppy.
Read Stephen King’s “Cujo.” It will all become clear.
#3. Mad Cow Disease
I am not permitted to donate blood here in the United States. “Why,” you ask? Because in 1993-94, there was an outbreak of bovine spongiform encephalitis, or “Mad Cow Disease,” while I was working in the United Kingdom. This little treat is thought to be spread by tiny protein particles called “prions” that are mostly found in the brain and nervous tissue of infected animals. And, since hamburger or ground beef contains all sorts of unknown cow parts, including nerves and pieces of the spinal cord, the advice at the time was not to eat any. And, on the last day of my last rotation, there in jolly, jolly England, I unthinkingly celebrated by eating shepherd’s pie full of a flavorful ground cow.
Wish me luck. Spongiform encephalitis may not show up for years. When it does, your brain turns into a giant, mushy Swiss cheese. No moooooo hamburger, please.
#2. Flesh-eating Bacteria
Imagine that you have a pimple on your shoulder—nothing serious, nothing unusual. Maybe you squeeze it and notice that it’s a little more tender than you’d expect, but no biggee. In a few hours, though, there’s some surrounding redness and heat. Gee, maybe you shouldn’t have squeezed it after all. Gosh, it’s getting bigger. And darker. And seems to be spreading down your back.
Better get to a doctor, but it may be too late! Necrotizing fasciitis is a poorly-understood infection that features two or more types of bacteria working in synergy to rapidly eat through skin and muscle. Treatment requires life-saving fluids, IV antibiotics, and aggressive surgery that can leave patients disfigured and disabled.
It’s only a pimple…
#1. Brain-eating amoeba
I snorted plain tap water at night to clean my tortured sinuses of all this Memphis pollen. Until, that is, the first reports of infection by Naegleria fowleri. Members of the amoeba (plural, amoebae) family, these microscopic creatures are found in shallow southern lakes, hot springs, and now even-gulp residential water supplies. Be prepared if you take a fall while water skiing or stir up some silt from the bottom of a relaxing spring. Once up into the nose and sinuses, Naegleria finds its way across the complex defenses that protect the brain and spinal cord, causing inflammation and deadly swelling.
By the time the headaches and fever appear, it’s too late. There is no known treatment.
Well, that’s all for now. There are lots more medical conditions that might be considered scary: infections that rot your eye sockets, reactions to drugs that make your skin slide off, and worm invaders of all types and sizes. Let me know if you’re interested, and perhaps we’ll come up with another list soon. Maybe the “Top 10 Most Bizarre Medical Conditions”? Have a fun and safe Halloween!