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It’s March, 1957. You travel to a remote island region to study a strange disease affecting the indigenous people. The people are hunters and farmers without written language or any modern technology. Despite being vicious warriors, they are extremely friendly and want your help. They believe they are being killed by sorcery. Healthy individuals will suddenly develop a strange walk, followed by slurred speech, facial ticks, and uncontrolled fits of laughter. You notice, however, that while they lack the physical ability to control their speech, they remain intelligent and coherent.
Within only 3 months, they will become completely incapacitated, unable to move or eat. In a cruel twist, however, they remain conscious, and, sadly, fully aware of their own suffering. Most die of starvation or dehydration due to the inability to swallow. Some face a possibly more merciful, early death from secondary infections, such as pneumonia (due to inability to cough). Once the first symptoms occur, death is certain, with 100% dying in 3-6 months. Treating the symptoms and secondary infections only prolongs patient suffering.
You decide that you must discover the cause of the disease, and quickly, as one person in the tribe dies every three days, and the illness appears to be spreading, especially among children. You plan to do research and report your findings at an international conference. You have 2 years to gather as much information as you can before then.
Your group is made up of well-trained physicians. Here are the additional observations you have made:
The disease is specific to a tribe of ~12,000 people that live in several distinct villages. The tribe is socially isolated from neighbors with little inter-tribe marriage.
Despite occasional violent and non-violent contact, neighboring tribes are not affected – nor have any medical workers become ill, thus the disease does not appear to be airborne.
Every village within the tribe is affected with an annual death rate of about 1% and increasing annually. Despite being in every village, the disease appears to affect specific families; some families are completely unaffected while others have multiple members who are sick.
The disease almost exclusively affects women and children. In most families where one woman is sick, other women of the same family and their children eventually develop the disease. This fact has strained relations between men and women in the tribe; the women believe the men are attacking the women and their children with sorcery. Men suspected of being sorcerers are being murdered by men who have lost their wives.
As physicians, you know that all infectious diseases cause an immune response, typically in the form of inflammation, however, when you examine the sick, no inflammation is present. In fact, no evidence of any immune response whatsoever can be found, but without an autopsy you can’t be certain.
The disease does not respond to any common drug treatments you try, including antibiotics, steroids, and vitamin treatments.
- Performing extensive autopsies and recruiting a neuropathologist
- As physicians, you are trained sufficiently to do a complete autopsy, but it will take time to gain the trust of the people enough for them to allow you to take an entire body. Additionally, you will want to recruit a neuropathologist to carefully examine the brain samples, but all this will take some time. It will take 6 months to do the work and get all the results. Do you want to do a full autopsy and recruit a neuropathologist?
- Recruiting a group of epidemiologists
- If you would like to know more about what the people of this tribe are eating and drinking relative to other neighboring tribes who are not sick, then you will need to recruit a group of epidemiologists to do an exhaustive study and allow them to investigate. This study will take 1 year. Do you want to recruit a group of epidemiologists?
- Recruiting a microbiologist
- If you want to test food, water, and bodily fluid samples to try to identify and culture any infectious organisms which might be present, then you will need to recruit a microbiologist and allow him/her to investigate. This study will take 6 months. Do you want to recruit a microbiologist?
- Attempting to infect common laboratory animals
- If you think the disease may be infectious, then you can quickly set up a small laboratory and keep some small mammals to do animal testing. Setting up the lab is quick, but it may take time for the animals to develop any symptoms. You feel you can be adequately set up to test mice, rats, guinea pigs, and rabbits. It will take 6 months to see any results. Do you want to attempt to infect laboratory animals?
You have 24 months to collect data. Decide on which tests you want to perform (choose these one at a time because some new options could come up, based on the tests you choose). Once you have decided, visit the Google Form link https://forms.gle/35QqcMn952VujPGF8 (Links to an external site.) to get your results for each test.
Report: Submit a 1.5 page response on the case. Explain the difference between infectious, genetically inherited, and environmentally caused diseases. Describe whether you think this particular disease is infectious, genetically inherited, or environmentally caused. Describe your thoughts about the case, discuss anything that struck you as odd or something to look into further, analyze the tests you performed, and provide insights on what you think is happening.
Format: 1.5 page response (double-spaced, 12 pt font, 1″ margins). margins). (1 page is the minimum, but if you go over, that’s okay). Your response should be formal and professional (you can use the words “I” and “me”, but keep this as professional as possible). Avoid contractions, cliches, idioms, and formatting errors, and make sure you have correct grammar throughout. See thefile to get an idea of how to organize your report.
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