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Ward Z; beware of zombies

30/10/2017

 
The patient staggered into the treatment room of A&E, moving slowly and erratically. His eyes were unfocused and he only stopped moving when he reached the wall opposite the door. His anxious wife walked in behind him and took a seat opposite the examination couch.

The Doctor took one look at the patient…
Ophiocordyceps unilateralis zombie fungus
Dr Garner when he's been on duty for the week! Ha Ha Ha
​…and decided that no interaction would be forthcoming from him and as the patient seemed quite safe standing facing the wall, the Doctor decided to get the history from the wife before going any further.
 
“He was fine until we got back from holiday” she said. “We have recently been in South America on a bird watching holiday in the Amazon jungle. We had a great holiday and he was fine whilst we were away but ever since we got home he has been behaving increasingly strangely. He has become more and more zombie-like to the point where all he wants to do now is climb up things. What do you think is wrong with him Doctor?”
 
“Did anything unusual happen whilst you were away? Was anyone else unwell?” the Doctor asked.
 
“No, everyone else was fine. It’s just him.”
 
The Doctor then moved to examine the patient. He turned him round and the patient climbed up onto the examination couch. The Doctor drew the curtain and stripped the patient down to his underwear where he noticed some odd fluffy white patches on the patient’s skin, puzzled the Doctor asked the wife if these were “new”!
 
“Ummm …not really” said the wife.

“When did these first appear?” the Doctor asked.
 
“Oh I noticed smaller ones whilst we were on holiday but I didn’t think much of them, it was very humid, but they do seem to have got bigger since we got back” she replied.
 
The Doctor took a swab from a drawer and carefully collected some of the white material onto the end before sealing it into the transport tube.
 
Leaning forward the Doctor tried to listen to the patient’s heart with his stethoscope but as he leant near, the patient suddenly jerked forward and tried to bite the Doctor. The Doctor leapt back with a yelp and the patient settled down quietly again. The Doctor tried again but again the patient tried to bite the Doctor’s face!
 
“Crikey that’s weird!” thought the Doctor but maintaining his professionalism he just quietly abandoned his examination and went back to talk to the wife.
 
“Well, we will need to run some tests to see if we can work out what is going on. I’m going to admit him for observations and we’ll start those tests straight away”.
 
“But he will be alright Doctor, won’t he?” pleaded the wife.
 
“Let’s get the tests and then we’ll see where we are up to” answered the Doctor in that non-committal way we use when we haven’t got a clue what is going on.
 
The patient was gently coaxed onto a trolley and wheeled off to the ward. Blood tests were organised and an MRI brain scan was ordered. The swab was sent to the microbiology laboratory to see if anything could be seen; the clinical details just said “zombie!”
 
Later that day the Radiologist came running on to the ward to find the Doctor “what the heck is going on!? I’ve never seen anything like this” shrieked the Radiologist …”the brain scan shows multiple filamentous structures branching throughout the brain... the whole brain is riddled with them!!”.
 
“Come see our patient!” said the Doctor. They went back to see the patient who was becoming increasingly agitated. Every time anyone came near he tried to bite them. He kept trying to climb up on his bed or pull on the curtains, always trying to get higher and higher.
 
“What are we going to do?” exclaimed the Doctor.
 
“Call the Microbiologist” answered the Radiologist.
 
Having heard the story, the Microbiologist rushed into the lab and found the swab. Carefully he made two slides of the sample and stained one with Gram’s stain and the other with cotton blue (the stain for fungi).
 
Looking down the microscope the Microbiologist muttered “just as I thought… Zombie fungus!” He ran back to the phone to speak to the Doctor again, “Yes, you heard me. Isolate the patient in the side room. Strict barrier precautions and FFP3 masks. Start antifungals, liposomal Amphotericin B, Caspofungin and Posaconazole… anything you can get your hands on. This is Zombie fungus… you have to act quickly but it may already be too late…It is highly contagious”
 
The treatment was started and the patient was made as comfortable as possible. The Doctors agreed to meet first thing in the morning to see how the patient was doing.
 
“All we can do is wait and hope that in the morning he has started to improve” said the Doctor to the increasingly anxious wife.
 
It was an anxious and sleepless night for all concerned. None of those involved were able to get the image of the patient out of their minds and all kept looking at their own skin for fluffy white lesions. All hoped for the best but expected the worst.
 
The next morning the Doctors arrived on the ward, all looking bleary eyed and bedraggled. The Microbiologist peered cautiously through the window in the patient’s door.
 
“Oh no,” he gasped “we were too late.”
 
All took turns looking in. The patient was stood on his bed with his teeth firmly clamped to the railing of his bedside curtains. He was clearly no longer breathing.
 
The junior Doctor took a double take.
 
“What the heck is that?” he exclaimed. “Those things sticking out from the top of his head; round bulging bits on top of what look like stalks…what are they!?”
 
The Microbiologist took another look. “Oh …yes, that’s the fungus and those round bits are the sporangia full of spores ready to release them into the air…”
 
“RIGHT!” exclaimed the Microbiologist “No one goes in or out of that room until we get a team of experts in with hazmat suits to clear things up. We need to evacuate the rest of the patients off the ward ASAP just in case…your ward is CLOSED with immediate effect”.
 
They sprang in to action, one collecting the “do not enter” door signs while the rest of the team started the evacuation.
 
Suddenly the Microbiologist froze. He had heard a sound that filled him with dread. A soft squeaking sound had broken through his thoughts and then the squeaking had stopped. He knew he was too far away to do anything; his actions would be too late…But he had to try…as if in slow motion he turned around shouting… “Nooooooooooo!”
 
But it was no use; the tea lady had stopped her trolley and was already opening the side-room door calling…“Cup of tea?”
 
There was a gentle pop and a cloud of white fungus spores filled the ward. A look of horror showed on every face… the zombie apocalypse had begun….
 
Okay, okay, so I have an over active imagination but the zombie fungus does exist… it just doesn’t affect humans… yet?! But as it is Halloween I couldn’t resist the temptation to tell you about something really scary and horrifying.
 
There is a species of fungus in the tropical rainforests, especially the Amazon, which really does turn insects into zombies. I know it exists because I have seen it!!! And yes I had many sleepless nights in a hammock afterwards. The best known is called Ophiocordyceps unilateralis or cordyceps fungus for short, but there are many others which cause a similar infection. The main host for Ophiocordyceps unilateralis is the carpenter ant but it can also infect other insects.
Ophiocordyceps unilateralis zombie fungus
fungus attacks the insect by penetrating through its exoskeleton. The insect shows patches of white filamentous fungus on the outside whilst the fungus burrows deeper inside. Various chemicals are secreted by the fungus causing a behavioural change in the insect making it climb up high before it involuntarily locks its jaws on to the plant.
 
Once the insect is locked in place the fungus produces fruiting bodies called sporangia which contain spores. The spores are then released into the air and due to the height the insect achieves in its “zombie” state, the spores can settle out over a wide area, thereby infecting more insects. Needless to say the process kills the insect. Essentially the insect becomes a mindless zombie whose only “thought” is to climb higher and higher until the moment of “puff” and doom is spread onto more unsuspecting insects. Creepy, huh!?
 
Happy Halloween!
​
Picture
Ever tried zombie fingers?

P.S. I’m sure this isn’t the only weird and scary thing out there. Have you come across anything sinister in the bug world that has given you the creeps? Let me know.
Kassidy Fugate
2/11/2017 02:24:38 am

Wow! You really put on a show there at the beginning, it was almost believable! That microbe is extremely hard to top! The craziest microbe I've ever came across was in my last microbiology class we were able to grow Pseudomonas Aeruginosa. This is the microbe that can cause disease in the blood stream and when plating and incubating, it leaves an absolute awful smell if I remember correctly. How exactly did you come across finding this specific fungi?

David
8/11/2017 09:29:27 pm

Hi Kassidy
Pseudomonas aeruginosa is a bit of a pain when it causes infections. You might like to see this earlier blog to see why http://www.microbiologynutsandbolts.co.uk/the-bug-blog/tricked-by-a-competent-bacterium-pseudomonas-aeruginosa.
I came across the fungus in the Manu biosphere in Peru... I'm lucky to be able to go on some amazing holidays...

Virginia Coots
6/11/2017 02:07:19 am

I'm thinking you may have another career with that kind of plot. It's a thought! Anyway, are these types of fungus found anywhere else other than the tropical regions? Is it that they need the moist atmosphere or is it that the insects are more prevalent? As bugs go I'm not a person to get freaked out easily, but just the thought of insects that can inject different viruses into the body makes my skin crawl. The tick, not a scary looking insect by my standards, but think of the damage it can do?!

David
8/11/2017 09:32:30 pm

Hi Virginia
Yep, ticks are pretty creepy, we have to take them off our cats on a fairly regular basis, and there are some great tick borne infections. For me though the scariest bug of them all is the mosquito... microbiologically speaking as they are responsible for so many deaths worldwide... but personally I really don't like cockroaches... it's a long story...
David

Charlie link
6/11/2017 09:16:50 am

Hi Dr Garner.
Been reading your blog for a while now - I'm currently a clinical fellow in Microbiology down in Cornwall, so all very relevant and interesting. This story in particular!
With regards to Cordyceps - which I've found fascinating ever since a highly popular video game called 'The Last of Us' - would I be right in assuming that to infect humans it would require significant changes to any virulence factors in its possession. I'm guessing that it's evolved over thousands of years to parasitise and accurately control it's host organism, and therefore to do so with humans would equally take exposure over many years. Even if it were to somehow affect a human or primate host, would the chemicals used to direct control have any affect in us?

David
8/11/2017 09:36:06 pm

Hi Charlie
Thanks for the comment, glad you like the blog.
I think you're right, it would take a significant amount of time for this fungus to adapt to humans. It would need to change to be able to penetrate skin not an exoskeleton, survive in a warmer host, evade our more complex immune system and then as you say change the chemicals that would control behaviour... I suspect our curtain rails are safe for now :-)
However if you would like to think about a parasite that can change human behaviour have a read about Toxoplasma gondii... I will get around to a blog about this in the future...


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    David Garner
    Consultant Microbiologist
    Surrey, UK

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