The Case of the Fever That Wouldn’t Go Away

Cambridge Health Alliance's Dr. Lou Ann Bruno-Murtha discovered a rare infectious disease, spread by rodents, right here in Massachusetts.

man with thermometer

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Werner was sure he was coming down with the flu. The 73-year-old retiree, who lived with his girlfriend in a five-unit Harvard Square building, first noticed the fever on a Saturday in October 2018—a little early in the year for the virus to emerge, but not unusual. Yet unlike most flu symptoms in healthy adults, which typically improve over time, Werner’s grew more severe, and he felt himself getting weaker. His fever persisted. He didn’t feel like eating. His knees buckled when he tried to walk. Eventually, he couldn’t even rise out of bed. His girlfriend and his primary-care physician both begged him to go to the hospital, but he resisted until he felt so awful he couldn’t hold out any longer. “I finally went to the emergency room,” he says, “where they started trying to identify the problem.”

At first, doctors at CHA Cambridge Hospital searched for a simple explanation. They ordered a chest X-ray to check for pneumonia, and did routine tests to look for common bacterial infections. When the results came back negative, though, they began to wonder: Could it be leukemia? A blood analysis ended that hunch, but did show indications of some type of infection. Meanwhile, Werner continued to decline.

At a loss for what was wrong after days of searching for answers, Werner’s doctors reached out to the only medical detective they could think of who might be able to help: Lou Ann Bruno-Murtha, Cambridge Health Alliance’s division chief of infectious diseases. After taking the case, she immediately began asking questions. “Had Werner traveled anywhere recently?” Not really, he replied, just to Martha’s Vineyard for two days. “Had he encountered any animals?” Actually, he had noticed a lot of rabbits and rats around his Cambridge property—and in fact had disposed of two dead rabbits using a shovel and plastic bags around Labor Day.

As she listened, Bruno-Murtha felt a light bulb go off. Given Werner’s history, combined with his particular symptoms, the doctor began to suspect a severe form of leptospirosis, a rare bacterial infection secreted in rodent and rabbit urine that’s typically found only in developing countries. After all, she thought, Leptospira bacteria survive in soil, and it had been a very rainy season. They could have penetrated through even a small breach in the skin of his hand. On a hunch, she began treating Werner with intravenous antibiotics while she waited for the results of a specialized blood test to come back from the Centers for Disease Control and Prevention. Not long after, the official verdict was in: Werner had contracted Weil’s disease, a deadly strain of leptospirosis, right here in Massachusetts.

Soon after receiving antibiotics, Werner started feeling better, and he ultimately made a full recovery. Bruno-Murtha, meanwhile, is working with the Massachusetts Department of Public Health to get the word out to other clinicians who might be stumped by a similar medical mystery.

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