Review: The Perfect Predator

 The Perfect Predator is a memoir of the author's successful attempt to shepherd her husband through a horrifying encounter with a multi-resistant bacteria. What comes through in the book is that both the author and her husband are adventurous in ways that make you wonder how they survived this long:

The few mosquito bites on the back of my thigh had started out as minor irritations. Several weeks later they were infected masses the size of golf balls, then baseballs. I kept telling the doctor that whatever it was, it was eating me. I could feel it feeding, especially at night. Occasionally, it hit a nerve and my leg would jump like a marionette being manipulated by a sadistic puppeteer. At such times, I would slap at my bulging thigh and the thing would lie dormant for a little while. The doctor thought I was nuts at first, but when a one-inch pupae with three double rows of epidermal spines suddenly emerged while I was on the examining table, he was stunned. Turns out I had been afflicted with an infestation of Dermatobium hominis, a botfly that ingeniously captures mosquitoes and lay its eggs on their underbelly. When the mosquito bites its host, the newly hatched botfly larvae crawl into the wound, feed on their host’s flesh, and then pupate. Yum (Page 241)

I expected the encounter with multi-drug resistant bacteria to be in some exotic location, and in fact, the Thomas Patterson first ends up in the hospital in Egypt. There, his wife Steffanie discovers that there's a pseudo cyst that's been in his body for goodness knows how long that's finally caused gastronomic distress. He goes from bad to worse and is medically evacuated first to Frankfurt, and then back to San Diego.

There's never a definitive answer as to where he picked up the multi-drug resistant bacteria, but the suspicion was clearly raised that it was likely to be in the Egyptian clinic where he was first diagnosed. What follows is an exercise in understanding what it takes to gain access to these phage therapies. First, you'd have to be capable of reading and searching through research papers. Secondarily, you have to be well known enough (Strathdee is an epidemiologist and is well known to the UCSD hospital system) that when you send e-mail to researchers and various approval agencies for compassionate use of a previously untested drug, the response is quick and in the affirmative. Then you have to get lucky. There were several places in the narrative where Patterson was declining and the doctors had to make a decision as to whether to proceed with phage therapy or to stop it. The decision to stop would have been fatal.

Phage therapy is pretty cool stuff, but it's definitely not a panacea --- the author describes having multiple teams at work searching for viruses that could infect and defeat the drug resistant bacteria. 2 teams came up with two cocktails of 4 phages each, that were then IV'd into the patient's body in various places. But the bacteria eventually became resistant to both cocktails of phages, resulting in another search for more viruses that could do the job. What finally finished it off was a combination of another set of phages along with an antibiotic (in becoming resistant to the first batch of phages the bacteria had lost some of its protection from antibiotics). The recovery still took years. You don't walk out of a 9-month stay in the ICU without consequences, but the authors eventually went back to their risk-taking lifestyle.

The book highlights how bad the post-antibiotic era is going to be. You're probably not socially connected to one of the best medical research centers in the world and get this type of treatment:

A post-antibiotic era. That’s how some of the world’s top health officials, including former CDC director Tom Frieden, describe the global threat of antimicrobial resistance (AMR). By 2050, one person could die from a superbug infection every three seconds each year, making AMR a more immediate threat to humankind than climate change (page 304)

There are many lessons in this book --- first about how important it is to have someone advocating on your behalf when you're in dire straits in a medical system. Second, I thought that medically affiliated people would be inclined to take less risks in travel. Clearly I'm wrong! Lastly, antibiotic resistant is a big deal. The author admitted to bringing cipro while travelling, and at the end admits that she was contributing to being part of the problem. 

The book is compelling, if harrowing reading. Well worth your time.