The mysterious death of an Idaho man from a pneumonia-like illness so perplexed a rookie federal health investigator that he kept his personal notes on the case for 15 years.
Suddenly, a few months ago, those files turned out to be much more than a sentimental keepsake. That’s when Dr. Rick Goodman recognized that details about the death--his first case--matched those in a report describing a respiratory disease that was killing dozens of people in the Southwest.
“It just hit me,” said Goodman, now an editor at the Centers for Disease Control and Prevention. “I’d been staring a case of hantavirus in the face.”
The Idaho man’s death in 1978 is no longer a mystery: It’s the earliest confirmed case in the United States of hantaviral pulmonary syndrome, as the disease is called.
That finding is important because learning the history of a virus helps scientists determine what causes epidemics, said Dr. Gary Simpson, an infectious disease specialist with the New Mexico Department of Health.
After determining what factors lead to epidemics, health departments can develop “sentinels,” or tip-offs, to alert the public when the same conditions arise again--just as they now use in the Southwest to prevent outbreaks of bubonic plague, he said.
But until last summer, researchers were unaware of this form of hantavirus or its ability to attack a victim’s lungs. Hantavirus, in an even rarer form that destroys the kidneys, has been in the United States for years without causing epidemics.
Only recently have scientists learned that the respiratory form may be just as old. No one knows why it has resurfaced so fatally.
Since the outbreak almost a year ago, Goodman has edited more than a dozen reports for the CDC about the rodent-borne hantavirus and the respiratory disease it causes.
It wasn’t until December, while reading about another suspected case, that Goodman linked it to the death he reviewed shortly after joining the CDC’s investigative epidemiology team.
Still nostalgic about his first work assignment and puzzled by the death of an otherwise healthy 24-year-old man, Goodman had kept his personal notes on the case, even as he moved from research to administration as a CDC editor.
“I tore open the filing cabinet, found the notes” and showed them to a colleague, who also was struck by the similarity to hantavirus.
“It was a case of not seeing the tree for the forest,” Goodman said.
After making the connection, Goodman gathered autopsy specimens from state health officials and the University of Utah Hospital, where the man died on Sept. 22, 1978.
Goodman confirmed his suspicions after painstaking laboratory tests showed that the virus--the same strain that struck the Southwest--had killed the man.
On March 11, he talked to the victim’s widow, who is now remarried. She declined to talk with the news media.
Back in 1978, the man’s death had sent Goodman to Montpelier, a small Rocky Mountain town of about 3,000 in southeastern Idaho, near the Wyoming line.
His job was to find out what had killed the young man, an avid sportsman who was a volunteer fireman. Goodman conducted numerous interviews with his widow, hunting buddies and co-workers at a chemical fertilizer plant.
All he found was dead ends. He couldn’t even confirm a local physician’s belief that cases of respiratory disease were increasing.
“We left, basically, without a clear answer as to what caused his death,” Goodman recalled. “It always struck me that we went out there and we didn’t find anything.”
Now he marvels at connecting the cases.
“There are very few instances in medicine where you solve the problem such a distance of time from it,” he said.
Goodman’s discovery is an example of “serendipity in science,” said Victoria Harden, historian at the National Institutes of Health. The apparent luck actually comes after much hard work, when “suddenly it all falls into place when you least expect it,” she said.
A similar happenstance at the CDC came when researchers were investigating another often fatal respiratory illness, Legionnaires disease.
The cause of Legionnaires was discovered in 1976 when CDC scientist Joe McDade connected information he had found in his files to the outbreak in Philadelphia months earlier. Later, the agency eventually linked the disease to earlier cases--just like hantavirus.
Knowing the full history of such a virus--that it can start with just a single case and lead to outbreaks years later--forms the basis for the CDC’s research and prevention efforts, Goodman said.
But for the Idaho man, even knowing the cause of his death would have given physicians little help in curing him. There is still no treatment today for the disease.
Hantaviral pulmonary syndrome is believed to be carried in airborne particles of dried feces or urine from rodents. In the Southwest--and the Idaho case--the carrier is the deer mouse. Researchers are still trying to identify the rodent carrier in cases in Florida, Louisiana, California, and the Northeast. So far, the CDC has confirmed 60 cases.
Early symptoms resemble the flu, but the disease progresses rapidly to breathing difficulties and shock. It is fatal about 60% of the time.
The hantavirus family is named for the Hantaan River in Korea, where the first strain was discovered decades ago. That virus infected about 3,000 American soldiers during the Korean War, killing 190 by destroying their kidneys. The virus itself was not identified until more than 20 years later.
Hantavirus Cases by State
States with hantavirus cases confirmed by the Centers for Disease Control and Prevention. Numbers may differ from those provided by state health departments because some departments list suspected cases. Arizona: 11 Colorado: 5 California: 3 Florida: 1 Idaho: 4 Indiana: 1 Kansas: 2 Louisiana: 1 Montana: 2 New Mexico: 20 Nevada: 3 North Dakota: 2 Oregon: 1 Rhode Island: 1 South Dakota: 3 Texas: 1 Source: Associated Press