Bacterial Bug Tests Scores of Triathletes

The fever started on Sunday, July 5, exactly two weeks to the day after she competed in the Springfield, Ill., Ironhorse triathlon.

Like many seasoned athletes who compete in these grueling events--actually three events in a single competition: a swim, a bike ride and a run--she dismissed the idea that she was getting sick. But the symptoms grew progressively worse over the next 72 hours, with muscle aches, fatigue, a pounding headache and the shakes.

“I called a friend at work, and that’s the last thing I remember” before waking up in a hospital with an intravenous line dripping into her arm. “He came to my apartment, found me lying on the floor drenched in sweat and carried me to the emergency room,” she said.

Christine, 33, a physical therapist from Holland, Pa., who asked that her last name not be used, is one of more than 1,800 athletes from 44 states being sought this week by “disease detectives” from the federal Centers for Disease Control and Prevention in collaboration with state and local health officials.

They fear that hundreds of triathletes who participated in one or both of two events, held June 21 in Springfield and July 5 in Madison, Wis., were sickened after exposure to Leptospira, a bacterium rare until now in the United States. They want to make sure the athletes are receiving proper treatment.

The illnesses provide another illustration of the growing danger posed by infectious disease organisms around the country stemming in part from the practices of modern-day society.

“We always seem to forget that infections are out there, that we are vulnerable and that they can cause us problems,” said Dr. John La Montagne, deputy director of the National Institute of Allergy and Infectious Diseases. “Our only hope is to stay one step ahead of them.”

Many Americans think of infectious diseases as primarily a problem in the Third World. But the rate of fatal infections in the U.S. population has actually increased by more than half since 1980, after decades of steady declines, according to the CDC.

From 1980 to 1992, the most recent figures available, the death rate due to infectious diseases jumped 58%, from 41 to 65 deaths per 100,000 population in the United States, the CDC reported in a study published in 1996.

“Common source” outbreaks, such as this one, appear to be a significant contributor.

Across the country, people are taking up new forms of recreation that put them in contact with organisms that otherwise would have been undisturbed. Homeowners are moving farther into the woods, bringing them closer to ticks that carry diseases, such as Lyme. International travel is making it easier for lethal microbes to travel across the globe--from an African rain forest to an American neighborhood.

And the indiscriminate use of antibiotics, anti-virals, anti-parasitic and anti-fungal drugs is spawning deadly mutant strains of organisms.

Just a month ago, eight young children in Atlanta contracted a serious E. coli bacterial infection at a popular water park--one of the kinds of pools that are proliferating across the country.

Triathlons, virtually unheard of 20 years ago, have created another opportunity for exposure.

The sporting event--apparently the lake swim--was quickly identified as the probable source because so many people seem to have been affected and also because CDC and state and local health departments have beefed up their tracking system in recent years.

“A lot of technology has gone into building these new surveillance systems, and we’ve got our state and local health departments thinking more about these emerging threats and about how people in this mobile society might in some way be linked,” said Dr. Jordan Tappero, the CDC medical epidemiologist who is heading the investigation.

Leptospirosis, which can be serious or life-threatening, is carried by animals, rats, pigs and dogs, and is often transmitted through their urine. Humans are exposed through contact with water contaminated with the animal’s urine. The incidence frequently rises in places where there have been floods.

Stoney Mayock II, 68, of Boulder, Colo., who has completed more than 200 triathlons, became seriously ill, experiencing a fever that climbed to 105 degrees after he contracted the disease at the Ironhorse. He noted that older athletes are especially vulnerable because they “are in the water for a longer period of time due to a slower swim speed.”

Mayock speculated that heavy rains in the area in the days before the triathlon “could have caused drainage into the lake and contaminated it.”

Signs of illness can develop anywhere from four to 19 days after exposure. The disease is easily treated with certain antibiotics. But left untreated, it can cause kidney damage, meningitis, liver failure and respiratory problems.

Mary Proctor, a communicable diseases expert with the Wisconsin Health Department who is familiar with the disease, recognized the symptoms and helped organize the response after the Madison triathlon director received several calls from participants who had become ill.

Since then, health officials have contacted more than 600 athletes, and “about one in five is experiencing some signs of illness,” ranging from mild symptoms to hospitalization.

Christine was fortunate; after she was hospitalized, the physicians administered a course of antibiotics that cured her infection and she has recovered fully.

But she initially had no clue to the nature of her illness.

“As an athlete, you think you’re strong and your body can combat anything,” she said. “But I was wrong. I’ve never felt so bad--ever.”