Contagion Read Online Free PDF Page B

spread of the disease along the lymphatics of the neck.
         “Some of these nodes are necrotic,” Calvin said.
         “Exactly,” Jack said. “In fact most of them are necrotic. The disease was spreading rapidly through the lymphatics, presumably from the throat and bronchial tree.”
         “Airborne, then,” Calvin said.
         “It would be my first guess,” Jack admitted. “Now look at the internal organs.”
         Jack presented the lungs and opened the areas where he’d made slices. “As you can see, this is pretty extensive lobar pneumonia,” Jack said. “There’s a lot of consolidation. But there is also some necrosis, and I believe early cavitation. If the patient had lived longer, I think we would be seeing some abscess formation.”
         Calvin whistled. “Wow,” he said. “All this was happening in the face of massive IV antibiotics.”
         “It’s worrisome,” Jack agreed. He carefully slid the lungs back into the pan. He didn’t want them sloshing around, potentially throwing infective particles into the air. Next he picked up the liver and gently separated its cut surface.
         “Same process,” he announced, pointing with his fingers to areas of early abscess formation. “Just not as extensive as with the lungs.” Jack put the liver down and picked up the spleen. There were similar lesions throughout the organ. He made sure everyone saw them. “So much for the gross,” Jack said as he carefully replaced the spleen in the pan. “We’ll have to see what the microscopic shows, but I actually think we’ll be relying on the lab to give us the definitive answer.”
         “What’s your guess at this point?” Calvin asked.
         Jack let out a short laugh. “A guess it would have to be,” he said. “I haven’t seen anything pathognomonic yet. But its fulminant character should tell us something.”
         “What’s your differential diagnosis?” Calvin asked. “Come on, Wonderboy, let’s hear it.”
         “Ummmm,” Jack said. “You’re kinda putting me on the spot. But okay, I’ll tell you what’s been going through my head. First, I don’t think it could be pseudomonas as suspected at the hospital. It’s too aggressive. It could have been something atypical like strep group A or even staph with toxic shock, but I kinda doubt it, especially with the gram stain suggesting it was a bacillus. So I’d have to say it is something like tularemia or plague.”
         “Whoa!” Calvin exclaimed. “You’re coming up with some pretty arcane illnesses for what was apparently a hospital-based infection. Haven’t you heard the phrase about when you hear hoofbeats you should think of horses, not zebras?”
         “I’m just telling you what’s going through my mind. It’s just a differential diagnosis. I’m trying to keep an open mind.”
         “All right,” Calvin said soothingly. “Is that it?”
         “No, that’s not it,” Jack said. “I’d also consider that the gram stain could have been wrong and that would let in not only strep and staph but meningococcemia as well. And I might as well throw in Rocky Mountain spotted fever and hantavirus. Hell, I could even throw in the viral hemorrhagic fevers like Ebola.”
         “Now you’re getting out in the stratosphere,” Calvin said. “Let’s come back to reality. If I made you guess which one it is right now with what you know, what would you say?”
         Jack clucked his tongue. He had the irritated feeling he was being put back in medical school, and that Calvin, like many of his medical-school professors, was trying to make him look bad.
         “Plague,” Jack said to a stunned audience.
         “Plague?” Calvin questioned with surprise bordering on disdain. “In March? In New York City? In a hospitalized patient? You got to be out of your mind.”
         “Hey, you asked me for one diagnosis,” Jack said.