Dr. Price on Vector Transmitted Disease 6/18/26

Speaker A: UCLA and then neuro medicine, infectious disease at Baylor. And uh, since then been uh, working at Houston, private practice in Houston,

Speaker B: all

Speaker A: the teaching and about 40 different countries, different projects, different places. But uh, in Houston the world's coming to me. And uh, so um, a lot of uh, different people for different places. Very diverse. And uh, number one language is English. Number two, Spanish. Number three, Vietnamese. Number four, Chinese. I don't know, the language is just English. Okay, so I want to talk to you about the uh, vector transmitted diseases. Um, basically because um, it's becoming more common YSC in Houston, not just the world. So um, first case I want to talk about, it was a 36 year old female who came to the Mercy room. I, uh, work at Memorial Herman Memorial City, which is a pretty big hospital. And um, she had fever and headache for several days. The headache was getting worse to the point where she was sort of mostly unresponsive. And uh, she was septic. She had elevated lactic acid. White count was normal, gland count was low. Liver function tests were elevated. So they put her on vancomycin and cefepime and they arranged for a smile. Tap, blood cultures, urine cultures, chest X ray showed maybe a little bit infiltrate at the right base, but not much. So cultures were all negative. Spinal tap was normal and platelet uh, count, uh, was dropping. Their function tests were going hepatitis A, B and C. Antibodies were negative, HIV is negative, and she uh, was getting sicker. So that's when they asked me to see her. So, um, I put her on doxycycline because, uh, you know, it made sense that they did what they did. But, uh, it wasn't working. With a little platelet count, elevator lyric function test and a headache, it had to be typhus or Rocky Mountain spotter fever. She had not traveled anywhere. Um, so it's not something that she got from overseas. So, um, I order you a typhus. Uh, there's murine typhus, there's epidemic typhus, and there's scrub typhus, which is now on this slide. So murine is transmitted usually by a flea. It's caused by rickettsia typhi. Uh, whereas epidemic is usually transmitted by louse lice. Um, and then scrub type is transmitted by mite. So what's the difference between a flea and a mite? You can see a flea, you may not see a mite, but even, uh, if you can see a flea and they're jumping around, they're usually jumping around on your legs. Uh, whereas a mite can be anywhere, it can cause a Rash around the ears is kind of common. And of course, uh, lice are much bigger and all transmit disease in one way. They take a blood meal and they defecate and then the feces gets into the bite. A lot of times there may be an eschar, but I can never find the eschar. Sometimes eschars and difficult places, uh, if it's um, from a flea, it's down in the legs usually. If it's uh, lice, it's mostly in the waist area and you can find the nits in the clothing. So the thing they have to do also when you have any of these diseases is try to get rid of the bug. So, uh, meaning clean clothes, clean bed sheets and use permethrin. So, um, these are the vectors. There's Elias flea and the mite can't see them because I don't have a picture of it. I'm putting out a picture of it. Um, um, urine. Typhus is worldwide epidemic is Africa, Asia and then, uh, sylvatic, meaning that's in animals in usa. Um, clinical manifestations are pretty similar. Headache, fever as. Whereas blood test, um, would indicate the low platelet count. Elevated liver function test, uh, that's if you see it, uh, far along. Sometimes it doesn't get to a low platelet account if they come in early, which usually hardly ever happens. So now, um, I guess, um, years ago I would see typhus in Houston every two or three months. But, uh, now I'm saying two or three times a week. It's kind of dropped off a little bit actually. And uh, I think the problem was we're seeing a lot of new infectious diseases since we had a little border problem. And so people were coming up. They were kind of like in a refugee camp all the way up from wherever they're coming from and, uh, bringing the lice and the fleas and the mites with them and then the fleas come on up. So most of people I see with typhus, uh, uh, are not immigrants. I see a lot of immigrants, but I don't. But typhus is not in them for some reason. It's in, uh, people. There's one lady who had typhus and she was homebound and she would never. She didn't go anywhere. Only place she went was out in the backyard. She never doesn't remember getting bit by, uh, anything, but she had it. So treatment of choice is doxycycline and uh, alternatives. Okay. If you get chloramphenical, I don't think get it here in the United States you can get overseas in those days. I could get it, but then they have few side effects. That's why we don't have it. And also use azithromycin, some benefit. So prevention is get rid of the lice, get rid of the fleas and uh, I guess there's some prophylaxis. If you're working in um, area. There's a lot of fleas, a lot of lice which is like everywhere. Uh, take doxycan once a week or 100 milligrams daily. So that's typhus. Another case I had, uh, uh, also it was a 64 year old male who was admitted to ICU because he was, he was very septic. They put him on uh, almost the same cocktail medications, vancomycin, cefepine, M and metronazole because, uh, they felt he had aspirated. So he did have what appeared to be aspiration pneumonia. Blood culture were collecting. He ultimately had a spinal tap. Urine cultures cultured everywhere. Nothing grew anything anywhere. A lot of times, as you know when you have aspiration pneumonia, nothing gross. Um, so he got worse. His liver function tests were going up. They checked all the serologies and then I noticed, ah, they asked me to see him. I noticed he had a rash, rash around his ankles and he had Rocky Mountain spider fever. So the rash begins in the ankles and it can spread other places. More like a particular rash. And uh, I'm gonna skip all that stuff right now. So transmitted by tick. Uh, it's common in the United States, Canada, Mexico, some parts of South America. Uh, similar symptoms, but I'm trying to get through the rash. Here's, here's the rash. It's usually, uh, typically, not that we always get typical stuff, but typically it's in the ankles, more petechial, and it can spread to other parts of the body. And scrub typhus, which I don't have slides of, the rash is more diffuse. And um, Rocky Mountain spa fever and scrub typhus, that's also called sushi gumushi fever. Um, it's very important to start antibiotics as soon as possible. In murine typhus, uh, it may be not that important, but by the time people get to me, um, I treat, you know, some, some people say you do not have to treat, uh, murine typhus, but by the time it gets to me, so, uh, so the diagnosis of Rocky Mountain spot fever is based on the symptoms, the rash, uh, headache, and also the blood testing, which is very similar to typhus. There's confirmatory diagnoses Serologies, you know, the. At least two, two weeks, two to four weeks apart. Um, they're working on pcr, is not very reliable. Treatment again is doxycycline as soon as possible. Toxic clean for adults, for children, whether they're one years old or older. And if they're pregnant, it's doxycycline. Yes sir.

Speaker C: So there's, there's no real alternative for Rocky Mountain spotted fever, there is no

Speaker A: alternative unless you go if you want to live.

Speaker B: So uh,

Speaker A: okay, so it's thought that the older tetracyclines have more likelihood of giving the side effects to pregnant females and the kids less than 8 years old. And that doxycycline has very little, um, relationship with that, those particular problems. That's what they're thinking. Um, prevention. Um, there's no vaccine. Um, early detection and removing the tick as soon as possible is a good idea. So that's Rocky Mountain spine fever. Another case, uh, have a whole bunch of cases of um, a primary care doctor have um, have a patient who has fatigue. There's a lot of people that have fatigue. It's not necessarily infectious. Uh, there was a chronic fatigue which is probably due to many different things. They thought at one time it was due to Epstein Barr, but didn't look like that was the case. Uh, could be due to other things like malaria, uh, which we see in Houston. Other thing we see in Houston because the border, we see malaria and people have never left Texas. That's kind of rare. We have a lot more hiv, a lot more syphilis and a lot more tuberculosis. Routine tuberculosis, atypical. So um, all the time because people have fatigue and they do a Lyme test. Houston is really not in the area where Lyme disease is. You do the blood test anyway. Uh, it's thought that it's in the Lone Star tick, but it's typically in the deer tick, which is mostly in the north eastern United States, northwestern United States and Wisconsin, Minnesota, so Connecticut on, up on, on the east coast and then Northern California, Oregon and Washington on the west coast. Um, their tick is really, really small tick. It's kind of hard to find. They hang out, they're trying the, the animal that the overtakes were like are the deer and the younger ticks like mice. So if you live near wooded areas, you're kind of at risk in those areas of the world. Areas of the United States, Lyme disease also in Europe, it's a little bit different disease there. So, um, okay, the name of the tick is. You can read it there, I can't pronounce it. So you live in the air forest. Of course. The organism is spirochet. This is the spirochete. And, uh, so there's different symptoms. The biggest problem with Lyme disease for us is making a diagnosis. So the first, the primary infection, early infection is, uh, erythema chronicum migrans, which is, um, is rash. Um, sometimes it clears in the middle, sometimes it doesn't. Slowly enlarging rash. Usually, uh, in early disease, it's single.

Speaker B: Okay.

Speaker A: It can be disseminated early. Disseminated could be multiple. Multiple, uh, locations where this rash may be in one person. Um, there's also, uh, other early manifestations, which is hard block, uh, could have aseptic meningitis. And there's, um, subcutaneous, uh, chronic Lyme disease is arthritis. Usually in one joint, one or two joints at a time. It goes to other joints. So the treatment, there's post treatment syndrome too. It's kind of like, uh, you hear like, long, uh, Covid. I don't who made that up? But, uh, so it's probably a more immune response because you cannot find the bacteria in a situation. Sometimes Lyme disease, if you have a patient with Lyme disease, they have other diseases are transmitted by Saint tick, such as Babesia. I've checked for, I've checked for babiesia all my life. I've never found it, so I don't know how it is for y', all, but I can't find it. Also the, uh, anaplasma ehrlichiosis transmitted by same tick. So diagnosis. If you have erythema, chronicle migrants, you got the diagnosis and you don't need to do any blood tests, uh, with early assimilated or late infection, uh, what is supposed to be done? You do an ELISA test. If that's negative, it's not likely to have Lyme disease. But sometimes when that's the negative, sometimes, uh, the referring doctors will do other tests like the western blot. You're not supposed to do that unless you have a positive Lysa test. But sometimes it's done, and sometimes they get a few bands that are positive. Um, but to have a positive IgM, you need to have at least two of the three. Sometimes there's one, and that sometimes confuses, uh, people. And the positive IgG, at least three bands. Once you have that positive test, say a, uh, patient comes in and they say they had Lyme disease a long time ago they were treated and now they got arthritis again. And, uh, their doctor does the test that's positive. It's going to be positive forever. So it's very hard to diagnose recurrence or, uh, recurrent infection. Um, the only way you can really diagnose recurrent infection is if they have arthritis and they come from the area where Lyme disease is. So I've been sent a lot of patients with Lyme disease, uh, treatment. Treatment for early disease, uh, is doxycycline, uh, for five to seven days. If you have, um, art block, uh, a lot of times, uh, it's preferable to use rocephin. Same thing with neurological disease. Uh, Rocephin is probably a better choice. Um, for chronic Lyme disease, it's not cycling for a longer period of time. And uh, but it's a very confusing, it's a very confusing thing. Okay. So I, I, a lot of people have been sent to me with Lyme disease, but I don't know if I ever seen Lyme disease. Because there's this other thing in, uh, southern United States like Texas, that's uh, Starry syndrome. So that's southern tick associated rash illness. So you have the same rash, doesn't usually go to the crime, doesn't go to the heart block or arthritis. Um, it's not clear if it's really necessary to treat. Uh, but because it may be Lyme disease, typically it's treated. So it's mostly in the southeastern United States. It's transmitted by the Lone Star tick, which is this tick. And the lone, uh, star tick is in the orange areas. Seems to be spreading. So Starry, uh, syndrome is being found as far north as New York. And, uh, manifestations are very similar to Lyme disease. Diagnosis is difficult. So typically if you live in those areas where Lyme disease is not, and you have the rash and you have few other symptoms, it's most likely Starry, uh, syndrome, and typically treat with toxicline. So that's all stuff. There's other tick. Uh, go ahead. Yes.

Speaker D: Is Starry caused by a pathogen or is it just a inflammatory reaction?

Speaker A: We, uh, think it's a pathogen. They think it's a pathogen, but we

Speaker C: don't know for sure.

Speaker A: I mean, it could be Lyme disease, so it could be a variant.

Speaker B: So.

Speaker E: Yeah.

Speaker C: Uh, you mentioned. No, I think this is awesome. Thank you. Uh, you mentioned that, um, chronic Lyme, but I, there's so much debate over that term.

Speaker A: You just don't have what you mean by

Speaker D: that.

Speaker C: And you said doxycycline for 28 days. Is that something that you, that you

Speaker B: are doing for Patients.

Speaker A: Uh, yeah. So really, if it's starry, that's not. It's. Starry is not very well defined. So it's not clear if it's a Lyme disease or it's something different. So typically, people get placed on doxycycline for a month.

Speaker E: For a month.

Speaker A: And then some are left with, uh, arthritis. I mean, maybe they have arthritis before they're getting older and getting arthritis. Um, and some are left with fatigue. But like I said, fatigue is kind of difficult to come, uh, up with an answer. It could be due to a lot of different things. Also be due to depression and could be the fact that patients read too much. Uh, happens.

Speaker C: So we have a patient like that who's been treated with doxycycline for Lyme. Um, and then we did an elisa. It was negative. You know, would you recommend going and doing the zero like that? We have this tick panel, and some of you guys have ordered the tick panel that kind of includes a number of different tick, you know, vector born. This is including Rocky Mountain. What is that? Does it include that or not?

Speaker E: I just ran into this where I ordered the tick panel for someone, and the only thing that's on the tick panel at St. John that we actually even have in Oklahoma is Ehrlichia. And so what they told me to do for St. John specifically is if they're acute and it's too early to get antibodies for Rocky Mountain spotted fever, order the tick panel, call them and say, I only want Ehrlichia. That way they don't run. All the other things that we don't even have at Oklahoma that are on it. There's no.

Speaker A: Just one for Ehrlichia.

Speaker C: No, it's very kind of.

Speaker E: I think that that's at least what.

Speaker D: Yes.

Speaker C: It's kind of confusing what to study.

Speaker E: Pathologist.

Speaker A: Yeah, I'm clearing things up for you. Right.

Speaker C: Some kind uh, of. So basically what you're saying, though, is we don't need to be worried about, like, we don't really have Lyme disease here.

Speaker A: Yeah, we don't think we have Lyme disease. Yeah, I, I, uh, early on in my career, people used to be a lot of people that. A lot of patients when they said Lyme disease, Starry syndrome was not known back then. And, uh, so I finally, I guess the researchers got to concede that there's something going on, but they don't think it's. They've never been able to identify Lyme from either the tick or from the patient. I mean, uh, the Organism. So okay, I have another. How do you get the other.

Speaker B: Uh,

Speaker A: there's other uh, vector transmitted diseases. Malaria. We uh, see a lot of malaria at Houston Travelers now. So um, and then there's uh, tick paralysis. Tick paralysis, Interesting. It usually is in children and using the western United States and um,

Speaker B: the

Speaker A: child two or three years old is all of a sudden not walk anymore and they become uh, neurological disease and it kind of ascends another disease that's similar to that but it starts from the, from the crowners down. And um, So the deal with that is like these uh. Okay, the question on the boards is that um, a bunch of people up in Alaska, there's a beach whale and they start eating it. So um, and then usually the elders are the ones who eat first and they get sick first. So uh, you have to get the antitoxin pretty quick with them, otherwise they quit breathing and stuff. Whereas, uh, tick brows will do the same thing. They have a little bit more time because it's a sense before it gets to the cranial nerves. So what you do for that is you find the tick and take it off and then within 24 hours in the United States everything's normal. In Europe it's a little bit different. It takes a little bit longer, like uh, 48 to 72 hours. So that's uh, kind of interesting disease.

Speaker B: Are we seeing any other mosquito vector borne illnesses in the US like the West Nile virus? That was.

Speaker A: Yeah. So West Nile, um, you know, when it first came out, when it was, it first arrived maybe 15 so years ago and it was a sort of big thing. But most um, people have been exposed to it. Most people do not get really sick from it. Antibodies. And there's Zika. So Zika, um, West Nile and Zika are from Uganda. So um, Zika. So there was a, there was a. Back uh, in the 1960s or 70s there was a big push to get rid of a certain uh, mosquito in all of Central America and part of southern United States. And everything was going well except the United States did not really cooperate with that. And therefore the, you know, you have to keep. Like in Houston there's a whole lot of tires with water in them everywhere. So um, so that's a big breeding ground for mosquitoes. And of course they, they. The biggest place to have St. Louis encephalitis used to be Houston. So I don't know why it's called St. Louis except. And it wasn't really diagnosed in St. Louis, it was diagnosed in Vandalia, Illinois. And um, the patient from Vandalia was at Washu in St. Louis. And that's why I call it St. Louis. I don't know if you want to know all that stuff, but all this stuff is in my mind. Okay. I want to talk to you about. We have a project in Uganda, a community project. And um, it's a very simple thing, um, with life changing impact. So um, as y', all, you know, 2.3 billion people, a lot of people lack basic sanitation and millions of people still practice open defecation. When they practice open defecation then the soil gets contaminated, the drinking water gets contaminated. Disease is transmitted. Disease associated with poor sanitation account for about 10% of all global disease. It's thought by World Health Organization that a lot of people, a lot of kids, less than 5 die because of that. One of those things is soil transmitted helmet diasis. So that's Ascaris roundworm worm in Robius vermicularis hookworm. About 1.5 billion people are affected with that.

Speaker C: And

Speaker A: it's one of the most common infections. The problem with that is people, children get infected, they get really tired and they don't pay attention to school or they're sleeping through class. And uh, the cycle of poverty persists. So um, I was asked by a patient's husband to go to Uganda with him. He was setting, he was a lawyer, he was setting up ah, libraries and small schools in rural Africa. So the little red dot is where we were. That's in Zombo district. Zombo is a very remote district. It's right on the border with um, the Congo. Right um, next to where the Ebola outbreak is right now. So there's Kampala where the M is. And in Kampala, uh, is where Entepi, the international airport is. Where the A is next to the M is where the Zika forest is. And up here's uh, Lake Victoria. And now goes up and there's a Lake Albert. And uh, the area and the Nile goes up towards the Sudan. West of the Nile is West Nile. So got West Nile virus, you got Zika virus, you got a bunch of other stuff including soil transmit Matthiasis. So um, what they do, uh, there's a law in Uganda. You have to have a sanitation system in your, your homestead and you have to have a sanitation system in the school. There are, there are 90,000 schools in Uganda. 60,000 of them are private, but all have to have a sanitation system. And they dig pit latrines. Pit latrines are nasty and there's a lot of Mosquitoes, a lot of flies that transmit pathogens to the food. And the pit latrines are probably propagating by diseases including soil transmitted hemothiasis. So there's the pit latrine. So we come up, uh, we came up with a. Other people came up with a, uh, solution which is change pit latrines to compost toilets. So the way you change the pit latrine compost toilet is you cement over the hole and then you make a toilet. And um, and the benefit. And then you have a, you have a compost heat. And the benefits of compost heat is it's very sanitary. And, uh, also the end product is fertilizer. Uh, we prefer not to use the compost until we make sure there's no pathogens. So, uh, we usually test the compost heat. So, um, this picture shows what coffee looks like without fertilizing with compost. And the picture above is with compost. So compost sanitation is, can be replicated. Uh, I don't need to import any fancy technology and it's sustainable. So we decided to do a little test in Uganda in Zombo district. So in January 2015, the school children, school children of different ages, see what the prevalence was by looking at just one stool test per person. Then April that same year, we started, uh, compost in the schools. And uh, we figured we'd start in the schools, then the children go home to their parents and tell them what they're doing. And uh, they will tell the parents how they're doing things wrong. So anyway, so we looked again at the stool samples in, uh, October every year, another program where we went to a lot of children's other school. So uh, we went to different villages where children were not in school and tried to introduce the compost system. So we also talked about clean water. So we had, uh, the government of Uganda drills boreholes, but usually within a couple weeks, somehow they're broken. So we had filters and we did rain. We installed rainwater catchment systems at the schools. So we provide clean water. Uh, we also talked about hand Washington, in order to have hand wash, you have to have soap. They don't have soap. So we got a guy from Marua, which is a town, a very big town a little bit north of Zombo, and he made soap. And we had him teach some of the locals how to make soap. I thought they'd make a business, but they didn't. So I have people that work for me there. And so we make soap. Initially, it's selling for more, uh, Less than what it cost me. So I told him we have to change that. Also, the World Health Organization wants us to get more medicine and vitamin A. So I don't. I think that taking more medicine is good for about a week unless you change people's habits. And then we educated the parents and the children, show them pictures of, uh, worms up close. And they are horrifying once we show them that, they would do anything. So education, we got clean water, we had soap. Um, we initially, uh, gave them shoes. But we realized shoes are kind of expensive. I think a little more expensive than that. What they really are, because I think someone's making a little money off of me. But we realized that shoes don't work when you don't wear them, which they didn't do because, you know, they're used to running around barefoot and they get shoes on, they trip over each other. So they. And also the parents like to reserve the shoes for church and stuff like that. So. So doing that project, initially, the 73.7% of the kids had at least one parasite. Um, after we started, few months after we started the composting, it was. Had dropped down to 50%. And we did the composting education, and we have people there going through each village, each school, teaching over and over again. Um, ultimately we got down to less, about 15%. And during that time, initially, a lot of kids were malnourished and in fact, uh, very severely nourished and was all age groups, by the way, younger, uh, kids and older kids, males and females. And then as far as the school, uh, uh, the villages where the kids did not go to school, um, about 94% of one village accepted compost because we were giving it to them, we're making it for them. And, uh, the others, the other village, about 55%. And so the instance went down from 95 to 50% on one village and went up from 100 to 61% of the village. Uh, then the pandemic hit and we couldn't test any further. So the conclusion is that pit latrines are kind of nasty and they, I think, propagate disease, whereas compost sanitation is an alternative solution. Um, okay, so, so the pit latrine, when they make the pit latrine, they put a far away, as far as possible from the house, from the household. Um, but with composting, there's no smell, there's no flies. And so some people have even put it into their own home so they don't have to walk as far.

Speaker D: Uh,

Speaker A: so we feel the conclusion is that, uh, uh, composting is the way to go along with hand washing. Good, uh, water. And education doesn't require any technology. Local materials essentially do the job. So what happens is you do your thing in the toilet and then you, uh, take some sand, like either sawdust or, uh, dead vegetative material, put on top the bucket where you just did what you did. Okay. So the bucket. When the bucket gets like, uh, uh, half, half full, then we go put it in the compost heap. You put it inside the heap, put it, make a little nest with. There's dead material around, like straw or dead grass. And you put it in there and you cover it. And then the metabolism, uh, of the bacteria, they cook themselves to death. So we have these long probe, uh, thermometers, uh, that we go down to the heap and it goes up to 70 degrees centigrade. And, uh, by. In about six months, there's no longer any pathogens because they have, uh, metabolized themselves to death really high. So they die. And then we, uh, as I said, we take the, um, compost, get it tested in a lab in Nairobi and Kampala, and there's no pathogens. And we let them use it on their crops. Yes.

Speaker C: So those big compost pits that doesn't seep in, that doesn't leach into the, into the groundwater. I guess because it's not a hole in the ground.

Speaker A: Yeah. So it doesn't tend to attend. No, uh, it doesn't.

Speaker C: Okay.

Speaker A: So, um, so it's. It's a better. It's better. So, you know, pit. You know, the pits for the pit latrines, they're part of the groundwater.

Speaker B: Oh.

Speaker C: So let's see.

Speaker A: So, you know, so it, it's not perfect. It would not work. It does not work in Kapala. Does not work in. Whereas, you know, in a real. In an urban area, but in a rural area, it works. Also works in, uh, a lot of people who are like handicapped. And uh, you know, all they have in the past was a hole. They have to scan the hole and they're always falling in the hole, all the. On the hole or in the hole. And uh, and so they like sitting down. It's just more comfortable for them. So in some areas where there's, uh, you know, desert areas, and it's a little more difficult because you don't have as much dead vegetative material. So, you know, it's not perfect, but it's, It's. It worked in that, uh, area. So another question. Yes, sir?

Speaker D: I don't know if that particular area

Speaker B: of the world has a rainy season, but what if there is one? What do you do during the rainy season? Do you prepare the ground on which you build the compost piles, et cetera?

Speaker A: So we like the compost pile to be in the shade or in a tree. Uh, I don't like it being the sun, uh, nor the rain. So yeah, in Uganda they have three, three rainy seasons. So um, so it rains a lot. So uh, we keep it in the ground. We also have other projects there. So we have wounds, you know, they, they don't have soap. So anytime they get, they have these horrendous, horrendous, uh, wounds. Humongous. And you ask them how long they had. Oh, about, I don't know, about 10, 15, 20 years. And you ask them what happened. Oh, I got stuck with a stick. Every one of them says that. But I guess, you know, if you don't have soap, you don't clean wounds. They're going to get big. So, um, so we have that project where we're doing wounds and uh, a few other things. Sometimes some of the women in the group talk to the girls about administration and stuff like that. It's not something they talk about. And a lot of times girls get pregnant when they're you know, 12, 13 and then the cycle poverty persists.

Speaker B: So,

Speaker A: so that's that. Okay, this is uh, malaria. Can you see the parasite? This is a patient of mine that went to Sudan. He didn't like to take, uh, malaria prophylaxis. Made him feel bad. So he had 23% of his, uh, 23% of his red cells were parasitized and he was, when I got, they asked me, Sam, he was seasoned already. So at the time we didn't have the fast acting malaria medications. All we had was doxycycline, clonamycin, hyluron. Uh, we used to use quinine. We don't have quinine anymore. Used to, when we ran out of quinine, quinine, uh, we use quinidine now. We don't have quinity. So uh, so we need anthem or testimony so that at that time I told the hospital we need to have some on hand. But they didn't do it. And so this particular patient came in on a uh, Saturday morning and Saturday night we called my hotline at CDC and they said they call us back first thing Monday morning. So I figured I wasn't going to have the real strong medicine until Tuesday. I figured he would probably die by then. So. Okay, so what, why did you probably. You're not supposed to do. So what I did is I took all his blood out and put new blood in, total exchange. I did three times. Because after one time it was still over ten. And then, as you know, malaria goes through a three to four day, uh, cycle. And, uh, so. So that's what I did with him. He survived with no complications. The hospital wasn't too happy. Some amount of money. So now they have on hand the straw mother medications.

Speaker B: I just.

Speaker A: I just thought I'd throw it out for you.

Speaker C: So.

Speaker A: Okay. Any questions about anything, sir? Open defecation.

Speaker D: Does that just refer to defecation, uh, without covering it or.

Speaker A: Okay, so the pit latrines are, like I said, nasty. There's a lot of flies. They. They don't. There's a bad odor.

Speaker D: Huh.

Speaker A: So some people, instead of going the bathroom there, we'll just go out in the field somewhere. That's open defecation. So then the parasites get in the groundwater and. And the hookworms will travel maybe 20 meters away from that, uh, particular spot. So a lot of people are barefoot. They walk along barefoot. Hook or minerals. The, uh, feet. And hookworm is a big problem. They're working on a vaccine for in Houston for hookworm, but, uh, still in development stage. So that's open defecation. It's big in a lot of places in the world. It's very big in India.

Speaker B: So

Speaker A: that's a good defecation.

Speaker D: Out of curiosity, with the compost piles, if the center of it is where the heat, uh, builds up enough to kill the bacteria, are the per. Is the periphery still infected? And do you have to try to, like, harvest from the middle when the compost is done composting or.

Speaker A: We don't know for sure, but when we send the soil samples from different parts of the heat to the labs, there's no pathogens.

Speaker D: So the whole heap can become usable material.

Speaker A: Yeah. So, uh, really, what should be done, you just have more than one, uh, one heap. You know, you use this for like three to six months and you go the next one depends on your volume. I mean, uh, some schools are big schools. They may have 20, 20 heaps. 20, 20 compost.

Speaker D: So.

Speaker A: And they're working on 10, 10 at a time. So I think the whole village use it. So, uh, so, um, so in that particular area, um, finance the whole thing. Uh, but after we proved that it works somewhat, uh, we expand to other places. So there. I told you there's like 90,000 schools in Uganda, 60,000 private schools, most of them are Christian schools, but not all. Some are Muslim schools. So there's an organization, Kampala, that, uh, a Christian organization that develops curriculum for the Christian schools. So we work with them to get in some of their schools. So we will, uh, finance two stances, and that's not enough for the whole school. And if they see that it's. It's, uh, something they want to do, then they can expand it. And I have. We have people there that can help them. One time we did that and

Speaker E: Christmas,

Speaker A: uh, break mine, broke in and stole all the compost. Kind of weird, but that's what happened. So things like that happen in Africa.

Speaker B: Are you separating liquid and solid waste? Because that's what we do here.

Speaker A: Uh, no. Okay, so that's a good, good question. Uh, some. Some people do, but we do not. Any questions about anything I said or anything? Any question about any infectious disease you want? Oh, clarification. Yeah.

Speaker D: Um, my family member and I were talking about this because there was a tick bite in the family, and we believe that the head was left in after we removed the body of the tick. Is it still. I've heard mixed reports on whether that's an infectious concern or not. Uh, is disease transmitted just by the head being left in there or what?

Speaker A: Um, I don't think anyone knows. You need to get the head out.

Speaker D: Yeah.

Speaker E: Okay.

Speaker A: I guess it's transmitted, you know, by, uh. Yeah, the head is probably the most important part to get out. I don't think anyone has done a study just keeping the head in and taking the body versus taking the whole thing out. I don't think that's been done.

Speaker B: Prophylactic treatment, certain thresholds for tick being a person.

Speaker A: Okay, so, um, say you get bit by a tick and uh, where. Where there's Lyme disease, then they're going to give you dox, you get a tick bite, they're going to give you doxycycline. In Houston and other places where it's not really limes, is not really big, then it's, uh, sometimes it's done, sometimes it's not.

Speaker B: Is there a certain threshold of like 24 hours on the person that you have to.

Speaker A: Yeah, so that's a good question. Yeah. So, um, uh, typically, most of, uh, the tick transmitted diseases, for whatever reason, they don't. Are not transmitted unless they're attached for over 24 hours.

Speaker E: Okay.

Speaker A: Not all. So, like ehrlichiosis. Uh, and, uh, that is not.

Speaker B: That's.

Speaker A: That's not the case.

Speaker B: You okay with that for 24 hours, treating them toxy Prophylactically?

Speaker A: Um, yeah. Yeah. So most. I. I would think most physicians everywhere do that.

Speaker D: So Ehrlichia transmits more quickly than.

Speaker A: What's that?

Speaker D: Is it that Orlichia transmits more quickly?

Speaker A: Yeah, for some reason, uh, some, uh. Like, uh, Ehrlichiosis transmits quicker, and I don't really know. I don't think anyone really knows the reason. One last question.

Speaker D: With the tick paralysis, does that resolve spontaneously at any point, or is it going to persist until.

Speaker A: It's going to persist until you take the tick. I don't think anyone knows why that happens.

Speaker D: But if the tick, like, detaches at some point.

Speaker A: If the tick detaches, you haven't died by that time. And, uh, then, yeah,

Speaker D: it has to be off, though.

Speaker B: You ever see, um, river blindness?

Speaker A: So in Uganda, they have, uh, river blindness and oncosaciasis transmitted the value of that black flee by fly. And, uh, so everyone, uh, there gets ivermectin once a year. So the healthcare workers so come to their huts. It has a little book, and it gives you the pill. Watch you take the pill. And, uh, that protects you from river blindness for the year.

Speaker C: Wow.

Speaker A: So, uh, in areas where there's loa loa also, that can't be done because, uh, that could cause the kind, uh, of increase in the filaria and the loa loa and cause major problems. Anything else?

Speaker B: You see, Leishmania, when you're over there.

Speaker A: What's that? See last mania more often. Okay. So it is, uh, not common in, uh, Uganda. It's more common in Central and South America, and it's more common in, like, the Middle East. I mean, both those places. And, uh, like in Honduras, there's a. There was a lot of problem with, uh, cutaneous leishmaniasis. So what they do have in Uganda is jiggers, is flea, larva, flea. And the flea, okay, they are in a mud m. They're in the mud hut with a mud floor. And if you get fleas in the. In the dirt, that's a big problem. And it's also a problem in schools because they have the same thing. They have dirt or m. Mud floor. If, uh, fleas get into the dirt, that's a major problem. They got to close it down. So, um, so the fleas come out and bite you mostly around the fingernails or the toenails. And you get these swelling and the ulcers. And it's the larva that's growing very, very painful. If you get a lot of them, you can even get, uh, Major infections and sepsis and you can die from it, but it's very debilitating. So, um, so where you get rid of it usually dig them out. So, uh, so we would go at the hut and we. The larvae out of these kids. Okay, they're not American kids, so they don't really scream too much. You know, it just looked like they're kind of interested in what you're doing. They just don't cry. But American kids kind of cry. So, um, so we did that and I was doing that one time. My wife was wearing these big boots all the way up. We kind of. My two sons, I kind of made fun of her. And then, uh, so we were. I noticed about one kid, a, ah, three year old was on my lap. I noticed while I was holding him, that flea jumped off of him and onto me. Okay. About three or four weeks after I got back, man, I couldn't walk, man. I had these spots on the bottom of my feet and I got to think, oh, man, I jiggers. So I went to my diet's friend and I said, hey, I think I have worm or something in my foot. Do you mind digging it out? He said, you don't have a worm, you just have infection. I said, okay, okay, then just last infection later. Uh, not too much longer. He says, oh, my God, you got a worm coming out. So it happened to me one more time and I just did it myself.

Speaker E: So.

Speaker A: So that's jiggers. That's debilitating. That's another thing we do. We go with hot t. Little bumps. Like you said, you don't need a doctor for that. Just, just. I just tell my guys you gotta go. Go take out the jiggers, you know, every Friday.

Speaker B: So easy to identify.

Speaker A: Yeah.

Speaker C: Wow. Thank you, Dr. Bryce.