Thai Cave Rescue: A Doctor's Guide to Diagnosis & Treatment
This is the first in a series of “Relevant Refreshers” by Horizon Revenue Solutions. We strive to enhance the viability of clinical practices but also want to offer a change of pace in our relationship with the clinics we serve by providing short reads that are relevant to a clinical practice.
Recently, an amazing tale of survival unfolded over two weeks in a mountainous area of Thailand; twelve children and one adult were rescued from a flooded cave after being trapped for two weeks.
This is a prime example of, “you’ll probably never see it, but definitely still need to know it.” Back in the early days of training to become healthcare providers a brief amount of time would be spent on topics like what happened out in Thailand.
While the entire group made it out, there are many hurdles they have yet to face. Some of the more obvious and pressing issues include undernourishment and physical stress from being secluded in a dark, confined area. Another, and perhaps overlooked issue that the children may face is a product of where they were trapped; illnesses associated with caves.
What Illnesses are Associated with Long Exposure to Caves?
Generally speaking, cave-related illnesses are often overlooked due to their rarity and lack of medical research time dedicated to the deep, dark dwellings. Some of the familiar players include histoplasmosis (often heard of in conjunction with the term spelunkers) and rabies, as cave-dwelling bats are capable of transmitting it.
Histoplasmosis is a fungus that resides in soil or bird/bat droppings. Exposure to it can cause a wide array of non-specific symptoms and often silent symptoms thus making it a difficult diagnosis. A patient may experience cough or flu-like symptoms usually arise 3-17 days after exposure.
There are many complications if gone untreated, particularly in immnocomprimised patients. Pneumonia, respiratory failure, and fibrosing mediastinitis are just a few illnesses that can be contracted.
How to Diagnose Such Cases
A diagnosis can be reached in many ways; samples from sputum, blood or urine. The method of choice is to look for antigens in the urine as a blood sample may take up to 6 weeks to analyze. The definitive diagnosis is via sample culture.
How to Handle Treatments
Treatment is straightforward upon diagnosis (sans accompanying treatments for secondary issues). Immunocompetent patients often recover on their own. In fact, a considerable portion of the population in the Ohio and Mississippi Valleys have been exposed to histoplasmosis and remain asymptomatic.
For acute/chronic/disseminated disease, antifungals are the preferred treatment. Initial recommended treatment is amphotericin B (monitor renal function) followed by PO itraconazole (monitor hepatic function). The treatment timelines are 6-12 weeks for acute and 1 year for severe disease.
If you have any questions or would like us to cover any other topics, please feel free to reach out to us! If you are interested in a free practice assessment for your private medical practice, give us a call at (408) 444-8845, or simply contact us at www.horizonrevenuesolutions.com.
- Shaunveer Chima, MD