Claire Panosian Dunavan,
MD, FIDSA, DTM&H (London)
UCLA School of Medicine
Division of Infectious Diseases
10833 Le Conte Ave, CHS 37-121
Los Angeles, CA 90095-1688

Division office: 310-825-7225
Voicemail: 310-794-6053
Facsimile: 310-825-3632

A Patient’s Ancestry Makes Him Vulnerable To A Dustborne Infectious Disease

Discover, February 2009

After 30 years in the doctor trenches, every so often I think about patients I desperately wanted to save—and didn’t. At the top of my list is Arthur Lewis. A quiet, well-mannered teenager, Lewis developed a fungal infection that attacked multiple organs. Three years and many treatments later, the fungus claimed his life.

Most infectious diseases are color-blind; their outcome has nothing to do with their hosts’ hue. But Lewis’s illness, coccidioidomycosis, was different. His African American ancestry put him at special risk for the battle he bravely fought and lost.

His struggle reminds me of a basic truth in medicine. Although excellent care can tip the balance between life and death, in some cases patients have genetic vulnerabilities that all the high-tech care in the world simply cannot conquer. Genes aren’t everything when it comes to coccidioidomycosis, a rare soilborne illness that can be acquired by inhaling dust. Other variables (like the dose of inhaled organisms, underlying lung anatomy, and subtle or overt immune problems) also influence the course of the illness. But genes can gravely color the outcome. Some patients with acute coccidioidomycosis experience a short-lived infection that takes no more of a toll than the flu. In other cases, patients develop a chronic hacking cough, unexplained rashes, and joint pain. Many patients do not require specific treatment, but those who do can have tragically different outcomes.

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Claire Panosian Dunavan, MD, DTM&H (London), 2008 President of the American Society of Tropical Medicine and Hygiene, received her education at Stanford University, Northwestern Medical School, Tufts-New England Medical Center, and the London School of Hygiene and Tropical Medicine. First as Chief of Infectious Diseases at LA County-Olive View Medical Center, then as Director of Travel and Tropical Medicine at UCLA, she has been a UCLA professor, clinician, and teacher since 1984. She has also worked overseas in Haiti, Taiwan, the Philippines, Pakistan, Vietnam, Albania, Armenia, and Tanzania, among other countries.

Dunavan’s second career as a print and broadcast journalist includes 6 years as a medical editor, reporter, and co-anchor for Lifetime Television. In 1997, her interview with a dying physician won an international “Freddie” Award. In 2000, with her husband Patrick Dunavan—an 8-time Emmy Award-winning documentary filmmaker —she produced a television program on hepatitis B which has reached 300 million international viewers. In recent years, she has written regularly for national newspapers and magazines. She currently writes a weekly column called “The Infection Files” which runs in California newspapers. Her journalism spans issues in infectious diseases and public health affecting everyone on the planet to global health policy and economics.

© 2010 Claire Panosian Dunavan