Prefect Predator

Personal and emotional context provided by the speaker.
Disclosures: speaker’s husband and speaker own stock in a phage company.
Speaker is an unpaid adviser to another phage company, Felix Biosciences.
Warning issued regarding disturbing patient photos to be shown during the presentation.

The story began in 2015 during a vacation to Egypt over Thanksgiving.
Both speaker and husband are scientists: husband is an experimental psychologist and evolutionary sociobiologist, speaker is an infectious disease epidemiologist.
The husband, described as overweight (6'5" and approximately 300 pounds), crawled into the red pyramid, showcasing the extent of physical activity.

Following a seafood meal, the husband becomes violently ill while preparing to visit King Tut's tomb.
Initial assumption of food poisoning due to violent vomiting and abdominal pain.
Speaker calculates incubation periods for gastroenteritis based on potential tainted food exposure.
Concerns heightened with the development of back pain.
Decides to call a doctor on the ship as conditions worsened.
Reached out to personal acquaintance, Dr. Chip Scooley, head of infectious diseases at UC San Diego, for advice.

Encouraged to take the husband to the closest hospital, which was actually a clinic in Luxor lacking formal hospital facilities.
Clinic had a CT scanner, diagnosing the husband with pancreatitis.
Pancreatitis identified as a symptom of a larger issue, prompting a medevac to Germany due to severity.
Lesson learned: importance of travel insurance, particularly for medical evacuation in lower-middle-income countries.

Arrived in the ICU; all personnel were in full PPE due to potential contagious microorganisms from the Middle East.
Endoscopy performed revealing a gallstone lodged in the common bile duct, which had caused an abscess filled with murky fluid.
Abscess size likened to a small football, indicating a long-standing issue.
Lab cultures revealed the presence of Acinetobacter baumannii, recognized now for its resistance.
- Historical context: once considered benign in the past, now known as a multidrug-resistant organism.

Acinetobacter baumannii is adept at acquiring resistance genes from others and forming biofilms, complicating antibiotic treatment.
The antibiogram revealed significant resistance: 15 antibiotics tested, most labeled "r" for resistant.
Identified as needing heavy-duty antibiotics, highlighting concern regarding limited treatment options.
The speaker expresses realization that modern medicine's efficacy against resistant strains is not guaranteed.

Statistics shared: by 2050, superbugs could kill 10 million annually and cost 100 trillion globally.
Highlighted keyword: superbug mortality rates were documented (1.2 million deaths known to be attributable to resistant bacteria in 2019).
Push for awareness: Tom's case amplified recognition of a global health crisis.

Medi-vac completion back to San Diego, collaborative care from the speaker's colleagues.
Too weak for immediate surgery, effort to establish drainage via interventional radiologists.
Complications arising from an internal drain leading to septic shock.
Ensuing symptoms characterized as a cytokine storm with escalated heart rate and severe physiological distress.

The husband fell into a coma, and the speaker decided to explore phage therapy as an alternative treatment.
Definition of phage therapy provided: uses bacteriophages (viruses targeting bacteria) as a means of treatment, dating back over 100 years.
Historical context discussed: discovery tied to cholera research conducted in India.
- Mention of significant contributors like Ernest Hankins and Felix de Harrel, who first identified and named bacteriophages.
Phage therapy records indicate it was overshadowed by antibiotics in Western medicine.

Detailed description of phage biology and mechanisms:
- Scanning electron micrograph shows phages attaching to bacteria and injecting genetic material.
- Phages are selectively lethal, targeting specific bacteria without harm to others, contrasting traditional antibiotics.

Speaker reached out to researchers for phage isolation compatible with the husband’s bacteria.
Collaborative efforts detailed with researchers in Texas and Europe emerging from initial communications.
The FDA was contacted for compassionate use approval based on patient’s dire condition.

Discussion of procedural challenges within the clinical treatment framework, including dosage and administration routes for phages.
Risks associated with endotoxins and identifying safe phage preparations.

Initiation of phage therapy in March 2016.
- Documented as a pioneering treatment within the U.S. context.
Multisystem organ failure noted prior to therapy, underscoring the patient’s critical condition.
Sequential phage administrations began yield successful results; initial coma lifted within three days.
Comprehensive effect of treatment observed, leading to the husband’s gradual recovery, exit from the hospital in August 2016.

Publication of Tom’s case report, illustrating the clinical importance.
Establishment of the first dedicated phage therapy center in North America (iPATH).
Notable cases of phage success and ongoing efforts to expand applications and trial bases.

Call for continued clinical trials to validate efficacy and safety of phage therapy alongside traditional antibiotics.
Strategies needed to develop libraries for phages against different pathogens and narrow host ranges.

Exploration of synthetic biology in phage engineering potentially altering bacterial interaction outcomes.
Potential applications in agriculture, food safety, and public health.
Discussion on new pathogens and consideration of alternative uses for phages.

Acknowledge the importance of continued vigilance against antimicrobial resistance exacerbated by crises (COVID-19).
Ongoing dialogue around equitable access to phage therapy globally, recognizing community support fundamental for advancing the field.
Final thoughts shared about the integration of phage therapies into routine clinical practices for systemic infections.