on Vancouver Island a series of strange and lethal symptoms strikes residents without warning investigators are in a desperate search for the cause of the deadly illness to solve the mystery they must hunt for clues in the most unlikely places but even as they close in on the location of the killer the evidence points to one terrifying conclusion it is all around them [Music] [Applause] [Music] some of the names in this program have been changed Vancouver British Columbia Canada's West Coast metropolis a high-tech city on the edge of wilderness [Music] across the Bay lies Vancouver Island stretching almost 300 miles along the Canadian coast this island is home to immense old-growth forests ancient woodlands that make it a mecca for outdoorsmen but for travelers and residents alike that wilderness would soon reach into the heart of civilization in a most alarming way in 1999 Murray Benson was rushed to the island's main hospital in the city of Victoria she had been sick for several days with an excruciating headache and a high fever now she was delirious in the ER doctors diagnosed her with meningitis a raging infection that causes swelling around the brain and spinal cord soon her organs began shutting down within hours despite the doctors best efforts Murray Benson died doctors wondered how had an otherwise healthy young woman died so suddenly at autopsy the medical examiner took tissue samples to find out what they didn't know was that these samples held a rare and dangerous killer that would soon overtake the island over a year later the mysterious disease struck again our third Labe was a self-employed house painter who had lived in victoria most of his adult life for the past several weeks he had been suffering from flu-like symptoms but he thought he could ride out the illness as the summer of 2001 wore on he developed chest pain and a dry cough then he started coughing up blood that evening he told his wife about how he was feeling they were scheduled to leave for Germany the next day to visit with family it was a trip they had been planning for years he didn't want to ruin it he was feeling pain in his left side and I thought probably because he walked a lot and he was usually very active and a kind of a workaholic then he told me that he had been spitting up blood so I began to worry and told him he should go to the doctor at the Royal Jubilee Hospital in Victoria Arthur was referred to a specialist in respiratory illness and sent for x-rays taking a medical history the doctor asked Arthur if he was a smoker in fact Arthur had quit more than 10 years earlier whenever you meet someone who's been a smoker and who's coughing up blood obviously the first concern is of an underlying tumor or and in this case a primary pulmonary malignancy a shaded area on Arthur's chest x-rays trouble dr. bohlson well his x-rays were actually pretty subtle the right lung was totally clear but at the root or just adjacent to the root on the left lung there was a very ill-defined shadow Arthur imagined the worst he worried how it would impact his wife and his daughter Angela his doctor had suggested it may be a tumor it could be cancer it could be a number of very serious things so dad was scared the doctor recommended Arthur undergo a bronchoscopy an exploratory procedure to determine what the shadow on his x-ray was inserting a hollow tube fitted with a tiny video camera down the patient's windpipe into the lungs the doctor looked for the cause of bleeding and any tumors as the doctors worked Arthur's family waited anxiously for news we didn't know what the doctor would find it really depended on whether or not there was something wrong with that if he would be able to go on this vacation that he had planned he wanted to go on this trip so if there were a lot of things up in the air at that moment so we were quite nervous the bronchoscopy took over an hour procedure itself went fine it was not complicated and he had basically normal Airways you could not see any obvious tumor or polyp within the Airways in fact I couldn't even find a blood trail on this occasion the tests had found no obvious dangers the source of Arthur's symptoms remained a mystery as a precaution the doctor removed a tissue sample and sent it to the lab for testing once Arthur recovered from the anesthesia the doctors gave him the preliminary results Arthur and his entire family were relieved that his lungs did not look cancerous but the doctor couldn't make a final diagnosis until the lab report came back in several days so I was pleased to be able to reassure him somewhat that I didn't see an obvious tumor although not having all my samples back I couldn't give him a definite answer with this good news and feeling well enough now to travel Arthur decided to take his vacation Arthur and Carol flew to Germany the very next day as the leaves were heading overseas lab technicians at Royal Jubilee Hospital tested Arthur's lung sample they found no malignant or cancerous cells but while checking for tuberculosis and other bacteria the text did find something unusual Arthur's lungs were infected with a strange fungus Cryptococcus neoformans common to Vancouver Island this fungus had almost never before been linked to major health problems among healthy residents but in Germany the labs dream vacation was quickly turning sour days after they arrived Arthur began complaining of severe back pain his son-in-law took him to the local hospital as they drove Arthur's pain became unbearable his head was pounding his fever soaring and he was becoming delirious to the German doctors the symptoms suggested he was suffering from swelling around his brain a condition called meningitis a neurologist took blood samples and withdrew spinal fluid from Arthur to check for what might be causing his illness but because the pain had started in his lower back neither Arthur nor his family connected this sickness to his lung problem they told me that they really didn't know what it was but he was going to be in the hospital for a while because they suspected meningitis then I really got scared the lab detected a high white blood cell count in Arthur's blood which indicated that his body was fighting some type of infection the doctors diagnosis bacterial meningitis they put him on massive doses of antibiotics to fight off any bacteria in his system in all the physicians tried six different medications but Arthur didn't respond to any of them his pain became more intense as his condition deteriorated the German neurologist told Carol he didn't think her husband was going to survive you should probably call your family because we are doing everything we can for him and he's not responding and it doesn't look good so then I really panicked desperate for some way to help her husband she called their daughter Angela in Vancouver and told her of the grave diagnosis half a world away Angela Newman was just starting her day when she got the call see what out she was stunned by the news that her father did not have long to live searching for help she consulted with Arthur's doctor in Canada dr. Paulson had examined Arthur before he left on his vacation she hoped he could help she explained what was happening and the doctor reached a startling conclusion he said your dad's test results came back with Cryptococcus which is normally nothing to be alarmed about it's something that people have and if their immune systems are intact they they're able to fight it off and so I didn't even think twice about mentioning it to you and but in your in your dad's case it has led to meningitis which happens in very very rare cases if Cryptococcus was the cause of Arthur's illness the German doctors had no idea they hadn't been doing anything to cure it because antibiotics only treat bacterial infections they were useless against the Cryptococcus fungus my first question to dr. Paulson was can this be cured and he said yes if there's enough time I don't know I don't know how bad it is at this point I don't know what stage at that dr. Paulson thought that Arthur's rapid decline was puzzling at the point I met mr. late I had no evidence that his immune system was not up to par so it's very unusual that he would get this sick [Music] paulsen contacted Arthur's doctors in Germany hello it's dr. coleson calling from Victoria he relayed his biopsy information he then recommended medications to treat Cryptococcus the German doctors put Arthur on the antifungal medication right away now all they could do was wait to see if his body would respond back in Canada dr. Poulsen decided that Arthur's condition was so unusual that he should contact the Vancouver Island Health Authority microbiologist dr. Pamela Kipps II had never seen Cryptococcus affect a healthy person so dramatically the fungus spreads like pollen on spores through the air normally it's not that dangerous unless it was now changing in some way I think I was worried that there may be more cases out there that we weren't aware of so the first thing I did was alert all my other colleagues in pathology to be on the lookout for more cases even as public health officials put out the first alert of a severe Cryptococcus infection the fungus was spreading some 50 miles away from Vancouver Island Bryan and Keira white lived on the Canadian mainland an avid outdoorsman Bryan started to feel strangely sluggish in the late summer of 2001 [Music] suffering from chills in a fever he thought he was coming down with the flu [Music] eventually the symptoms subsided except the chest pain it only grew worse within hours Brian was rushed to a Vancouver emergency room convinced he was having a heart attack his wife Kara couldn't believe what was happening to her husband brian has always been an incredibly fit outdoorsy healthy guy so for him to to get something of this type was was just kind of like being hit by a bolt of lightning ER doctors hooked Brian up to a heart monitor and did an electrocardiograph the doctors quickly determined that Brian was not having a heart attack as the chest pains continued Kara white became more concerned it was quite clear that this case was somewhat perplexing so they right away concentrated on the area of the chest but you know they didn't even know if it's lungs initially but then as they narrowed it down to lungs then then they saw the growth on the lungs a chest x-ray revealed a large suspicious mass doctors told the whites that it looked like Brian had cancer over the next two weeks Brian endured a brutal regimen of testing as well as x-rays he had cat scan and he had blood tests everything that was possible to go over him with a fine-tooth comb was was done with Brian finally Brian underwent a biopsy so that doctors could obtain a sample of his lung the retrieved tissue was sent to a lab where it was examined and cultured the results came back negative for cancer but positive for a fungus the findings were confirmed Brian had Cryptococcus these extreme symptoms were so rare to see two cases within several months was more than just unusual it was alarming health officials feared that the Cryptococcus was transforming morphing into something much more dangerous than they'd ever seen before in the late summer of 2001 an unusual infection caused by a fungus known as Cryptococcus had struck two residents of Vancouver Island public health officials in Canada put out an alert for patients with flu-like symptoms who weren't responding to antibiotics Brian White turned out to be one of a half-dozen patients who fit that description in an average year doctors would see just one or two cases related to the fungus in patients with compromised immune systems all that was starting to change I think our worst fear is that what we're seeing is the tip of the iceberg in the sickest patients and is this the beginning of an outbreak that's going to affect a whole lot of people searching for clues health officials decided to take another look at tissue samples from the infected patients technicians perform cero typing tests to examine the organism structure and help identify it what they found was surprising they were dealing with a strain of Cryptococcus known as neoformans Gaddy aye a strain that had never before been seen in Canada and one that could be deadly the news chain that we're talking about variety Gallo is much more virulent it's able to cause illness in people with normal immune systems microscopic spores of the fungus can infect the lungs left untreated the infection can spread to the central nervous system and all through the body resulting in death this strain is most commonly found in tropical parts of the world where it lives in the forests it's been described quite commonly in Australia where it's been associated with the eucalyptus tree and also in South and Central America and Africa were again eucalyptus she's been a common source for it but some other tropical and subtropical trees as well Cryptococcus can also grow in soil and rotting wood leaves and mulch health investigators took environmental samples from around Bryan White's home with this new strain investigators had no idea where it had come from or where to find it trying to pinpoint the source of the infections epidemiologist began questioning all the people who had become sick now recovering Bryan white the one patient who did not live on the island detailed where he had traveled over the past year Bryan revealed that he had recently been to Borneo a South Pacific island [Music] investigators wondered if he could have picked up the illness there then again he had also recently been to Vancouver Island hiking in the back woods investigators would need to turn elsewhere for answers health officials next interviewed Arthur laves wife Carol while people after six weeks of recovery Arthur was too weak to talk to investigators Carroll revealed that they had not traveled at all before Arthur became ill this meant Arthur could have been exposed somewhere on Vancouver Island even his own backyard believing he could have contracted the fungus from the compost or topsoil in his garden they collected samples of each for testing [Music] samples from both patients yards were sent to the University of British Columbia to be checked for Cryptococcus lab tech swab petri dishes and allowed the cultures to grow for 48 hours but the findings were not what they expected the results were all negative we thought we might have a link but we didn't turn up anything desperate for answers the Health Authority decided to contact their counterparts at the British Columbia Center for Disease Control the provincial CDC put out a wide-scale alert an unusual strain of fungus was on the rise doctors would have to be extra vigilant the responses came in almost immediately the first surprise the CDC began hearing about an increase in Cryptococcus infections among wild animals the dead creatures were sent to a lab for autopsy tissue samples were taken for testing the results clear evidence of the new Cryptococcus in this case we had an elevated number all in animals with no pre-existing disease so right away that was highly unusual beyond the wild animals the island residents were also reporting an increase in respiratory infections among domestic pets something was attacking the animals lungs and nervous systems the vet took cultures from the sick animals they too were positive for the fungus so around the same time as we were finding cases in humans the veterinarians are finding cases in animals and they assured us that this was a brand new finding so again this was just added more intrigue to this whole mystery because where are the animals getting it Cryptococcus was proving to be one of the very few diseases that could infect animals and humans alike all living things were potential victims and public health officials began to confront their worst fear that the outbreak might start spreading to the mainland before they could find the source a rare fungal infection known as Cryptococcus was attacking residents of Vancouver Island on the west coast of Canada investigators from British Columbia CDC had sent out an alert to area doctors trying to determine the scope of the outbreak what they learned was alarming dr. Jeanne Adams read the alert and suspected that one of her patients had suffered from the same illness but two years earlier in 1999 Murray Benson an otherwise healthy 40 year old woman had died from an untreatable form of meningitis in light of the alert dr. Adams now suspected Murray died of Cryptococcus fortunately the doctor had a frozen sample of the patient's spinal fluid she sent the isolate over to the CDC office along with the medical records at the British Columbia Center for Disease Control scientists thought and cultured the sample if this woman had died from Cryptococcus it meant that Vancouver Island had a killer on its hands and for much longer than anyone had realized soon they had their answer the woman's tissue sample tested positive for Cryptococcus neoformans Gaddy eye it was time to intensify the hunt for the source of the disease they knew that the deadly fungus can live in trees but in an island of forests finding which trees would be the daunting task as investigators race to find the origin of the Cryptococcus more residents on Vancouver Island were getting sick an outbreak was underway CDC investigators decided it was time to conduct a risk analysis they needed to find a common link between the patients to figure out where the disease had come from local and provincial health officials reviewed all of the patient information by the winter of 2001 they knew of over 30 cases of Cryptococcus the age span of the patients ranged from an 11 year old child to an 87 year old retiree they had only one thing in common they had all visited or lived on Vancouver Island that still left several thousand square miles to investigate on the hunt for clues the researchers turned to the Center for coastal health a veterinary agency because animals tend to stay close to their habitats the investigators thought they might help locate the source of the fungus [Music] dr. Craig Steven began conducting his own study of the animal outbreak by talking to pet owners as well so just like the people we did a case control study for the animal so we would find animals who've had the disease and match them to animals that didn't and then ask the owners about what they ate their medical history their travel history medical investigators logged where the two dozen infected pets had lived and travelled with their owners what they found was that the animals and people had in fact intersected at one part of the island it was called the douglas-fir zone and it contained a large public park for microbiologist Karen Bartlett the idea made sense this particular zone is very interesting because it's a different climate than anywhere else in British Columbia they're different trees that are associated with that zone and they're milder warmer winters and very dry summers so that was our first clue that the organism might be localizing because of the climate the wooded land had a number of places where Cryptococcus could thrive [Music] epidemiologist thought they had found the source of the outbreak now they had to prove it in a park that stretched on for miles containing thousands of trees the team took tree samples entering in the coordinates with a global positioning system the system is accurate to within five feet that way they could find the exact tree again we went through a series of different sampling techniques initially we were looking at taking what we call bulk samples which is to basically take a baggie and scoop out any woody debris in for example the Boles of trees or where a limb has fallen off the team of scientists spread out to process the park in tropical climates the virulent Cryptococcus is most commonly associated with eucalyptus trees but investigators decided to cast a wide net testing all types of trees in hopes of finding traces of the fungus one of the interesting things about the Cryptococcus neoformans gattie eye is that it has as part of its life cycle it needs to live in trees and this was an unusual manifestation typically in infectious diseases we're studying organisms that are passed from person to person in this particular case it's different that it's passed from trees to people microbiologists at the University of British Columbia took the samples from the park and prepared them by putting them in a liquid solution then the solution was cultured to see if the fungus was present there are lots of other fungi that grow in and around trees and so I was getting lots and lots of things growing on the plates but not the thing I was looking for as the source of the Cryptococcus remained a mystery the number of those suffering just kept growing on Tuesday February 26 2002 Deborah Chau brought her sister Esther young to a local Vancouver Island Hospital a long sickness of flu-like symptoms had taken a terrible turn Esther had developed extreme back and neck pain double vision and a tingling in her hands Deborah had never seen her sister so sick she couldn't lay down she couldn't sit up she couldn't stand up the pain was so bad and I was very concerned and worried the doctor put Esther on morphine for her terrible pain infectious disease specialist dr. Wayne guess choir was called in to assist on Esther's case he ordered a series of tests including a cat scan and a spinal tap as he reviewed the cat scan there seemed to be nothing unusual in the results in the hospital lab Esther's spinal fluid appeared cloudy an indication she was suffering from a severe infection then further testing showed that Esther spinal fluid contained Cryptococcus Esther's physician was alarmed at how an otherwise healthy woman could be so severely sick he put Esther on antifungal medications and reported the case to the British Columbia Center for Disease Control it marked the 40th known Cryptococcus case since the outbreak had begun as one more victim struggled for life the source of her disease remained as elusive as ever and the danger would only keep growing [Music] in early 2002 medical investigators around vancouver island canada pursued a new killer that had sprung up in their area a fungus called Cryptococcus neoformans Gaddy eye dozens of residents had contracted painful life-threatening infections with an entire island at risk health officials were racing to locate the exact source of the fungus before more fell ill scientists at the British Columbia Center for Disease Control believed it was centered in one specific part where many of the victims had gone very early on in the process we realized that the case is for clustering on the east coast of Vancouver Island there's a lot of trees on the east coast of Vancouver Island and to be most efficient in looking for the organism then we went to places where either cases of human or animal had been reported after several weeks of searching scientists had a breakthrough when they located a Douglas fir tree that tested positive for the fungus we finally found a positive sample at which point the whole picture changed and we realized that we were on the right track microbiologist returned to the area where they had found Cryptococcus dr. Bartlett wanted to figure out how it was passed to people the primary hypothesis that patients could have inhaled the fungus she decided to test the air the team used handheld samplers containing small strips that trap particles as they filter the air dr. Bartlet also set up air slit samplers on the ground and high in the trees throughout the park these devices hold several petri dishes within a metal container a battery-powered pump pulls air in through the device the unique design mimics the human respiratory system the next day the scientists retrieved their samples from the park they incubated the petri dishes in hopes that Cryptococcus would grow the results this time were conclusive they not only found proof that Cryptococcus spores were in the park but that massive quantities were floating in the air we found not only the organism was in air all around the trees but it was in high concentration around the trees and this was the first time that this has ever been reported in the world the fungus was everywhere they found a thousand units per cubic meter 40 times higher than ever recorded in the world Cryptococcus was far too widespread to eradicate even if there was a pesticide type of thing that you could use in the environment that we kill Cryptococcus the problem is is probably gonna kill all kinds of other essential organisms that are important for the ecosystem so that really isn't an option even though investigators didn't know how the fungus got there they needed to inform the public it was in a public park that some 700,000 people visit every year and we had to find a way of getting the information out to people that there was a potential that they could potentially be part that everybody wants to be in On June 6 2002 the British Columbia Center for Disease Control issued a public health advisory on Cryptococcus neoformans Gaddy eye they also held a press conference if they have never ever in the world documented a cluster of patients like we have this is the first time ever in the world that they've had to so many patients that we consider this to be a new event though previously unknown on Vancouver Island a deadly form of Cryptococcus had affected Australia for decades the Canadian sent slides of their strain to Australia for comparison scientists there perform genetic fingerprinting on the samples they found that the Canadian fungus was identical to the Australian strain Cryptococcus neoformans Gaddy eye in the tropical regions of Australia residents rarely develop sickness from the Gaddy eye strain because they build up natural immunities to it somehow the deadly strain had left 10,000 miles of ocean and appeared half a world away in Australia the rate of infection was only one in a million but Vancouver Island had already seen a rate nearly 10 times that we think that what happens is that the majority of people are exposed to this in the environment and their body develops immunity to it without them even becoming ill no one knew how long it would take for the Vancouver Island residents to develop a natural immunity until then people of all walks of life remained vulnerable [Music] Cryptococcus had already killed one and infected 52 others in the Vancouver Island area it was only a matter of time before the fungus claimed its next victims [Music] a deadly fungus was striking residents and visitors on Vancouver Island Canada once a strictly tropical infection a virulent strain of Cryptococcus had migrated to British Columbia where the population had little immunity in late summer 2002 nearly three years after the outbreak began Esther young struggled for her life against the fungus she was losing a significant amount of weight due to the nausea and unable to keep down food her headaches had a record and her overall fatigue got to the point where she found it very difficult to cope despite treatment she continued to develop a whole series of complications from the infection she lost 35 pounds and became blind in one eye [Music] Debra Chao watched helplessly as her sister deteriorated I was feeling my sister was dying and those were the words that came out of my mouth when I went and saw the doctor I said my sister's dying you've got to do something [Music] Esther now needed help to breathe despite the therapy Esther's condition did not improve it all in fact she was slowly deteriorating doctors gave her morphine for the pain they also performed an MRI to see if the fungal infection had penetrated her brain at this point it was not just a meningitis in other words an infection around the brain now the infection was inside the brain was now involving very integral parts of the brain which was a major change the doctors told Deborah that Esther was not responding to treatment on August 8 2002 Esther young quietly passed away from pneumonia brought on by the Cryptococcus infection for health officials the tragedy was doubly alarming they didn't know why Esther hadn't recovered with treatment and why she was the only one not to respond to medication why the drugs weren't working is still a mystery we still don't know is there something unique about Esther we knew she was a unique lady but was there something unique about her illness was there something unique about the type of fungal infection she had that made this what appeared like virtually impossible to recover from today the big question remains unanswered how to stop it our first year in 99 we had six cases that we know of the next year in 2000 we had 11 cases in 2001 we had 17 cases and about midway through 2002 we already had 19 cases so our worst fears are that you know the outbreak is gonna get bigger perhaps even tourists might be affected on brief visits to the island warning signs are still posted in area parks informing the public of the dangers posed by the fungus dr. Pamela Gibbs II and her colleagues believed that the best defense is awareness we feel it's our responsibility to let visitors to the island and people who live here know that this fungus has the possibility of being a very severe disease investigators still have not been able to track down exactly how the organism was introduced on Vancouver Island but they do have several theories they speculate that Cryptococcus arrived from Australia on imported plants or trees once in Canada winds could have lifted the spores and deposited them in native trees and soil for dr. Craig Stephen and the rest of the team the animal deaths have also shed light on another possible source in 2000 several dead porpoises washed up on the shores of Vancouver Island when dr. Stephen examined the animals lungs he found them filled with Cryptococcus investigators wondered if the fungus could have been carried around the world on water currents and inhaled by porpoises whatever the source health professionals can only prevent more deaths by educating the public to watch for symptoms early and long treatment with antifungal medication is the best weapon the only weapon against the organism arthur lab survived his bout with Cryptococcus he continues to live with his wife Carol and his daughter Angela on Vancouver Island life is just getting back to normal Arthur doesn't work as many hours or as long as what he used to Brian White has regained most of his formerly active life as well he lives with his wife Kara and daughter in North Vancouver having beaten the fungus doctors believe Brian may now be immune to it I think it's made me feel a bit more vulnerable I think I got a bit more of a spring in my step a bit more clear about my priorities about getting things done about paying attention to the little things in life to this day over fifty cases and two deaths from Cryptococcus have been reported on Vancouver Island the outbreak is ongoing and the fungus is still reported in high concentrations in the douglas-fir zone scientists continue to track it hoping to find a way to stop the lethal disease in time the people of Vancouver Island may well develop an immunity until they do the deadly spores are still a threat an ancient killer floating in the air [Music] [Music]