TITLE: MARYLAND RESEARCHERS; `Pfiesteria' tied to memory problems
BYLINE: PHILIP HERVEY, Staff writer
EST. PAGES: 3
DATE: 09/14/97
DOCID: MRNS21445
SOURCE: Sunday Star-News - Wilmington, N.C.; MRNS
SECTION: Local/Regional; PAGE: 1B, 5B
(Copyright 1997)
On the other end of the phone line, David Jones was struggling
to find the words.
"I know what I want to say, but it does not come out,"
Mr. Jones said.
A second-generation commercial fisherman who lives about 500
yards from the Neuse River in Craven County, Mr. Jones believes
he suffers symptoms related to exposure to Pfiesteria piscicida,
the toxic microbe blamed for fish kills in North Carolina and,
most recently, Maryland.
As he fumbled over his words, Mr. Jones was asked if he had
problems with his memory.
"That's right. OK," the 53-year-old said.
Two years ago, North Carolina health officials spoke with Mr.
Jones and others who complained of maladies after coming into
contact with the Neuse River. Today, top state health officials
in Raleigh say they still lack the scientific data to say for
sure how, or even if, the organism affects people's health.
But in Maryland, a team of medical experts in less than three
months says it has identified a "likely link" between
Pfiesteria and people believed to have come into contact with
it.
Last week, North Carolina began putting together its own team
of experts to examine whether the problems found in people in
Maryland are affecting North Carolinians - and if Pfiesteria is
to blame.
In Maryland, a team of physicians from the University of Maryland
at Baltimore and Johns Hopkins University ran medical tests looking
for suspected links between Pfiesteria and health problems in
13 commercial fishermen and state employees exposed to water in
the Pocomoke River.
The key finding: a consistent pattern of memory loss.
Of 11 patients given an in-depth neurological test, 10 had
shown the same memory deficiency, said Glenn Morris, a professor
of medicine at the University of Maryland. Other problems, such
as skin rashes, were looked at, but memory loss was the only symptom
that showed up consistently, he said.
The team classified the memory loss as "moderate."
"It's like they go to the store and they can't remember
why they went to the store, and when they go home, they can't
remember if they went to the store or not," Dr. Morris said.
In at least one instance, a patient was suffering memory loss
a month after exposure to the river.
No conclusive proof
But Dr. Morris, whose team is examining 17 more people, said
all the evidence so far is circumstantial. Establishing a concrete
link with Pfiesteria could take years of research.
"What we have is one single data point," he said.
"There are dozens, if not hundreds of questions" left
to answer - the duration of the symptoms, the amount of exposure
required, whether the source is through skin contact with the
water or via the respiratory system. Or even if Pfiesteria is
to blame.
"We don't know why this happens, or what the mechanism
is. We don't know how these persons have been exposed to the toxin.
We're not 100 percent sure it is the toxin in the water,"
he said.
"But it is a reasonable hypothesis that rivers containing
large numbers of Pfiesteria organisms may cause health problems
in humans."
Maryland and North Carolina might not even be dealing with
the same kind of Pfiesteria, he added.
North Carolina's team will include at least two representatives
each from the medical schools at University of North Carolina
at Chapel Hill, Duke University and East Carolina University.
An official from the Center for Disease Control is also involved.
The state is keeping panel members' names confidential, said Debbie
Crane, spokesman for the Department of Health and Human Services.
A key component of the study will be information collected
through a toll-free number set up to field calls from people who
think they have been exposed to Pfiesteria. The number, (800)
662-7030, is staffed from 8 a.m. to 5 p.m. weekdays.
By Friday, the fourth day of the hotline, about 45 people had
called in and answered a 35-minute questionnaire designed by Maryland
officials. Red flags include complaints about burning skin and
respiratory problems, Ms. Crane said. The state is also checking
people's medical history.
The state is less interested in rashes and skin irritations,
she said. The Maryland team did biopsies on patients with skin
problems, but found a variety of causes, such as skin cancer,
Ms. Crane said.
The state's Occupational and Environmental Epidemiology Section
will check the responses for potential candidates for physical
examinations by the medical team.
"The strategy is as soon as we get four to five days'
worth of calls, we'll see if there are any patterns," said
Stan Music, chief of the section. "We also will harvest from
this some calls we'll use to see if we have what the Marylanders
found. So we're going to do what Maryland did."
So far, no apparent pattern has emerged from the calls, he
said. Some reports are likely nothing more than chigger bites,
he said.
"Others reported big round lesions like the fish had,
chronic eczema-like activity, some respiratory problems. There
has been no pattern - it's been all over the place."
He would not name any of the symptoms that could trigger examinations
by the state.
"We want people to complain, rather than fit a pre-existing
pattern," he said. "I don't want to plant ideas. I want
people, if they have complaints, to tell us what they are."
Possible health problems caused by Pfiesteria were first reported
by N.C. State's JoAnn Burkholder, associate professor of aquatic
botany. After long exposure during research, she and a lab assistant
reported symptoms including confusion and the loss of short-term
memory and problems speaking.
The Aquatic Botany Laboratory at N.C. State's list of symptoms
experienced by researchers includes: memory loss, skin sores,
severe headaches, red eyes, blurred vision, breathing difficulties,
kidney and liver dysfunction.
Dr. Music said Thursday it's too early to say what, if any,
links there are between Pfiesteria and health problems.
"I'm willing to consider them," Dr. Music said about
the list of symptoms. "We're at a stage where nobody really
knows for sure what's going on, so everything has to be dealt
with seriously, and we have to proceed with the way science dictates."
Doctors seek guidance
In Craven County, residents remain skeptical about the state's
response.
A meeting more than a week ago between state officials and
local physicians there appeared to anger Dr. Music because it
was open to the general public, said Dr. Chris Delaney, a New
Bern physician who is a member of the Neuse River Foundation,
a group pushing for cleanup of the river.
He said criticism levied at the meeting upset Dr. Music.
"He received flak from people, but not from me,"
Dr. Delaney said. "I think people perceive that there has
not been action, and I think the facts support that. I think Maryland
had less time and less information, but did more with it."
Dr. Delaney said that despite concerns from local physicians,
few answers and little advice have filtered in from Raleigh.
"We certainly didn't get any response on how to identify
or manage patients. And there wasn't much of a feeling there was
a response in acknowledging there was a health problem here."
Another New Bern physician, Pete Rowlett, a general practitioner
at an urgent-care office, hasn't heard many physicians say they
suspect they have treated someone for a possible Pfiesteria-related
problem.
"I've seen skin infections, a puncture wound from a crab
shell, fish fin or barnacle," he said. "There's pain,
swelling, draining from the wound, but I haven't seen any sores
as described on fish."
A 1995 survey of people who might have had exposure to Pfiesteria
did not result in any physical examinations.
But Ms. Crane said that's because there was such a variety
of complaints that they couldn't narrow down the study. "They
were scattered across the board," she said. "There was
no symptomology."
`This stuff is real'
Neuse River Keeper Rick Dove, who says he has suffered a variety
of ailments, including memory loss, nausea and open, bleeding
sores, said he first noticed problems with his memory about 10
years ago, a time when fish kills were hitting the Neuse. He
said he has had his sinuses operated on and loses his voice frequently.
"I still don't know if it's old age or the water. I suspect
it's related to the water."
He still finds fault with the state's response in 1995.
"They didn't come down here, they didn't interview people.
They did it by telephone," he said.
Like Mr. Dove, Mr. Jones believes his health started to be
affected by the organism 10 years ago. In 1986, he began noticing
"bad-looking, embarrassing" sores form on his skin after
fishing trips on the Neuse and Pamlico Sound.
"More people have got the problems than they think because
they may call it the cell from hell, but it's also the creeper.
It creeps up on you. . . . Now I watch it more closely.
Look. This stuff is real, and it's bad. People just don't know.
ART: Caption: Staff art / GIL AEGERTER
DESCRIPTORS: Local/State
OTHER TERMS: Pfiesteria; health