>From Scientific American July 10, 2018
Rescued Thai Boys Being Watched for Illnesses Caught from Cave Animals
Medical responders will be on the lookout for signs of infection
* By Dina Fine Maron on July 10, 2018
Thai police stand guard at the Tham Luang cave area as operations continue for
the 12 boys and their coach trapped at the cave in Khun Nam Nang Non Forest
Park in the Mae Sai district of Chiang Rai province on July 8, 2018. Credit:
Lillian Suwanrumpha Getty Images
Youth soccer team members rescued more than two weeks after sudden flooding
trapped them in a cave complex in Thailand are now convalescing at a hospital
in the northern city of Chiang Rai. In addition to treating the boys for
potential dehydration, malnutrition and oxygen depravation, their doctors also
plan to closely monitor them for symptoms of diseases that may have been
transmitted by animals living in the cave system. Operations were underway at
the time of publication to rescue the 12 boys (ages 11 to 17) and their coach.
The “next step is to make sure those kids and their families are safe, because
living in a cave has a different environment, which might contain animals that
could transmit…disease,” news reports quoted a statement from Chiangrai
Prachanukroh Hospital as saying. The boys and their family members have been
told to watch for symptoms such as headache, nausea, muscle pain or difficulty
breathing, the reports added.
Yet based on the location where the boys were trapped—more than four kilometers
from the cave complex’s main entrance, past some fully submerged passages—and
the fact they have been swimming out wearing full scuba face masks, it seems
unlikely that they were living with bats in the cave or breathed in
bat-associated pathogens during their rescue, several infectious disease
experts told Scientific American. “It’s hard to imagine bats got that deep into
the cave because of all those narrow passageways, but it is possible,” says Ian
Lipkin, a zoonotic expert and professor of epidemiology at the Mailman School
of Public Health at Columbia University. “It’s unlikely that there would be
many animals in there,” notes Jonathan Epstein, a veterinarian and
epidemiologist at EcoHealth Alliance, a nonprofit organization that studies
pandemics and how to prevent them. Bats typically like to roost in areas they
can easily enter and exit, not in places that fully flood, he adds.
Bats in Thailand have been linked with a wide range of viruses—including Nipah,
which can cause brain inflammation, and others that are similar to severe acute
respiratory syndrome (SARS)—Lipkin says. But it seems more likely the boys
would have been exposed to infection-causing bacteria when they swam through
the dirty water with cuts and scrapes. “If you are trying to prioritize issues
with respect to health care for these kids, number one would be psychological
damage and second will be bacterial infections from the cuts and scrapes they
may have encountered—so things like tetanus,” Lipkin says.
When the boys first receive medical care they will be asked what elements they
were exposed to and if they saw any bats or bat guano, says Amesh Adalja, an
infectious disease doctor and a senior scholar at the Johns Hopkins Center for
Health Security. Rabies, for example, is often treated prophylactically if
someone was known to be sleeping in the presence of a bat. “But if there were
no bats in the cave, that will remove a lot of concerns about things like
rabies as well as concerns about dangerous diseases spread by inhaling infected
bat droppings,” Adalja says.
One of the chief challenges for the boys’ care team will be teasing apart which
health problems are due to dehydration and stress and which might be signs of
infection, because the symptoms can look similar, Adalja notes. Fever and an
elevated heart rate could be due to any of those factors, he says. “These are
all things you would expect to see in someone under this type of severe
stress—not knowing if they would live or die and then going through this
harrowing rescue.”
Other than treating any scrapes and bruises with antiseptic to stave off
infection, there may be relatively common gastrointestinal problems that will
also need to be watched. The team would have defecated in the cave and may have
drunk contaminated water as a result, Adalja says—and that water may have also
been teeming with bacteria that surged in with the rainwater. In the days
ahead, he says, “it’s important to do a head-to-toe examination and think about
what they were exposed to in that cave and in the water.”
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