The Doctor Is In: Medical-Veterinary Entomology Clinics for Undergraduates

It is Thanksgiving dinner in Akron, Ohio. Aunt Roberta has just returned from her IPM (Integrated Pest Management) field sites near Timbuktu in Mali, Asmara in Eritrea, and Entebbe in eastern Uganda. She is spending the brief holiday with her niece and nephew and their families, as usual. Aunt Roberta, generally quite a lively person, was subdued when she arrived this year. She had thought she had a mild bout of malaria when she was at her last field site in Uganda. But, she said, she had recovered completely from that. However, since she arrived in Akron a few days ago, she said she had been feeling poorly. She said it felt like delayed jet lag. At Thanksgiving dinner, her niece and nephew and their children noticed that Aunt Roberta could not follow the conversation and had forgotten to pass the peas even though asked twice. By the time the pumpkin pie was served, Aunt Roberta was slumped in her chair.Her niece tried to rouse her, but it was clear that she was losing consciousness. The niece and nephew rushed her to the emergency room. There, her family mentioned only that "Aunt Roberta iust isn't herself. " The physician and nurses neglected to ask questions that would elicit information about where she had been traveling. In the emergency room, Aunt Roberta now is forgetting the names of her niece and nephew. She begins to hallucinate about light trap collections but does not remember to mention her recent overseas travels and their locations. While in the emergency room, her blood smears and serum profiles are mildly abnormal (i.e., elevated liver enzymes, thrombocytopenia [low platelets], and elevated white blood cells with normocytic anemia). Her EKG (electrocardiogram) shows a few premature beats but otherwise is normal with some delayed conduction. Her physical examination is written up describing her as a 42-year-old white female with altered mental status and stupor, slight purpura on her ankles and abdomen, slight tremor in the face, and a low grade fever. The emergency room staff is puzzled. Meningitis is the tentative diagnosis and a lumbar puncture is performed. The cerebrospinal fluid (eSF) has mildly elevated white blood cells (neutrophils), elevated total protein, and negative Gram stain. Aunt Roberta is admitted to the hospital with a diagnosis of meningitis, possibly bacterial, and placed on a regime of i.v. (intravenous) antibiotics, seftriaxone, and ampicillin. However, she