<snip>

IC: Once Zoi left, Brad stewed over the case file for a while, before sighing. This was not a one-man case, even when he’d been a hot-shot diagnostician at Starfleet Medical he’d had a team to assist and debate ideas with.

=/\=Walker to Alexis Kane. Could you stop by my office please?=/\=

Cmdr. Dr. Brad Walker
Chief of Staff

=/\=On my way Commander.=/\= Alexis was off shift. She paused at her quarters and let Frigga inside before heading to primary sickbay. She entered and went straight to Walker’s office. She pressed the chime and waited.

Lt. Cmdr. Kane, AMO

The door slid open without a word. The overhead lights were off, with some dim side-table lamps providing the only illumination in the room. On the back wall was a patient file, but the patient’s name was obscured. A fairly impressive list of symptoms, and already-tried treatments, was on display.

“Dr. Kane, thanks for coming,” Brad said from a position near his desk, but not behind it.

Cmdr. Dr. Brad Walker
Chief of Staff

“Of course,” Alexis said crisply. Her attention was immediately drawn to the chart on the screen.

The medical info showed the following:

Patient Symptoms:
Fatigue, brain fog, aches (especially in the areas of previous injury), insomnia (difficulty falling asleep), unexplained dizziness, weight loss.

Testing:
Out of the series of tests (Complete blood panel, white cell count, standard hormone levels), everything was normal compared to patient’s baseline except for:

White Blood Cell count: slightly elevated
Albumin: Slightly Low
Total Protein: high globulin (resulting in an abnormal albumin/globulin (A/G) ratio)
Liver Enzymes: Normal, except very tiny increase in ALT, but still within a normal range
Thyroid- Low thyroxine (T4)
C-reactive protein test- moderate elevation
Cancer markers: negative
Antibody test results: negative for all the conditions they were testing for. Whatever it was, it wasn’t a specific autoimmune disease, even though it was making the body react as if it was.

Brain scan which showed cortex swelling. Patient just recently collapsed in Sickbay. They were holding their head and then passed out. Scan showed raised cortisol levels, a low BP and arrhythmia. The arrhythmia might be tied to the dizziness symptom.

A psychic attack was deemed unlikely by the patient (a telepath) given that their psilosynine levels were normal and the symptoms still occurred even when telepathic contact was not possible. So far the team was looking at overarching systemic causes, but it was suggested that perhaps it could be something on a smaller level.

~Helpful Computer

“My first reaction is this could be Seronegative Autoimmune encephalitis with hypothalamic involvement. But given the patient is telepathic, it could be Psionic Feedback Encephalopathy (OOC: something just made up. Autoimmune encephalitis specifically triggered by telepathic overload or external psychic interference.) However all of these scans have been very broad. We should run deep cellular scans,” Alexis stated.

Lt. Cmdr. Kane, AMO

Brad cocked his head and considered the thought. Neurology had never been something he’d ever seriously trained in, beyond ‘how-to-recognize-and-treat-a-concussion’, nor was it a specialty of any of the prior treatment team as far as he could remember. It was certainly an avenue to investigate.

“Would the patient need to be awake for those?” Brad asked. “Because I just put them on a 12-hour sedative about 90 minutes ago.”

Cmdr. Dr. Brad Walker
Chief of Staff

“No. It would be much faster, since that patient is less likely to wiggle and move and be restless. The tests for both Seronegative Autoimmune encephalitis with hypothalamic involvement and Psionic Feedback Encephalopathy are quick. The Deep cellular scans will take much longer, so the patient would be more comfortable asleep,” Alexis said.

Lt. Cmdr. Kane, AMO

Brad typed out the orders for the tests. All three could be conducted over the next eight hours, with the results on his desk for review before Dira awoke from her sedative-induced nap.

“I’ve ordered the tests,” he told Alexis. “They should be ready for review by 0800. That should give us about two hours to review the results before the patient’s sedative wears off.”

Cmdr. Dr. Brad Walker
Chief of Staff

Alexis nodded, “I’ll be back before 0800 then. Is there anything else, Dr?”

Lt. Cmdr. Kane, AMO

“No, Doctor, thank you for the suggestion. We’ve really been struggling to pin down the cause of this patient’s issues, this is a new avenue of investigation we’ve yet to consider,” Brad said, turning off the displays in his office.

“I’ll see you then,” he said.

OOC: We can flash forward, if Linds wants to put in the results for us to review?

IC: On it. :D Since he hasn’t told Alexis the patient is Dira, I haven’t given anything additional that might reference her specifically. But ask and I shall deliver (if I can).

IC: Brad walked into his office at 0730, sipping from a travel mug of coffee, and noting a blinking message light on his computer.

It was the results from the tests he’d ordered on the Captain the previous night.

Cmdr. Dr. Brad Walker
Chief of Staff

A few minutes later, Dr. Alexis Kane pressed the chime outside Dr. Walker’s office.

Lt. Cmdr. Kane, AMO

“Perfect timing,” Brad said as he opened the door. “The results are in, I was just about to pull them up.”

Both the tests for Encephalopathy and encephalitis were negative.

The deep cellular scans, however, showed something unexpected, something their pervious scans would not have been able to detect: embedded in the walls of many (but not all cells), was a stealth pathogen. This particular pathogen took the form of a fungus. In this semi-dormant state, the fungus seemed inactive and wasn’t growing, but was secreting toxins in minute amounts. It’s small enough that a person’s immune system doesn’t register the threat and doesn’t know to attack it.

“Huh,” Brad said idly.

Over time, stealth toxins like the one this fungus was releasing into the patient’s system kill the healthy cells they attack and force the liver to work harder resulting in a condition called toxic overload. Some of the early symptoms of toxic overload were headache, insomnia, fatigue, dizziness, tingling, malaise, joint pain and brain fog.

This state causes extra cortisol production as the body is now under stress it can’t do anything about, triggering a vicious cycle that can go on for a long time and eventually affects all organs and can lead to organ failure, usually with the liver being compromised first.

Interestingly, when the fungus was investigated it was the same fungus they had encountered at Starbase 157 when many people had thought they were in Alice and Wonderland. Since everyone exposed was treated, there were a couple possibilities: either the patient’s physiology made the treatment less effective, or perhaps they encountered minute amounts of the fungus after the initial treatment. Either way, the fungus lay dormant and undetected in her body until it was triggered to be more active and start releasing toxins. It was a known fact that stealth illnesses could be triggered by extreme stress (and thus a weakened immune system).

“Oh for crying out loud,” Brad moaned. “Not that bloody thing again!”

Captain Myqian, CO

Cmdr. Dr. Brad Walker
Chief of Staff