by Many people have heard of the randomized clinical trial, the “gold standard” of medical evidence, with results breathlessly making headline news. But what about the other kinds of evidence that make up evidence-based medicine? The first layer of evidence is the case report. Let’s learn more about case reports and a case of bartonellosis that has become known as “Swamp Boy.”
What is a case report?
Case reports are reports from clinicians, sometimes compiled with input from other professionals, about an observation from clinical practice. They may describe unusual symptoms, unusual diagnostic results, or unusual responses to treatments. They raise awareness about issues faced by clinicians that do not have clear answers. A series of case reports may be used as evidence to encourage government, nonprofits, or private investors to fund further research. This research can develop new diagnostic tools and therapeutics, or better characterize the disease. This can lead to a higher standard of care and accessible testing with standardized insurance coding.
Advances in medical diagnostics often hinge on clinical case reports. They help us advocate for research to support better diagnostic tools. Clinical case reports are especially important in the world of emerging infectious disease. Case reports serve as documented evidence of infectious organisms and the impact they have on an individual’s health and well-being. They often help providers understand new illnesses and identify infection among their own patient population.
Clinical case studies aren’t just beneficial for providers, they can help patients as well. They can serve as a general guide and resource to help patients start asking the correct questions. Clinical case studies may provide them with background and information that will get them one step closer to treatment. A patient may recognize themselves in a case report and take questions to their physicians that can help lead to better diagnosis and treatment.
Swamp Boy – A Case Report
In 2019, Galaxy Diagnostics co-founders Edward B. Breitschwerdt and Ricardo G. Maggi and medical director B. Robert Mozayeni, along with consulting physicians and others at the North Carolina State University (NCSU) College of Veterinary Medicine, published a clinical case report titled “Bartonella henselae bloodstream infection in a boy with pediatric acute-onset neuropsychiatric syndrome” in the Journal of Central Nervous System Disease.
Bartonella species infection is an excellent example of why clinical case reports can be beneficial to both providers and patients. Bartonella is a genus of infectious bacterium associated with fleas and other vectors that is increasingly associated with a range of chronic symptoms in humans. It is elusive and slow-growing. It can hide in non-reservoir hosts like humans. On top of that, it is an emerging infectious disease.
This case report follows a young patient who experienced psychotic symptoms over an 18-month period, including 4 hospitalizations. Conventional treatments for mental illness and autoimmune diseases did not relieve his symptoms. Meanwhile, medical bills were piling up. However, once his Bartonella henselae infection was identified, antibiotic treatment led to improvement.
This case report received some attention at the time, with stories on Fox News and articles in the New York Post, Gizmodo, and more.
A New Level of Public Awareness
Over the last two years, we have worked with Kris Newby, a journalist and writer, and Vox Media to make our 2019 case report accessible to the public. In October of 2022, NowThis media and Epic Magazine released Swamp Boy.
Swamp Boy chronicles the medical journey of Michael Campbell (a fictitious name to protect privacy) and his fight against bartonellosis. The article provides important context to Michael’s story and grounds him as an everyday person. This story describes the many hoops patients may have to jump through and the extraordinary expenses they may face as they struggle to find appropriate care when their condition is caused by an emerging or lesser known disease. It also shows providers how more sensitive diagnostics tools can raise the standard of care for their practice.
“Galaxy Diagnostics was founded to facilitate a more accurate diagnosis of Bartonella species infection (bartonellosis) and infections by other vector-borne pathogens,” said Amanda Elam, president and chief executive officer of Galaxy Diagnostics. “Every day, patients tell us how diagnosis has changed their lives. This case study demonstrates how dramatically an accurate diagnosis can affect the course of a young person’s life.”
Following the publication of the Swamp Boy graphic article, the case was used as an example of a framework for thinking about contested diseases in a New York Times publication.
Conclusion
Clinical case reports should be shared with the general public. They can give patients background and context for their own illnesses. They can raise important issues about the financial impact of pursuing testing and treatment. Case reports can serve as relatable stories that empower patients to ask questions that may lead to testing and care. Unfortunately, case reports are not always accessible. They may be hidden behind a paywall or filled with complicated language most people without medical or scientific training would have difficulty understanding.
At the same time, the medical researchers who can provide context for the case reports are often at hospitals and universities or at biotech companies and not accessible to journalists who can translate these stories into accessible media for the general public. An ongoing challenge in health education is how to bring all of these specialists together to do what they do best and develop information that is useful to patients.
Galaxy Diagnostics is pleased to have contributed to the group of research, clinical and media specialists who brought this story to the public. Providing scientifically accurate information to specialists and patients and advocating for testing accessibility has been something we have embraced as a vital activity in the diagnosis of vector-borne disease.
Burns, P. B. et al. (2011). The levels of evidence and their role in evidence-based medicine. Plastic and Reconstructive Surgery, 128(1), 305-310. https://doi.org/10.1097/PRS.0b013e318219c171 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124652/
Murad, M. H. et al. (2016). New evidence pyramid. BMJ Evidence-Based Medicine, 21(4), 125-127. http://dx.doi.org/10.1136/ebmed-2016-110401 https://ebm.bmj.com/content/21/4/125