An Online Wellness Magazine produced by The University of Texas Health Science Center at Houston (UTHealth)

Knowing the Enemy

Biggest battle facing humankind becomes personal for UTHealth student

By 2050, more people are predicted to die from drug-resistant infections than cancer. That alarming projection fuels microbiology and infectious diseases student Ayesha Khan’s tireless drive to win the war against superbugs at a center dedicated to this cause at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).

Guided by her supervisors, Cesar Arias, M.D., Ph.D., and William Miller, M.D., Khan is tasked with unraveling the DNA of the most persistent and lethal bacteria that have invaded patients, looking for innovative ways to outsmart the infection. Arias is a professor of infectious diseases who leads the Center of Antimicrobial Resistance and Microbial Genomics at McGovern Medical School, where Miller is assistant professor of infectious diseases.

An invisible issue

In an ironic twist of fate, the UTHealth MD Anderson Graduate School of Biomedical Sciences doctorate student found herself fighting this battle away from the lab bench and in a hospital bed. It began when she lost her voice to a persistent sore throat. Despite three rounds of oral antibiotics and two emergency room visits, she wound up in the hospital on intravenous antibiotics fighting a serious battle against a frightening infection.

But thanks to the expert care of Miller, Arias and Ron Karni, M.D., associate professor of head and neck surgery at McGovern Medical School, Khan was able to return to the bench to continue her vital work.

“To the human eye, infectious diseases and antibiotic resistance are an invisible issue. But resilient microbes are everywhere, constantly evolving to be stronger and they could have fatal consequences for everyone, including me,” Khan says. “That’s exactly what nearly happened and why, having worked on it as a microbiologist and experienced it as a patient, I’m even more passionate about finding ways to outwit and destroy these really nasty and increasingly clever superbugs.”

The 24-year-old’s struggle began in March with the troublesome sore throat. She thought nothing of it at first but after it didn’t budge, she visited a doctor who put her on antibiotics.

“It was a really bad case of strep throat, but I assumed the antibiotics would clear it. Most people suffering from strep throat would feel better within days. Instead, I kept getting worse,” Khan says. “I was prescribed stronger antibiotics. Still no change. Even combining two antibiotics didn’t make any difference.”

Her condition deteriorated to a desperate point where she could scarcely speak and was unable to swallow.

“I woke up in the middle of the night drooling. I was hungry and dehydrated but couldn’t eat or drink. Even breathing became really difficult,” Khan says.

Fortunately, her fiancé Omar Jishi was visiting at the time and he rushed her to the emergency center at Memorial Hermann-Texas Medical Center. Khan was treated with intravenous antibiotics to attack the infection more directly and doctors removed a large abscess that had formed in her throat to drain the infection and reduce the swelling that tightened her airway.

Within a week, she appeared to be back to her former good health and returned to work, conducting cutting-edge research and helping to find treatments for infected patients, who often have serious underlying conditions.

Aggressive and persistent

However, superbugs don’t always give up that easily — and what doesn’t kill them often only makes them stronger. Although the antibiotics initially helped the infection subside, some of the bacteria remained and continued multiplying, resulting in its return.

“My strep throat struck back with a vengeance in July. It was a rare strain of streptococcus, which was particularly aggressive,” Khan says. “Recurring throat infections are more common in children than adults and because I had no issues as a child, this was unusual. I could have picked it up from anywhere. The bottom line is that if the antibiotics don’t completely clear the infection, it will keep coming back. Every time I got more antibiotics, the few bugs that remained behind got stronger and more resistant.”

Khan ended up back in emergency department, but this time doctors couldn’t simply drain the infection since the abscess was much deeper and inaccessible.

“I had an extremely high fever and couldn’t see straight. It was like reliving the nightmare all over but this time there was no immediate solution. They tried to drain the abscess multiple times but it was futile because it was buried too deep. That’s what superbugs do – they evolve and take hold. Eventually, I asked the doctors to stop. I was in too much pain,” Khan says.

Concerned about what had become a serious, life-threatening infection, Miller and Arias became her doctors.

“They took me under their wing and advocated for my care, when I couldn’t speak,” Khan says. “Together we decided the best, or only real chance, of beating this infection for good was to eradicate its source and remove my tonsils.”

They called on Karni, a surgical expert in this area, to join the team. However, another dilemma lay ahead. Operating too soon with the infection still raging risked the possibility of the infection entering and poisoning her bloodstream. Their calculated patience, combined with carefully selected antibiotics, paid off and reduced the infection to a level where it was safe to operate.

“It was my first experience of such a severe infection that needed surgery, so naturally I was apprehensive,” Khan says. “Before this drama, I was an infectious diseases scientist researching these bugs. And the last time I was in hospital I was donating bone marrow as a healthy person. In times like this, you really need your mom. She works as a doctor in Dubai but came to be at my bedside and looked after me post-surgery. I couldn’t eat for 10 days, so I literally survived on ice pops, soup and energy drinks. Spicy food was out of the question for weeks, which was unfortunate because I’m Indian, and there is nothing in this world I love more than our traditional cuisine.”

Regaining her voice

Besides looking forward to a super-hot curry, something else spurred Khan’s swift recovery. She was one of just eight students selected for the highly competitive McGovern Medical School Dean’s Research Scholarship Award, which entailed one condition.

“I had to give a talk on my work on September 19th. This wouldn’t normally be a problem — eating and talking are my two favorite things, but my talk was exactly three weeks after my surgery,” Khan says. “In theory there was time for me to regain my voice, but it was tight and I had to take it slowly and rely on others to speak for me in the meantime, neither of which were easy. I mostly used a portable white board to communicate when I couldn’t speak.”

Slowly but surely her voice came back, returning in full on Sept.19 — the day of her talk about antimicrobial resistance, where she explained how bacteria aggressively adapt to evade successful treatment.

“I didn’t have a proper voice to practice with my lab mates, so I just hoped it would work out. The subject was so apt and ironic; the whole experience felt quite surreal. It’s easy to think doctors and scientists are somehow immune, but the truth is we’re all equally vulnerable and can get sick, too. Now I have a much greater understanding of exactly what it’s like to be a patient,” Khan says.

Determined to look on the bright side, Khan is convinced her experience will make her a better researcher and clinical microbiologist.

“It’s given me compassion and a whole new appreciation of family, friends, my lab mates, physicians and, of course, my fiancé. Without them, I simply wouldn’t have made it,” Khan says. “I’ve learned so much more about trust, what indescribable agony and lingering fear really feel like, how to find strength and belief in the face of weakness and despair.”

By far the hardest part of her ordeal was being forced away from her biggest passion and true calling.

“Being away from the lab and unable to work was just the worst. I felt so lost and frustrated. Now I’ve got my health and my voice back, I’m more determined than ever to help others win their fight — whatever it takes. I’m blessed to be a part of the Graduate School here where, even as a Ph.D. student, I can have an impact on immediate patient care,” Khan says.

Miller is clear that superbugs may have met their match in Khan.

“Ayesha’s tremendous intellect and enthusiasm are inspiring. I’m delighted to have her back in the lab doing what she does best,” Miller says. “Through her painstaking research and tenacity, great antibiotic treatment options have been uncovered, literally saving patients’ lives.”

Arias is equally hopeful.

“Antibiotic resistance is one of the biggest public health problems facing the world,” Arias says. “UTHealth is at the very forefront of tackling this, and Ayesha is making great strides as a budding clinical microbiologist on our team. By uniting scientists and physicians, we are having a tangible impact and I’m sure Ayesha’s role in this will only grow and become more formidable.”

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