The Wyrms of &alon

They were a couple. Ani and Jonan. They. Were. A. Couple. Girlfriend and boyfriend.

Guh.

I didn’t know which was worse: Andalon nearly giving me an undead heart-attack, Jonan, “Jonani” (Jonan’s term for their coupling), or my slowly creeping recognition that Dr. Derric might actually be as skilled as his record implied.

We—Ward E’s Crisis Management Team—sat in a meeting room off to the side of the reception area, opposite where the recent bunch of infectees had been seated. The only separation between the meeting room and the reception area was a wall of glass with a door in it. However, the glass—including the door—was filled with a transparent liquid-crystal solution that could change color and opacity at the drop of a hat. You need only input the desired settings into the wall-mounted console within the meeting room.

At the moment, people in the reception area who walked past the meeting room would have been met by idyllic footage showing broad-boughed oak trees beside a verdant pasture on a golden afternoon, with an old-fashioned big red barn standing further down the dale, mansard roof and all. I could see the rustic scenery from inside the meeting room. It was a faint apparition beneath the pale, whitewashed screen displayed on the glass’ inner side, onto which Jonan had uploaded his presentation for all to see. Somehow, Dr. Derric had managed to hook his personal account on the hospital server up the glass wall’s liquid-crystal display, so that he could manipulate the display screen from the comfort of his portable work console.

Jonan’s technological chops only grew more impressive from there. He had multiple windows open simultaneously, displaying patient close-ups, charts, lists of statistics, diagrams of cellular anatomy, as well as a whiteboard on which he could scribble ideas. And, on top of all that, he was a darn good public speaker.

“At present, rapid diagnostic tests for NFP-20 infection are still in development, though, with any luck, we should have working prototypes in a week or two. Until then, aside from direct pathological examination, confirmation of an NFP-20 diagnosis requires an observational record of one or more of the currently acknowledged characteristic symptoms. These include, but are not limited to, subdermal filaments, black sputum, epidermal nodules, necrotic ulcerations on the skin or mucous membranes. Of course, these are all for Type One infections.”

“Preferably,” Dr. Horosha said, “a rapid diagnostic test will arise sooner rather than later. It should go without saying that portable rapid diagnostic tests will be an essential ingredient in managing NFP-20 at the epidemiological level.”

“Finally,” Jonan added, gesturing at me with a nod and the tip of the stylus in his hand, “we have WeElMed’s own Dr. Genneth Howle to thank for having been the first to notice that Nalfar’s Delusion is the defining symptom of the Type Two variant of NFP-20 infection which seems to occur in a small minority of infected individuals.”

“Nalfar’s?” Ani said. “Never heard of it.”

Heggy—her elbows already on the table—leaned toward Dr. Lokanok. “It’s a delusion where you think you’re undead.”

“That’s…” Ani grimaced. “That’s horrible…”

You don’t know the half of it, I thought.

“That concludes our account of the currently known symptomatology of NFP-20 and the Green Death. Now, let’s move on to the part you’ve all been waiting for.” Jonan tapped his stylus at the corner of his console screen. Windows displayed on the wall scattered like leaves in the wind, and a new set of images popped into view. The heading Treatment Possibilities hovered at the top of the wall, indicating that Dr. Derric had moved on to the next section of his presentation.

“Treatment possibilities,” Jonan said. “From an epidemiological perspective, NFP-20 is currently the only pandemic of fungal origin known to medical science. Unfortunately—”

Frowning, Dr. Horosha shook his head. “With all due respect to the researchers at the Cartin Center, I worry that the identification of NFP-20 as a fungus might be in error.”

That raised Heggy’s eyebrow. “Oh?” She cocked her head back.

Horosha nodded. “Type Two cases notwithstanding, the Green Death is a systemic infection. Invasive systemic infections by fungal pathogens are quite rare in human beings who are not immunocompromised. Moreover, of those fungi capable of systemic infection of humans, they tend to do so opportunistically, unlike diseases such as plague, tuberculosis, or malaria, all of which are obligate pathogens. This makes the observed person-to-person transmission of NFP-20 notably uncharacteristic of a mycosis.”

“What else do you suggest it could be?” Jonan asked.

“NFP-20 may very well be a mycobacterium, rather than a fungus, in which case, treating it is going to be difficult, though in a different capacity than the difficulties associated with treating mycoses.”

“H-How so?” I asked.

Horosha steepled his fingers together. “Mycobacteria are the citadels of the microbial world. Their cellular walls are extremely thick, and tend to be extensively covered in extracellular matrices, replete with waxes and glycolipids. This makes them frustratingly difficult to stain properly for light microscopy, as well as greatly increases their resilience to most chemical attacks. For mycobacterial infections like tuberculosis, the treatment regimens require administration of antibiotics over a course of many months, if not years.”

Okay, that was bad.

Jonan pointed his stylus at Dr. Horosha. “Hold on now. I’m just as circumspect as the next guy when it comes to trusting DAISHU, but, in this situation, I happen to be inclined to believe them. DAISHU itself had assigned this little bugger the designation Novel Fungal Pathogen. They wouldn’t have done that if it wasn’t a fungus. It’s far more likely DAISHU caused the pandemic—wittingly or not—than it ever would be for them to lie or mess up when it came to properly identifying the germ responsible for it.”

“Lying is entirely within DAISHU’s purview, Dr. Derric,” I said.

“Though not apart from it, omitting unnecessary information is distinct from outright falsehood,” Dr. Horosha said.

Jonan waved his hand dismissively. “Anyhow, yes, I suppose there’s always the possibility that NFP-20 might be mycobacterial—and we can account for that contingency by including antibiotic cocktails as part of our treatment plans, but”—and this was a big but—“we need to face the very real possibility that treating NFP-20 infections is going to be frustratingly difficult.”

“Can’t you just give people antifungal drugs?” I asked. “Like for athlete’s foot.” (Not that I’d ever had it.)

“That’s the problem in a nutshell.” Jonan turned to face me. “Do you know the action mechanisms behind antibiotics?”

I wracked my thoughts in search of it, but Ani spoke up for me before I could answer.

“Calm down, Jonan,” she said. “Genneth isn’t your competition. Please don’t cause him trouble.”

“I would really appreciate that, yeah,” I said, nodding in agreement.

“The most commonly used antibiotics—the β-lactam class—function by inhibiting the biosynthesis of peptidoglycan, a key component of the cell wall of bacteria. The reason why antibiotics kill bacteria without killing the humans the bacteria are infecting is because they target components of bacterial biochemistry—such as peptidoglycan—which don’t occur in human biology. Though most people tend to think of humans and mushrooms as being rather different from one another, when we look at the biochemical and cellular levels, you and I,” he pointed at me, “have more in common with the yeasts that ferment our alcohol than we do with the bacteria that cause strep throat or pink eye.”

Horosha nodded. “Yes, this is true.”

“So what’s the hubbub?” Heggy asked.

Jonan’s expression turned grim. “Both as a hospital, and as society, I don’t think we’ve really given due weight to the challenges we’re going to face trying to treat a pandemic of fungal origin. Many of our most effective antifungal drugs come with significant side-effects because of how they interact with our biochemistry: altered estrogen level, kidney damage, liver damage, fever, seizures, inflammation of the heart, heart failure, alterations to drug metabolism, and more.”

“Yikes,” I muttered.

“I’ve taken the initiative to do research on non-standard and experimental antifungal drugs and other treatments which we should consider as part of our treatment plan for NFP-20 patients, in addition to standard workhorses like donazole, endafungin, or zintomicin.” He tapped his console screen. A list of medications unveiled itself.

“The most promising drugs I found were all enzyme inhibitors. Also, none of these have been approved by the Drug and Food Administration, but, given the stakes, that’s no reason not to use them. Some of these target enzymes not found in mammals, while others selectively inhibit the fungal orthologs of certain pan-eukaryotic enzymes. I think miforol will be our best bet. This selectively targets the fungal version of the dihydroörotate dehydrogenase enzyme, without affecting the mammalian analogue. This enzyme plays a vital role in biosynthesis of nucleic acids. There’s also gimotlin. Technically, gimotlin is a herbicide used to kill particularly hardy species of weeds, but its mechanism of action—the inhibition of the enzyme inositol phosphorylceramide synthase—also applies to many species of fungi. There’s also bluzepinab, which inhibits certain members of the Cytochrome P450 enzyme superfamily.”

“Wait,” Horosha said.

“Yes?” Jonan asked.

“Go back to the symptom page, please.”

Jonan complied.

“Hmm…” Dr. Horosha nodded. “If you look, notice there are scattered reports of disturbances in behavior and memory among both types of NFP-20 infection. I only just recalled that chronic Engoliss’ disease also causes systemic infection, along with neurological conditions.”

The whole room tensed up as soon as the word “Engoliss” had left Horosha’s lips.