Race With a Killer

A Dallas doctor believes he holds a miracle treatment for a disease that maims and kills children. Proving it will take another miracle.

Comments (0) By Charles Siderius Thursday, Oct 17 2002

Connie Jimmerson remembers that her daughter Tashica was a bit more attached to home than usual on that Friday seven years ago. She remembers it clearly.

Mark Graham

Dr. Brett Giroir, chief medical officer at Children's Medical Center of Dallas, believes Neuprex can save lives and limbs. Proving that to regulators has so far been impossible.

Mark Graham

Tashica Jimmerson's recovery after she became the first person to receive Neuprex for meningococcal sepsis was so remarkable that she made the cover of manufacturer XOMA's annual report in 1995. Even with treatment, Jimmerson lost parts of her fingers to the illness, but her mother, Connie, shown at left with her daughter, is convinced the drug helped spare her life.

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"She was fine," Jimmerson says. "She was just all up under me all that Friday. She wouldn't go play with the kids...I couldn't get rid of her," Jimmerson says.

The next morning Tashica awoke with what Jimmerson thought was stomach flu.

"She was running a temperature and throwing up. I just took it to be a little stomach virus, you know. I went to the store. I got her some soup, 7Up and aspirin," Jimmerson recalls while sitting at her home in Longview. "She just kept laying around. She didn't seem to be getting any better."

Tashica's condition rapidly worsened. She could barely stand. She was becoming incoherent, asking for water and forgetting that she asked. Then she didn't recognize her mother.

Although Jimmerson didn't know it then, Tashica was fighting for her life. A lethal bacterium was rapidly multiplying in her body, causing an illness known as meningococcemia or meningococcal sepsis, a severe blood infection that often mimics flu symptoms in its early stages. Meningococcal sepsis is caused by the same bacterium that causes bacterial meningitis, but, while frequently mistaken, the two illnesses differ greatly. Meningitis, an infection of membranes lining the spine and brain, is much easier to treat. Meningococcal sepsis is both difficult to treat and often deadly. Those who survive the disease are frequently left maimed.

Within hours, Jimmerson would be in an emergency room watching helplessly as Tashica hemorrhaged from her internal organs.

Each year, about 3,000 to 4,000 young Americans are infected with meningococcal disease, which encompasses both meningitis and meningococcal sepsis. Outbreaks have occurred among freshmen living in college dormitories and children in day care. The disease appears among those who have been in close contact, but it is selective, striking some and leaving others who are exposed unharmed. The disease terrifies parents and confounds doctors, who have a small arsenal of medicines for treatment. About 60 percent of the cases of meningococcal disease are meningococcal sepsis.

Antibiotics, even if started early, are often ineffective at preventing the devastating effects of the blood infection. In just a few hours, children such as Tashica can die, bleeding from every orifice while vital organs shut down in an unstoppable cascade. Those not dead within the first few hours have a better chance of living, but their limbs often turn blue because toxins released by the bacteria cause blood to clot, slowing circulation to the extremities. Frequently, hands, feet, arms and legs are amputated from gangrene that sets in as a result of small blood vessel damage.

At the small East Texas hospital where Jimmerson first took Tashica, doctors gave the 7-year-old a spinal tap, a procedure in which fluid is extracted from the spine and tested. Jimmerson says she was told to wait outside the examining room.

"They took so long until I just walked in on them. Just then they told me that they had to Careflight her to Children's in Dallas," she says. "The doctor came out and told me that they were going to have to Careflight her and that they had to sedate her...They stopped her from breathing and a machine was going to be breathing for her."

Doctors put Tashica on a helicopter ambulance for a flight to Children's Medical Center of Dallas, about 150 miles away. They estimated her chances at "50-50," Jimmerson says. But in those early-morning hours, a study team of nearly two dozen doctors, nurses and therapists headed by Dr. Brett Giroir, now chief medical officer at Children's and then director of critical care medicine, was about to test something new, a cloned human protein called BPI.

Giroir, a Harvard graduate and acting chairman of pediatrics at University of Texas Southwestern Medical Center at Dallas, believed the drug, named Neuprex by its maker, could give the body a powerful natural weapon to fight the onslaught of meningococcal sepsis.

When Tashica arrived at Children's Medical Center, she didn't appear to have much of a chance. Her heart had stopped three times before she arrived, twice in the helicopter. It was risky to infuse the potentially revolutionary treatment into Tashica. She might die, threatening more than two years of work leading up to that moment.

"By any rights she was supposed to die," Giroir says. "If you give her the drug and she dies, it might have killed the drug forever. The first person that gets it dies. That's not usually a good thing, but we gave it to her anyway."

Tashica, the first of what was supposed to be just eight test patients in this initial Food and Drug Administration-approved trial of Neuprex, survived.

"If you ever want a time you will remember, try taking a 7-year-old kid who's gotten three CPRs before she got here and you're giving her a drug that no sick person has ever gotten before. Pretty dramatic...It's subject to bias, but she stabilized essentially as soon as she got the drug," Giroir says. "You kind of say, 'I think something just happened here.'"