For this week's faculty spotlight, we talk to Paul Lantos, MD, about tracking and identifying Lyme disease, travel medicine, and his time in the Gambia, Peru and other locations.
How long have you been at Duke? How long have you been at the Division?
I have been at Duke in the GIM Division for 6 years, since July 2008.
What does a typical day for you at the Division look like?
Most of my time in the Division is devoted to my research activities, including data management, analysis, writing, and collaborating. My research studies combine patient data, environmental and social data, and digital mapping software to better understand the geographic distribution of disease.
I do my clinical work in the GIM Division as a member of the Hospital Medicine faculty. I care for hospitalized patients at Duke Hospital, and I am involved in resident and medical student teaching. The remainder of my time is devoted to my research activities.
You’re currently researching the transmission of Lyme disease in North Carolina. Can you tell me about this project?
The range of Lyme disease along the east coast of the United States has long been thought to extend to the northern reaches of Virginia but not further south. There is evidence, however, that the number of Lyme disease cases in southern Virginia has markedly increased over the last decade.
Is not entirely clear whether it is possible to acquire Lyme disease in North Carolina, but with each year it seems as if the “front” of transmission is moving closer. I am conducting several studies to better understand this.
First, I am studying the geographic distribution of human cases in Virginia and North Carolina. Specialized statistical methods allow me to identify clusters of cases, and to understand how these clusters have expanded and moved south over time. Using similar tools I am exploring what environmental and demographic variables are associated with these disease clusters.
Second, I am studying the conundrum of clinical decision-making about Lyme disease in North Carolina. Simply put, in a place where the disease is very rare it is hard to be confident that a positive Lyme disease test is truly positive rather than a coincidence. This places clinicians in a difficult position of trying to evaluate patients and their test results in an environment of low but changing risk.
Lyme disease is typically seen as being rare in North Carolina. Is this perception true? What are the reasons for this?
Lyme disease is indeed rare in North Carolina. Our incidence rates are several orders of magnitude lower than in truly endemic parts of the northeast, and it’s likely that many “cases” we identify are either imported to NC or are misclassified false positives. Humans are almost never bitten by deer ticks in North Carolina, deer ticks seem to have different feeding habits here, and it may well be that ecologic factors make North Carolina not suitable to Lyme disease transmission.
At the same time, it is now established that Lyme disease transmission is occurring in nature in NC among non-human biting ticks and among non-human mammals. What is not clear, however, is whether this will change in time. If human Lyme disease is spreading southwards, then maybe our low numbers are simply because the disease hasn’t arrived yet.
You have also undergone training in travel medicine. Can you tell me more about this field? What made you interested in this area?
In addition to my work in internal medicine I am also a pediatric infectious disease physician. During my fellowship my research focus was global health, and in particular malaria. I have also spent many months doing clinical work and research in Africa and South America. These interests led me to pursue a certification in travel medicine.
Travel medicine is a multidisciplinary field that deals with assessment and mitigation of risks associated with travel, as well as evaluating sick travelers who have returned from trips. Among the issues we commonly address in travel medicine are travel vaccinations, malaria prevention, avoiding food and water-borne illness, high altitude safety, and sun protection.
What’s one passion or hobby you have outside of work?
Outside of work I spend my time with my wife Gretchen and my children, Max (6) and Julia (4). My favorite hobby is photography.
Where in South America and Africa did you study? What that was like?
My first trip to a developing country was to the Gambia in West Africa during medical school, where I spent 2 months doing clinical work as well as a clinical research study with malnourished children. During my residency I worked in the Amazon rainforest in Peru for a month at a small clinic, and the following year I spent a month doing clinical work in a hospital in Ghana. During my fellowship I did field-based laboratory research on malaria pathogenesis in Senegal. Finally, since joining the faculty at Duke I traveled more briefly to Tanzania as part of a malaria research project.
How did you experiences in each continent compare? What's the most memorable experience for each one?
Both my personal and professional experiences were quite different in each site. But there is really nothing that can compare to one’s first trip to a developing country. Not just the medical experience and my first interface with true poverty, but also the cultural experience and the opportunity to immerse myself in a very unfamiliar environment. As for the single most memorable place, that had to be the Amazon. The size, depth, and wildness of the jungle were beyond anything I could have imagined.
What kinds of photography do you enjoy most/specialize in?
Before having children I especially enjoyed large format film photography, using a 4x5 and an 8x10 view camera. I had my own darkroom and experimented with “alternative” printing processes, like cyanotyping and Vandyke brown printing. I was living in Boston before moving to North Carolina, and my favorite subjects were architecture, cityscapes, and seascapes. Now my world has changed and I’m trying to perfect the art of photographing my own kids.
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Paul Lantos in Ghana in 2002[/caption]
