What started as a simple fall led to a diagnosis the Weiler family wasn’t expecting – 8-year-old Patricia Weiler has Crohn’s Disease.

After the fall, Patricia’s mother, Annette, immediately took her to their dentist, who prescribed antibiotics but the swelling persisted. Patricia then saw her pediatrician who referred them to a maxillofacial surgeon who noticed abnormal tissue architecture. She performed a biopsy, which confirmed granulomatous inflammation consistent with Crohn’s disease.

She was then referred to Racha Khalaf, MD, assistant professor in the Department of Pediatrics in the USF Health Morsani College of Medicine and a pediatric gastroenterologist.  Dr. Khalaf and her team performed several tests, including a biopsy of Patricia’s wounds.  When the test revealed several key indicators, Dr. Khalaf confirmed that Patricia has Crohn’s Disease.

Racha Khalaf, MD, USF Health assistant professor and pediatric gastroenterologist.

Crohn’s disease is a chronic inflammatory bowel disease that causes inflammation in the gastrointestinal (GI) tract.  It’s a progressive condition, meaning it can get worse over time if untreated, and an autoimmune condition in which the body attacks the lining of the digestive tract often causing pain, diarrhea, weight loss and fever.   Treatment goals for Crohn’s include symptom mitigation, endoscopic improvement, and remission.

Patricia goes to the Tampa General Hospital Pediatric Day Hospital every six weeks to receive an intravenous treatment of Infliximab, commonly prescribed for a variety of autoimmune disorders.  Patricia said her favorite part of her visits are being able to play with TGH Valor Service Dogs, who are there to provide a comforting presence to children in the hospital setting, and helped young Patricia quell her fear of needles.

Dr. Khalaf and other physicians who have met Patricia commonly describe her a “wise beyond her years” in the wake of her diagnosis.  She understands this will be something that will be with her for the rest of her life and understands that she needs to make certain lifestyle changes including limiting her sun exposure, the amount of processed foods, and reducing the amount of dairy she consumes.  Patricia still participates in her favorite activities including soccer, ballet, and playing with her dog Mitch and sister Annabelle.

Patricia Weiler (right) and her sister Annabelle with their dog Mitch.

Patricia has been in remission for more than nine months and mother Annette is very thankful for all of the doctors who helped get her pointed in the right direction for care and getting her questions answered.  She is especially thankful to Dr. Khalaf and her team for finally bringing an end to the mystery of Patricia’s health.

“From the first moment I met the team, they were very assuring.  They said they would become ‘best friends’ throughout this process and that’s exactly how it has been,” Annette said.  “It was scary at first, but the reassurance is what really helped us through this.”

“It’s not a disability, it’s just something with my body that I have to keep an eye on,” Patricia said.  “I’m very thankful that we found a team that helps me and my family with my problems, and we did it before it got worse.”

Video and photos by Freddie Coleman

Center connects pregnant women and their families, and the region’s medical professionals, to USF experts in preventing, diagnosing and treating the mosquito-borne virus

Zika virus can be transmitted from a pregnant mother to her baby during pregnancy.

The photos seen worldwide after the Zika epidemic gripped Brazil and spread across the Caribbean were compelling — depicting infants born full-term yet with small heads and blank stares, held by mothers with faces full of concern and resolve.

But when the Zika epidemic waned last summer, and the last of the Centers for Disease Control and Prevention (CDC) travel advisories to Miami-Dade lifted, these striking images of infants with microcephaly, one of the most severe potential neurological consequences of active Zika infection in pregnancy, faded into the background. So too did the ongoing news about how pregnant women could protect themselves from the mosquito-borne, birth-defect causing virus.

Still a threat

Florida should not forget the threat Zika poses and its unpredictability, USF Health experts said, noting that the virus still circulates in some countries, and travelers continue to return to the United States after visiting or living in areas at risk.

With vigilance in mind, USF Health recently contracted with the Florida Department of Health (DOH) to establish a Zika Referral Center.  Funded by $600,000 from the CDC through the Florida DOH, the three-year program launched in April. It connects patients and medical professionals with USF’s multidisciplinary team of experts skilled in providing diagnostic, treatment and prevention expertise to expectant mothers, fathers, newborns and infants affected by Zika.

Zika virus spreads through mosquito bites.

“Although there are some theories, we still don’t understand all the components of why congenital Zika syndrome burst onto the scene in Brazil in 2015. We do know pathogens are always evolving, so we need to maintain a heightened sense of alertness even when Zika cases decline,” said the center’s medical director Patricia Emmanuel, MD, chair of the Department of Pediatrics, USF Health Morsani College of Medicine.

“We will use this CDC funding to educate pregnant women and their families about transmission of Zika and its potential long-term impact on their infants, and to ensure health care workers stay aware of potential exposure in their patients,” Dr. Emmanuel said. “Doing that can help us detect and follow Zika earlier in pregnancy, so we might better understand the full spectrum of the disease.”

The new center establishes on Florida’s West Coast a complement to the existing Zika Resource Team operating out of the University of Miami Health System since 2017.  (The first identified outbreak of mosquito-borne Zika virus infection in the continental United States occurred in Florida in Miami-Dade and Broward counties during summer 2016.)

A multidisciplinary Zika response team

The USF Health center’s Zika response team includes pediatricians, a perinatologist, an obstetrician, a clinical geneticist, a neurologist, an infectious disease consultant, and a newly recruited nurse practitioner who serves as program and case manager.

USF Health and the University of Miami will share prospective data collected, including numbers of expectant women tested for Zika infection and information on the growth and development of infants affected, Dr. Emmanuel said. Starting with Tampa General Hospital, the center’s staff will also provide training for obstetric and pediatric health professionals at regional hospitals in Hillsborough and surrounding counties, as well as health care consultations based on current CDC evidence-based practices and guidelines.

Not all pregnant women exposed to Zika will pass the infection to their developing fetus. But, the most worrisome risk for those who do is that their baby will be born with microcephaly, a serious condition characterized by an abnormally small brain and skull that can lead to seizures, feeding problems, developmental delays and impaired vision and hearing.

Stephanie Ros, MD, director of obstetric services for the Zika Referral Center, says USF Health has played a leading role caring for pregnant women affected by Zika and is equipped with the multidisciplinary expertise and resources to address the complexities of birth defects, including congenital Zika syndrome, before and after birth.

Ready to diagnose, manage women at risk and their babies

“Because the long-term effects of Zika can be so far reaching, no one medical professional possesses all the expertise to properly diagnose and manage every aspect,” said Dr. Ros, assistant professor of obstetrics who specializes in maternal fetal-medicine.  “At USF we can provide one centralized location for patient referrals, where our team remains up to date on the latest protocols for testing and has access to the appropriate tools to take care of women at risk and their babies.”

USF Health is equipped with the multidisciplinary expertise and resources to address the complexities of birth defects, including congenital Zika syndrome, before and after birth.

The USF Health Zika Referral Center is modeled after the highly effective USF Perinatal HIV Program, a collaboration between USF Health’s pediatric infectious disease experts and the regional perinatal community that delivers complex care to help prevent mother-to-child transmission of the human immunodeficiency virus. In Hillsborough and Pinellas counties, no pregnant woman followed by this program has given birth to an HIV-infected baby since 2014, Dr. Emmanuel said.

“It’s a successful network that could be extended beyond Zika to other viral infections, such as hepatitis B or cytomegalovirus, which may seriously affect the health of newborns,” Dr. Emmanuel said.

For more information, visit health.usf.edu/medicine/pediatrics/zika-referral-center.