Monday, January 31, 2011

Haiti Cholera update

Hillary Clinton washes her hands during a visit to Partners in Health Cholera Treatment Center.

If you read or watch the news you may have seen reports that Secretary of State Hilary Clinton was in Haiti yesterday touring a cholera clinic.

Although the number of new cases is finally declining the outbreak is still far from over.

Steven Smith, a health official at the US embassy, told Clinton that "we're seeing a decrease in the number of cholera cases. Even more important, we're seeing a decrease in the number of fatalities."
But he said there were still hundreds of new cases a day countrywide.
The number of new patients at the Cholera Treatment Center, managed by US government grantee Partners in Health, has been reduced by half to about 40 per day since the start of the epidemic, a State Department official said.
Five patients have died at the clinic, the official said.
The death toll from Haiti's cholera epidemic is 4,030, the Haitian health ministry said Thursday, while the number of cholera cases totaled 209,034 as of January 24.

Sunday, January 30, 2011

Immune Attack

I'm not sure how I feel about educational video games. I mean they sound like a great idea but so does low alcohol beer and look how that turned out....

Anyway, I haven't even downloaded this let alone played around with it but 'Immune Attack' does look interesting if you a) are interested in the human immune system or b) loved the movie 'Fantastic Voyage' where a spaceship is shrunk to microscopic size and injected into someone's bloodstream. There's also an episode of Futurama like that, a tribute to the movie I guess, but I now realize I have the two confused in my mind.

Anyway, in Immune attack:

You must navigate a nanobot through a 3D environment of blood vessels and connective tissue in an attempt to save an ailing patient by retraining her non-functional immune cells.  Along the way, you will learn about the biological processes that enable macrophages and neutrophils – white blood cells – to detect and fight infections.

And they thought Jews were the bad ones...

Historically, when medical knowledge has not been sufficient, blame always follows. When the Black Death hit Europe in the 1340's, this is exactly what happened. European Jew's, who at this time were doing rather well financially, were the ones who took the rap. Jew's, whose religion promoted cleanliness, were among the least susceptible to Bubonic Plague because they managed to distance themselves from the reservoir of the disease, rats, and its vector, the flea. Of course, the nobles also lived relatively free of risk. So why then, were the Jews blamed? It turns out, the nobles quickly jumped into the blame game, eager to get rid of the Jews to whom they owed money.

As the disease claimed millions of lives, suspected Jews were objected to torture, during which they were interrogated regarding their role in the plague. These Jews, faced with the choice to either admit to their wrongdoing, or suffer continued torture, had a tendency to admit to anything suggested by their interrogators. One documented confession was that of the Jew Agimet of Geneva, who admitted that a Rabbit Peyret assigned him the task of going on a journey to Venice (and various other places affected by the plague) to poison the wells, thus infecting the population. (Remember that Jews usually drank from the wells of separate districts, making this a plausible reality.)

As word of confessions such as this made its way around Europe, things started to look very grim. Jews throughout much of Europe were burned and killed for their undeniable role in the spread of the plague. As documented in Strasbourg, Germany, "On Saturday - that was St. Valentine's Day-they burnt the Jews on a wooden platform in their cemetery. There were about two thousand people of them. Those who wanted to baptize themselves were spared. [Some say that about a thousand accepted baptism.] Many small children were taken out of the fire and baptized against the will of their fathers and mothers. And everything that was owed to the Jews was cancelled, and the Jews had to surrender all pledges and notes that they had taken for debts. The council, however, took the cash that the Jews possessed and divided it among the working-men proportionately. After this, wealth was divided among the artisans some gave their share to the Cathedral or to the Church on the advice of their confessors."

With no knowledge of epidemiology and disease, people struggled to find an answer to the problems of the plague. When the Jews were blamed, they had no way of fighting back, and with all odds against them, Europe gave in to the temptation of blame. Either for money or for a fruitless attempt at atonement, Jews around Europe were killed. Luckily, today this is no longer an issue, and instead of killing each other, we try to find a solution to the problems that we are doing a better job of understanding every year.

http://www.fordham.edu/halsall/jewish/1348-jewsblackdeath.html

Plague: Weapon of choice?

The bubonic plague has an interesting history of being used in certain acts of biological warfare.

The Tartars were a Muslim tribe that lived by the Black Sea in the Middle Ages. In 1346, they were infected with the plague virus, and many of their people died. The Tartars then decided that their best course of action would be to launch an attack on the Christian Genoese who had control of the city of Caffa in what is now a rather dry, depressing area of Ukraine. Of course, the Tartar army lost tens of thousands of men who became infected with the plague. Not wanting to be selfish, they decided to share the plague with the Genoese and lay siege to the city of Caffa by:

The Tartars decided to share their suffering with the Genoese. They used huge catapults to lob the infected corpses of plague victims over the walls of Caffa. As the Tartars had intended, the rotting corpses littered the streets, and the plague quickly spread throughout the besieged city.


The Genoese then packed their bags and took the plague back with them to Italy.



It only gets crazier. In World War II, the Japanese Unit 731, a military research operation charged with the task of creating biological weapons out of numerous diseases, weaponized the bubonic plague into a bomb they called the "flea bomb". Its design was simple: A large ceramic container filled with plague infested fleas and flour. When the bomb was dropped (as it was on a severely unlucky test village in Manchuria), it burst open and flour got everywhere, which attracted rats. The fleas would then mount the rats, and the rats would scurry away with their deadly cargo. A plan was made to drop these bombs on San Diego in September of 1945. The atomic bomb was dropped on Hiroshima a month earlier.


On a much smaller scale, Larry W. Harris, who was identified as a white supremacist and card carrying member of the Aryan Nation, was found to have purchased bubonic plague from a Maryland medical company using a phony identity. He was charged only with fraud, as he claims he was merely obtaining the material to promote awareness of the threat of biological warfare. The FBI clearly thought he had ulterior motives, possibly because they found guns, smoke bombs, and white supremacist paraphernilia inside of his house. Reports indicate he purchased about $300 worth of bubonic plague (I'm sure he made sure he could find the best deal possible on plague bacteria before purchasing).

Pandemic II

People probably already know about this game, but it's one of my favorites and I thought particularly appropriate around midterms...(Procrastination and 'studying' all in one? Kind of? Squee.)

http://www.crazymonkeygames.com/Pandemic-2.html

The point of the game is to create a disease and kill the world. It's slightly more difficult than it sounds, as the world is quite capable of manufacturing vaccines and closing borders, and it's very difficult to get Madagascar or Australia.

Enjoy.

Saturday, January 29, 2011

Genital warts, Cancer and HPV

Regardless of what you may have heard about chlamydia it's actually HPV, Human Papillomavirus Virus, that is the most common sexually transmitted infection in the US. One of the reasons for this is that in many cases the infected person has no signs or symptoms. Because of this the CDC estimate that by the age of 50 more than 80% of American women will have contracted at least one strain of genital HPV.

Whoa. Screechy noise. Backup.  By the age of 50 more than 80% of American women will have contracted at least one strain of genital HPV.

Although only a small percentage of these women will develop cervical cancer the fact that such large numbers of women are infected each year means that up to 1 million American women are diagnosed with cervical dysplasia each year. Cervical dysplasia, caused by HPV, is a precursor to cervical cancer and is painful and costly to treat. Of these 1 million cases each year about 11,000 subsequently develop cervical cancer and about 4,000 of these women will die. Every year.


So a safe and effective vaccine is going to be a great discovery right?


Widespread vaccination has the potential to reduce cervical cancer deaths around the world by as much as two-thirds, if all women were to take the vaccine and if protection turns out to be long-term. In addition, the vaccines can reduce the need for medical care, biopsies, and invasive procedures associated with the follow-up from abnormal Pap tests, thus helping to reduce health care costs and anxieties related to abnormal Pap tests and follow-up procedures.
—American National Cancer Institute

Because so many women are infected it is clear that women need to be vaccinated before they can become infected. The best way to do this is to vaccinate them before they become sexually active .

Oh oh. We used the sex word.
Wait, am I missing something here? We leave it up to private companies to develop vaccines and then we find it somehow sinister if they push for mandatory vaccinations when they develop an effective vaccine against a disease that kills thousands. Oh and did I mention that it is estimated (by the CDC) that at any one time 1% of sexually active adults have genital warts (also caused by HPV).

Don't make me post the genital wart pictures....

Friday, January 28, 2011

When Noise Trumps Knowledge, someone's going to get hurt


In November of 2010 there was a signifcant showing that vaccination rates for children, who have insurance, have been falling. This drop seems to be prompted by fears about a "link" between vaccines and autism.

When a child gets vaccinated and soon after develops autism symptoms, this supposed cuase-and-effect is a coincidence of the calendar and childhood development rather than a true link between the two.

According to the NCQA (The National Committee for Quality Assurance) the share of children who recieved the measles, mumps and rubella vaccine, MPR, fell from 93.5% in 2008 to 90.6% in 2009. This subsecquent drop is also seen in many other vaccines such as tetanus and whooping cough. Eventhough the drop in vaccination rates may seem small, viruses are "opportunistic things and it takes only a few holes in the immunity net for diesease to slip thorugh and range free".

A surprising result of the study done by the NCQA showed that public programs that provide vacicines at low or no cost have contributed about the spike in vaccine rates among lower-income families on Medicad. On the other hand wealthier families are getting information not from their doctors but rather from talkshows and the rumor mill spreading false vaccine scare stories.

The spread of these rumors is dangerous because vaccines save lives. The question is whether the decrease of vaccination rate will continue to truly dangerous level?

http://healthland.time.com/2010/11/04/vaccination-rates-drop-in-wealthier-kids-the-autism-rumors-take-a-toll/

Mercury in vaccines

A number of people asked about the issue of thimerosal, a mercury containing compound used as a preservative in many vaccines. There is a lot of information about this issue at the CDC website. One thing that may have confused many people is that despite there being 'no convincing evidence of harm caused by the low doses of thimerosal in vaccines' it was agreed that thimerosal use should be reduced or eliminated in vaccines as a precautionary measure. A number of countries have done this now, and some countries have now been using vaccines without thimerosal for decades.

This has allowed for some massive studies looking at all sorts of health related issues in children both before and after the use of thimerosal ceased. If this compound was really causing health problems in children we'd see a dramatic change as we stopped its use. However these studies have generally showed little effect and in a number of cases diseases like autism continued to rise in countries after they ceased using this preservative.

The WHO concurs with the CDC in finding no evidence of toxicity from thiomersal in vaccines and no reason on safety grounds to change to more-expensive vaccines.

There are now a massive amount of studies on vaccine safety, particularly the common childhood vaccines. Like all science the results may appear at times to be contradictory and confusing. One way to judge the validity of a website is to consider how it deals with this issue. Both the CDC and WHO websites contain summaries of all the large studies and make a recommendation based on the sum of the evidence.

Other websites, particularly those promoting an an anti-vaccine agenda, tend to cherry pick studies that conform to their view. Science doesn't work that way.

Thursday, January 27, 2011

Shakespeare and the Bubonic Plague


William Shakespeare lived in the Elizabethan era when the bubonic plague, sometimes referred to as the Black Death, was virulent. He was known to have a terrible fear of the deadly disease and its consequences and this is hardly surprising as it touched so many areas of his life including his life as an actor at the Globe Theater. There were high mortality rates amongst Elizabethan children and this was true of the brothers and sisters of Shakespeare some of whom were struck down by the Bubonic plague:

He lost his sisters Joan, Margaret ( just babies) and Anne (aged 7) to the deadly plague
He also lost his brother Edmund (aged 27)
But the greatest loss to William Shakespeare was his only son, Hamnet, who died when he was just eleven years old

I wonder if the bubonic plague has been mentioned in any of his work??

Plague Doctors




Doctors during the bubonic plague pandemic of the Middle Ages would often visit victims solely to verify whether or not they had the plague. Since “cures” of the time had little, if any, effect on the plague the doctors were basically useless. All they could do was diagnose the soon to be dead victim.

But at least they got to wear awesome costumes while doing it!

A Plague Doctor’s uniform consisted of:

· A wide brimmed black hat worn close to the head.

· A primitive gas mask in the shape of a bird’s beak. People suffering from the epidemic believed that the plague was spread through “bad air” (the Miasma theory), so there was a belief that the air would be drawn from the patient onto the beak of the mask, which was often filled with aromatic herbs and spices to overpower it.

· Red eye glasses were also part of the mask. They were thought to make the wearer impervious to evil.

· A long black overcoat. To minimize skin exposure, the overcoat was tucked in behind the mask at the neckline and extended to the feet of the doctors. The coat was usually coated head to toe in wax which was thought to repel the plague.

· A wooden cane. Used to direct family members or others around to move the victim. Essentially it helped the doctors touch the victim without actually having to touch them.

· Leather breeches. Worn beneath the cloak to protect the legs and groin area, a spot thought to be particularly sensitive to the plague because the lymph nodes in the groin area would swell when one was infected with the plague.

Black Death Song


A Medieval Song about the Bubonic Plague:

"A sickly season," the merchant said,
"The town I left was filled with dead,
and everywhere these queer red flies
crawled upon the corpses' eyes,
eating them away."

"Fair make you sick," the merchant said,
"They crawled upon the wine and bread.
Pale priests with oil and books,
bulging eyes and crazy looks,
dropping like the flies."

"I had to laugh," the merchant said,
"The doctors purged, and dosed, and bled;
"And proved through solemn disputation
"The cause lay in some constellation.
"Then they began to die."

"First they sneezed," the merchant said,
"And then they turned the brightest red,
Begged for water, then fell back.
With bulging eyes and face turned black,
they waited for the flies."

"I came away," the merchant said,
"You can't do business with the dead.
"So I've come here to ply my trade.
"You'll find this to be a fine brocade..."

And then he sneezed.

Plague without rats

From the Journal of Medieval History - Plague without rats: The case of fifteenth-century Iceland 

In the fifteenth century Iceland was ravaged by two epidemics which usually have been identified as plague. It is shown here that these epidemics were no less lethal than the Black Death in Europe. The first one probably killed half the population or more and persisted in the country for at least a year and a half. Since, for several reasons, it can safely be assumed that Iceland was not populated by rats at this time, this may offer the strongest available proof that an epidemic like the Black Death was not dependent on rats for its dissemination.

Wednesday, January 26, 2011

DR Congo Plague Outbreak Spreads

An outbreak of what is thought to be pneumonic plague has spread to a second town in the Democratic Republic of Congo. Pneumonic plague occurs when the Yersinia pestis bacteria infects the lungs. It has a very high mortality rate and can be transmitted from person to person by way of respiratory droplets. The outbreak began days after a diamond mine re-opened north of the country's biggest city. Sixty people have died so far and all have been diamond miners. Another 350 miners have been infected. Experts from the World Health Organization has visited the area to confirm that people are infected with the plague.

http://news.bbc.co.uk/2/hi/africa/4290783.stm

The Black Death and HIV resistance?

An article from China Daily dated from March 2005 claims that the Black Death may have provided ten percent of the European population with immunity to HIV.

There is a mutation in the CCR5 receptor called delta-32, which provides immunity to the HIV disease; scientists think that this mutation arose sometime during the Black Death epidemic when there was favorable selection pressure for it, given that it may have provided carriers with protection from the bubonic plague bacteria or from smallpox. European populations have the highest numbers of people with this favorable mutation.

According to the little picture above, HIV binds to the CCR5 molecule in order to enter the body's cells; however, the delta-32 mutation may prevent CCR5 from showing up on the cells, therefore preventing HIV from entering the body's cells.

http://www.chinadaily.com.cn/english/doc/2005-03/11/content_424041.htm

Distinct clones

Here's the recent Black Death - Bubonic Plague article I mentioned in class in case any of you are interested in molecular biology:
Distinct Clones of Yersinia pestis Caused the Black Death

Our results thus resolve a long-standing debate about the etiology of the Black Death and provide key information about the evolution of the plague bacillus and the spread of the disease during the Middle Ages.

S Z R Models

It seems somehow appropriate to reanimate this blog post from last year

I introduced the basic SIR model for a simple epidemic to you. this model actually has a long history and was first described by Kermack and McKendrick in 1927.

As I indicated this model has since been expanded to include virtually every disease scenario you can imagine.

Last year a group of Canadian mathematicians used this SIR format as the basis for an analysis of a zombie epidemic. Their paper: WHEN ZOMBIES ATTACK!: MATHEMATICAL MODELLING OF AN OUTBREAK OF ZOMBIE INFECTION ) - somehow it seemed appropriate to keep that in capitals) - describes a model that should look basically familiar to you.

Notice in their S Z R model (Z for Zombie of course) there are two extra transitions - from R back to Z (reanimation of the dead is well established in the zombie movie genre) and a movement directly from S to R (non zombie related death).

This is, perhaps unsurprisingly, the first mathematical analysis of an outbreak of zombie infection. While the scenarios considered are obviously not realistic, it is nevertheless instructive to develop mathematical models for an unusual outbreak. This demonstrates the flexibility of mathematical modelling and shows how modelling can respond to a wide variety of challenges in ‘biology’.

In summary, a zombie outbreak is likely to lead to the collapse of civilisation, unless it is dealt with quickly. While aggressive quarantine may contain the epidemic, or a cure may lead to coexistence of humans and zombies, the most effective way to contain the rise of the undead is to hit hard and hit often. As seen in the movies, it is imperative that zombies are dealt with quickly, or else we are all in a great deal of trouble.

Tuesday, January 25, 2011

Pneumonic Plague in LA--1924

By the 1880's America was transitioning from farmland to cities. A home of one's own was an American dream, which was becoming more achievable with the average Joe-the-Plumber home. These homes consisted of four to six rooms with a yard and a porch for community life.
By the 1920's, as America boomed, L.A. swelled with urban poor contributing to the migration of the white residents fleeing to greener, suburban pastures.

742 Clara St. was an average Joe-the-Plumber house. Built near the L.A. River in 1895 by the Mead family who eventually became wealthy and contributed to a foundation that offered, as was reported, "homes on easy payments and with profit, for wage earners, and people with small or moderate salaries".

On October 2, 1924 pneumonic plague broke out. The city responded fiercely. Neighborhoods were quarantined by officials. These neighborhoods could include a total of 1,800-2,500 people living there. Sometimes even when there was no plague, due to the ethnicity of the area, the streets were blocked. Inspectors would execute stray animals, tear off the siding of homes in order to fumigate the foundations, burn bedding , and bury garbage. Residents continued to get sick until the plague was contained in November. By the end of the year nearly 40 people had died.

The house on Clara St. became ground zero of the infestation. The residents at the time, the Caldersons, suffered greatly loosing three out of their four sons and other family members. Mexican were implicated in the spread of the disease. Unfortunately many lost their homes and jobs.

When all was done, 2,500 buildings were lost, the city dodge having to compensate the owners for their loss, and the disease was spun to be a positive claiming that LA was now a "ratless port".

http://www.latimes.com/features/la-hm-lostla1-2008nov01,0,4976047.story

Black Death from sleeping with your pets


A recent UC Davis study has proven that sleeping with your pets can increase your chance of getting Black Death. According to the news report, 60% of American households have at least one pet, and several of the owners sleep with their pets.

There are several mixed reviews regarding this recent study due to varying opinions about a pet's role in a family. Although pets can carry Black Death, many people believe the healthy benefits of having a pet (emotional attachment, etc) outweigh the risks.

So how can you avoid Black Death but continue to cuddle with Fluffy? Wash your hands, and take your pet to the vet regularly.

41 Interesting Facts...about the Black Death



A plague epidemic swept through Europe from 1348 through 1351, killing an estimated 25–60% of Europeans. Some estimates are as high as 2/3 of the population.

The exact death toll is difficult to measure from medieval sources. The number of deaths varied considerably by area and depending on the source. Current estimates are that between 75 and 200 million people died from the plague.

The term "Black Death" is recent. During the plague, it was called "the Great Mortality" or "the Pestilence."

Although the period known as the Black Death ended in 1351, the plague continued to return to Europe, with epidemics every few years through the end of the fifteenth century.

The Black Death was the second plague pandemic of the Middle Ages. Justinian’s Plague in the sixth century was deadly and widespread, but did not create the same devastation as the second pandemic.d

The Black Death followed a period of population growth in Europe which, combined with two years of cold weather and torrential rains that wiped out grain crops, resulted in a shortage of food for humans and rats. This caused people and animals
to crowd in cities, providing an optimal environment for disease.

In 1346, rumors of a plague that started in China and spread throughout Asia, Persia, Syria, Egypt, and India reached Europe. All of India was rumored to have been depopulated.

The first named victims of the plague died in 1338 and 1339 in the area around Lake Issyk Kul (Lake Baikal) in Russia, where a grave marker says, "In the year of the hare (1339). This is the grave of Kutluk. He died of the plague with his wife, Magnu-Kelka."

During a siege of the Genoese city of Kaffa by the Tatars in 1347, the inhabitants were reportedly infected with the plague when the Tatars threw the bodies of plague victims into the city.

In November 1347, a fleet of Genoese trading ships landed in Messina, Sicily after trading along the coast from the Black Sea to Italy. The ships carried dead and dying sailors, many of whom had strange black growths on their necks, in their armpits, or in their groins. Many coughed blood. Those who were alive died within days.

...see complete list at http://facts.randomhistory.com/2009/06/09_black-death.html

Great Vowel Shift


We don't have time to talk about ALL the possible consequences of a pandemic disease that kills maybe 1/4 of the world and up to 1/3 of Europe. But that isn't going to stop me mentioning one more here - the great vowel shift.

Sometime, probably quite quickly, and starting in the 1400's there was a major change in the way that the English language was pronounced. This has become known as the great vowel shift. One hypothesis for why this occurred is that it was related to the greater social mobility that occurred during and following the Black Death.

Curiously this change in the way words were pronounced occurred at the same time the printing press was creating its own revolution. It was only when printing was invented that word spellings became more fixed. So the Black Death may be one of the explanations for why many English words have what appear to be strange spellings - they are spelled as they used to be pronounced. However as this was becoming fixed by the spread of printed books a change in pronunciation swept through the land.

Strange but true.

Click here if you'd rather have the theory explained by dinosaurs.

government research on drug discovery

Worried that the pharmaceutical industry has slowed their discovery of new drugs, the Obama administration has created a billion-dollar research center for drug discovery. The aim is to discover compounds that drug companies will then take hold of and develop into drugs. Will academic researchers be good at drug discovery? Will pharmaceuticals make a large profit off of drugs discovered with publicly-funded research?

See the article here.

Monday, January 24, 2011

Rats and Plague

Scientific American magazine has a regular feature where they reprint news articles and stories from 50, 100 and 150 years ago. In the February 2011 edition they reprinted this article entitled 'Rats and Plague' from the February 1911 issue

ALTHOUGH the recent epidemics of bubonic plague in China, India, and other parts of the world have been always associated with outbreaks of the same disease among rats, the historical study of plague throughout the world reveals the singular fact that previous to 1800 very few references to a coincident mortality among rats have been put on record. Many excellent accounts of the older outbreaks, notably of the Black Death in Europe in 1347, and the Great Plague of London in 1665, are in existence, but careful research into these documents by modern historiographers — Haeser, Hirsch, Abel, and Sticker — has shown that for reasons difficult to discover very scanty mention of associated rat mortality has been made.

Check out the full article. This is a nice trailer for our next lecture.

Movie Monday

I just realized that I think I've posted more video clips for Bubonic Plague than any other disease. I'm starting a new tradition, Bubonic Plague video classics.

The always popular John Stewart:




and an interesting depiction of medieval flagellants in a German rock video:



For more flagellants and typical Python fun check out this post: Pie Jesu domine, dona eis requiem



The Black Death Movie

"The Black Death," directed by Christopher Smith, was released in June 2010 in the UK and tells the story of a monk who escapes with his lover from their plague-ravaged home. They stumble upon a village with healthy people who have been unaffected by the disease. According to the synopsis, it seems that the movie deals with some of the themes that we talked about today in class, such as the effect that the plague had on the Church, as well as the consistent attempts to blame groups of people for the outbreak of the disease.

http://www.imdb.com/title/tt1181791/

http://www.timeout.com/film/reviews/88560/black-death.html

Sunday, January 23, 2011

Simpsons classic

In 1991 Lyme disease was certainly in the headlines but I don't remember when the issue of chronic Lyme disease started to appear. Hard to believe it was 20 years ago but a show called the Simpsons was renewed for its second season and for episode 19 an uncredited Dustin Hoffman provided the voice of substitute teacher Mr Bergstrom who Lisa has a big time crush on. Of course setting this all up involved the temporary removal of regular teacher Miss Hoover.

At the start:

Miss Hoover: [shakily] Children, I won't be staying long.
                I just came from the doctor, and I have lyme disease.
                Principal Skinner will run the class until a substitute arrives.
   Ralph:       What's lyme disease?
   Pr. Skinner: I'll field that one.  [goes to blackboard]  Lyme disease
                is spread by small parasites called `ticks'.  [writes `TICKS'
                on blackboard]  When a diseased tick attaches itself to
                you, it begins sucking your blood...
   Miss Hoover: [not calmed] Oh...
   Pr. Skinner: Malignant spirochetes infect your bloodstream, eventually
                spreading to your spinal fluid and on into the brain.
   Miss Hoover: The brain!?  Oh, dear God...
   Class:       Wow 
 
and at the end: 
Miss Hoover:  You see class, my Lyme disease turned out to be psychosomatic.
Ralph Wiggum: Does that me you were crazy?
Janie         No, that means she was faking it. 
Miss Hoover:  No, actually, it was a little of both.  Sometimes, when a 
                 disease is in all the magazines and on all the news shows, it’s 
                 only natural that you think you have it.
 

Lyme Disease Potential

In class we have discussed the wide variety of symptoms that are associated with Lyme disease, which is why the disease is known in the medical community as "The Great Imitator". This ESPN article from 2005 tells the story of Florida State University quarterback Wyatt Sexton, who sought out an extra year of eligibility after being hit with a particularly debilitating case of Lyme disease. Sexton contracted Lyme disease and was not immediately diagnosed due to the vague symptoms he initially showed, but the advanced stage of the disease led to severe neurological harm that some suspected was drug abuse. The potential harm of the disease is demonstrated in this incident:
On June 14, the 20-year-old Sexton was doused by pepper spray and taken to a hospital after he was found lying in the street and identifying himself as God. His parents released a statement two days later that said drug abuse was not the problem.

The inflammation to his brain caused by the disease led to increasingly erratic behavior, and his doctor prescribed intensive antibiotic therapy which lasted several months. Sadly, Sexton never played another down for the Florida State Seminoles.

British author Alex Wade had his own journey with Lyme disease. The disease is not very common in the UK and as the author himself put it in this article in The Times, "not very many doctors here know about it". Unfortunately for Mr. Wade, not only had he contracted Lyme disease, but he also was suffering from cervical myelopathy, a degenerative narrowing of the spinal cord. He had extreme symptoms such as electric sensations coursing throughout his body, headaches, and an inability to coordinate his muscle movements. It did not help that his Lyme disease nearly prevented him from getting a corrective surgery for cervical myelopathy and could have potentially exacerbated his symptoms. Tragically, even after getting his surgery, the antibiotic treatments (in this case, doxycycline) he received could not completely ward of the Lyme disease which he tested positive for 3 separate times. It appears that he has a chronic case of Lyme disease, and he references the documentary Under the Skin, which proposes chronic Lyme is a hidden epidemic surrounded by uncertainty and misinformation to the public because of corruption and greed in the medical community.

Saturday, January 22, 2011

Zoonoses in the bedroom

Pet lovers will be interested in this story that hit the news today -

Why You Shouldn't Snuggle with Your Pooch in Bed

It isn't just dog trainers and the occasional finicky spouse who want you to keep your pets off the bed. A new report in the journal Emerging Infectious Diseases found that of the 250 known zoonotic diseases, which are transmitted between humans and animals, more than 100 are derived from domestic pets.

Curiously the paper, Zoonoses in the Bedroom, isn't even available yet so they must have put out a press release ahead of the paper. I was curious to see the paper because they do concede that:

..the health benefits of owning a pet outweigh its risks: studies show that having a pet can lower blood pressure, reduce stress, improve physical fitness and increase happiness.

My dog doesn't sleep on the bed (a Westie like the picture above) but only because he doesn't share well and hogs the blankets too much. However he sometime spends the day sleeping on it if we leave the bedroom door open. I'm guessing this isn't too good either....


Isla Vista and Hantavirus


Warning: This thing is evil


This entry connects with our reading from "The Coming Plague", more specifically, Chapter 15 All in Good Haste: Hantaviruses in America. In that chapter we learned about the hantavirus that killed several people in america and first broke out on the Navajo reservations in the Four Corners area of the United States. The symptoms associated with this virus if you remember were particularly terrifying.
You will be happy to know that a certain rodent, the California Vole (Microtus Californicus), is a carrier of a certain hantavirus dubbed the Isla Vista virus, making Santa Barbara County a reservoir for a potentially deadly strain of hantavirus. More information can be found at these links:

http://en.wikipedia.org/wiki/California_vole

http://vir.sgmjournals.org/cgi/content/abstract/76/12/3195





Friday, January 21, 2011

Cholera In Peru

This video is from the Pan American Health Organization and it documents the cholera outbreak in Peru and other parts of South America that we talked about today in class. It provides shocking visuals of the horrible sanitary conditions in which many people are forced to live, and also gives an account of how people are trying to fight the disease.

http://http://www.youtube.com/watch?v=KikmB33aX0g

Human behavior

For some diseases the easiest way to reduce the prevalence is by changing human behavior. If you could alert people to the riskiest behaviors and to the best practices then you could reduce the incidence. This obviously makes us all think of AIDS but the same principle applies to diseases like Lyme disease. The question is though, how do you best alert people? Do you scare them or do you take a more subtle approach. Many public service announcements take the first approach (the first video below) but some that take a different approach have been very successful. The second example is not for an infectious disease but the aim is the same - to change behavior. I would remind you that although your age group has a relatively low risk of death the number one cause of death (by a huge margin) is road traffic accidents.


Thursday, January 20, 2011

An Incorrect Diagnosis

How would you feel if you were told you had lyme disease and after three months of unbearable treatment you were told the diagnosis was incorrect??

That's what happened to 45-year-old father Phillip Moore. In 2004, Dr. Joseph Jemsek diagnosed Moore with Lyme disease in North Carolina. After instilling the idea that he was truly the one person that was going to fix him and make him better Moore agreed to the treatment. The treatment was an intravenous antibiotic treatment that made him so ill he had to take a leave of absence from his job.

Later, Moore learned that he did not have Lyme disease. Instead the other doctor informed him that he had a rare form of non-Hodgkin's lymphoma and unfortunately the cancer had spread. The initial treatment of the non existent Lyme disease delayed his cancer treatment.

Moore testified against Dr. Joseph Jemsek before the North Carolina Medical Board who disciplined the doctor for "unprofessional conduct". It turned out that Dr. Jemsek had diagnosed 9 other patients as having Lyme disease based on non-specific symptoms including fatigue and achiness. There was little to no evidence to support the diagnosis. His license was only suspended for a year and that suspension could be put on hold if certain conditions were met.

Dr. Jemsek is still prominent in the Lyme world. He opened an office in January in Washington D.C. treating Lyme disease.

How is it possible that this doctor is still able to practice and treat patients with no repercussions??

http://www.latimes.com/health/la-he-lyme-disease-side2-20101227,0,709347.story

Antibiotic University

Lyme Disease in the Media


It's hard to know what's more disturbing about Andy Abrahams Wilson's new documentary, Under Our Skin—the portrayal of the devastating effects of untreated chronic Lyme disease, or the film's assertion that the disease is being ignored because of the medical establishment's greed and self-dealing. Either way, after you see the film you will think twice about strolling barefoot through the grass, and those of us who have (or have had) Lyme will probably insist that our doctors do a thorough review of our records.

The film is paced like a horror story, and the cases Wilson follows are pretty horrible, especially if you're used to the two-weeks-of-antibiotics-and-you're-fine version of the disease. Unfortunately, some of his heroes come off as a bit crackpot. But his central point is rock-solid: This is a serious disease, spreading rapidly, and we need to pay it heed. See the film, then pull your socks up and stay on the sidewalk.

Real disease or medical myth?

In an era when most journalists simply re-write press releases (or simply cut and paste them) or report on a politicians latest tweet it is refreshing to find an article where a journalist appears to have actually done his homework and done some, gasp, journalism.

This article,  Chronic Lyme disease: A dubious diagnosis, was in the Herald-Review last month and is well worth a read. What do you think?


Lyme disease is real. The bacterial infection, chiefly transmitted by deer ticks, can cause rashes, swollen joints and inflamed nerves and usually is curable with a round of antibiotics.

But doctors around the country are telling patients with common medical problems such as back pain, poor concentration and fatigue that their ailments all stem from a chronic form of Lyme disease that can evade standard treatment and wreak havoc for years. To fight what they believe is a persistent infection, the doctors often order months or years of intravenous antibiotics, which can cost tens of thousands of dollars.

Strong evidence isn't on their side. But in a golden age of dubious medicine, that doesn't matter.

These days, advocates can raise big money to ``Unmask A Cure'' for a disease that already has a cure, and doctors disciplined by medical boards are held up as heroes. State legislatures around the country are passing laws to prevent medical boards from disciplining doctors who treat chronic Lyme with therapies that clinical trials have shown are dangerous and don't work.


Read the whole article.

Lyme Disease Outbreak of 1975


In November of 1975, the Connecticut State Health Department received a call from two mothers who each reported that their child had been diagnosed with juvenile rheumatoid arthritis. Both mothers knew of other children with similar diagnoses in the area of Connecticut they inhabited; Lyme, Connecticut.

The reason that these reports of the disease alarmed officials was because juvenile rheumatoid arthritis was not only very severe, but was also extremely rare in children. And many children had been diagnosed with the disease.

So, officials at the Health Department contacted Dr. Allen Steere, a rheumatologist at Yale University who was fascinated by the case. Steere’s task force helped identify 39 children and 12 adults suffering from rheumatoid arthritis; uncharacteristically high numbers considering that the disease usually affects 1 child out of 100,000.

Steere also discovered several other interesting aspects of the outbreak:

· Most of the cases appeared during the summer, suggesting either a summer virus or an infection carried by an insect or tick vector.

· Unlike other summer diseases this one did not seem contagious.

· 25% of the victims reported having a spreading skin rash before experiencing other symptoms.

· The outbreak was limited to 3 Connecticut towns: Lyme, Old Lyme, and East Haddam.

· Most of the victims inhabited heavily wooded, rural areas; not in the urban setting.

After considering all of these factors, Steere concluded that the disease had yet to be recognized by the medical world and that it was also transmitted by an arthropod (insects). Thus, he named the disease “Lyme Arthritis” (changed to Lyme disease when it was discovered that the joints were not the only parts of the body affected by the infection).

However, Steere was not the first in the world to discover the disease. In 1909, Swedish dermatologist Arvid Afzelius described, in his work, an expanding, ring-like lesion in those bitten by the Ixodes tick. He named the rash “erythema chronicum migrans,” which is Latin for “chronic red rash that increases in size,” or “ECM” for short.

For additional facts about life of Ixodes tick vectors click here.

Wednesday, January 19, 2011

Posts and comments - a reminder

Now that the course is underway and some of you, hopefully, are checking in here regularly, here's a reminder about how to post and comment.


Posts to the blog will be made by myself, by Erin (and possibly past TA's who do drop in occasionally), and by students in the L&S honors program. If you are not an honors student and would like to post here just send me your e-mail and I'll send you an invite. You have to become a member of the blog to make a post (hence the requirement for an invite) but there's no entry requirements and no qualifications required.

Everyone is welcome to post comments on any posts and you don't need to sign up to do that. If you try and add a comment on a post it will look like you need to be signed up because that's the default option but you can change it to anonymous if you wish. You will have to prove you're not a robot though. Also, because I have made commenting open to anyone it means we sometimes get hit by spam. For that reason I have comment moderation turned on. Comments may not appear immediately and may need to be moderated but unless you are trying to sell viagra or promote your nude celebrity website I'm not really vetting comments for content. 

In the LYMElight


Soap star Debbi Morgan reportedly has been diagnosed with Lyme Disease, which was released to the media yesterday after she took an unexpected leave of absence from her show, "All My Children." She claims to have had it "in her system" for over 15 years, and yet she was just recently diagnosed.

Among the many other well-know figures who have contracted this disease are George W. Bush, authors Meg Cabot (the "Princess Diaries" series), Amy Tan ("The Joy Luck Club"), and Alice Walker ("The Color Purple"), and former NY Mets pitcher Tom Seaver.

Musical Hallucinations and Lyme Disease

I found an interesting article from 2003 which presents information from a study investigating the possible connection between muscial hallucinations and Lyme Disease. According to the article, two patients, both with persistent cases of the disease, had musical hallucinations after oral antibiotic treatment. However, the hallucinations stopped after IV antibiotic treament started, but resumed once the IV antibiotics stopped. Neither patient seemed to suffer from hearing impairment, which is often a cause of these kinds of hallucinations. However, one patient did have a lesion on an area of the brain typically associated with musical hallucinations, so this may have been the cause.
Doctors were unable to draw any definitive conclusions on the connection between lyme disease and musical hallucinations, but the cases provided interesting evidence.

http://http://www.medscape.com/viewarticle/459205_3

Chagas disease

Various species of Triatomine bugs, which if infected can transmit Trypanosoma cruzi also known as Chagas disease or American trypanosomiasis

Although we won't cover Chagas disease in this class I thought I'd better clarify my answer that it wasn't found in the US.  In fact like many questions the answer is both more complicated than expected but also more interesting.

Actual vector borne transmission of Chagas disease is though to be rare in the United States. Although some of the vector species are found here they generally thrive under poor housing conditions where, for example, people have mud walls or thatched roofs. However because the US has so many immigrants from Mexico, Central America, and South America - where an estimated 8 to 11 million people are infected - it is inevitable that a fraction of these immigrants are infected.

By applying published seroprevalence figures to immigrant populations, CDC estimates that more than 300,000 persons with Trypanosoma cruzi infection live in the United States.The vast majority of these cases are not correctly diagnosed - at least partly because doctors in the US do not consider Chagas disease when treating patients.

The CDC considers Chagas disease to be a 'Neglected Infection of Poverty' - infections that disproportionately affect impoverished people in the United States. These infections are considered neglected because relatively little attention has been devoted to surveillance, prevention, and/or treatment of these infections.

Because there may be a large number of undiagnosed cases in the US there is some concern about it getting into the blood donation system and since a test was developed in 2005 blood donations may be screened for Chagas disease.

George Clooney's face

I'm not sure I see it myself but George Clooney did indeed suffer from Bell's Palsy as a child and it is still visible around his right eye. The internets are not short on celebrity information:

While suffering from the malady – it went away within a year – his left eye closes and he is unable to eat or drink properly, earning the nickname Frankenstein. "That was the worst time of my life," he tells the Mirror in 2003. "You know how cruel kids can be. I was mocked and taunted, but the experience made me stronger." 

Clooney's middle school photograph gives little indication that he will later twice be named the sexiest man alive.

Strictly speaking a diagnosis of Bell's Palsy only applies when no specific cause can be identified (as appears to be the case with George Clooney). When a specific cause is identified the patient is no longer considered to have Bell's palsy. Because the facial nerves exit the skull through narrow holes anything that causes inflammation can act to block the transmission of nerve signals. Common causes of Bell palsy (which then ceases to be Bell's Palsy - how confusing) are tumors, strokes, head trauma and infections such as some herpes viruses and Lyme disease. Only if the cause remains unknown does the diagnosis of Bell's palsy, or idiopathic facial paralysis, apply. That's just fancy doctor speak for 'your face is paralyzed and we don't know why.'

Forest Fragmentation May Increase Lyme Disease Risk

Patchy woods, particularly those consisting of less than five acres, may have more Lyme disease carrying ticks, which could increase both risk and incidence of disease in these areas. This is particularly worrisome given that this fragmentation is common in cities & in suburbia. Researchers found that smaller forest fragments had more infected ticks, which could explain the increase of Lyme disease in the U.S. in recent years. These findings provide a way in which the risk of Lyme disease could be reduced by adjusting our land use practices by decreasing fragmentation of forests into small patches, particularly in the northeastern U.S. where the incidence is the highest.

Tuesday, January 18, 2011

To start the week off with a laugh


"You have an extremely deadly and infectious disease. Stay away from people!"
...
"FREE HUGS!"


"You're feeling great? That's unusual...we'd better run some tests."

Making a difference

Antiobiotic resistance is a real and growing problem. If you were wondering what you could do about it individually then the CDC is happy to help with information and suggestions.

I think one of the problems is that although we should minimize inappropriate antibiotic use, in cases where it is appropriate then you should finish your prescription as indicated by the doctor. Taking fewer pills, even with the best of intentions, does not help and, in fact, is likely to make both you, and the problem, worse.

The CDC site also has information for doctors and the title of their video indicates one of the problems doctors face:
CDC Commentary: Don't Give In and Give Those Antibiotics!   Tips on how to communicate with patients about appropriate antibiotic use for upper respiratory infections.

Super Bacteria Survive Without Genetic Resistance


It turns out that genetic resistance is not the only way that bacteria are able to survive antibiotics, according to a new study by The Journal of Medical Microbiology. So called, "Persister Cells" are created in very low numbers, but have an exceptional ability to survive in the presence of all common antibiotics, without having developed a genetic resistance.

When small quantities of these persistent cells remains after antibiotic treatment has taken care of most bacteria, the infection still has a chance of coming back. Studies have even shown that the amount of persister cells shows a relationship to the presence of antibiotics. n one study, the amount of persister cells created was lower when the bacteria showed a resistance to the present antibiotics.

This may suggest that the production of persistent cells is another method of survival for bacteria, acting as a Noahs's Arc for the infection to survive even when most of the bacteria is destroyed by antibiotics. Scientist hope to develop a new form of infection treatment which combines antibiotics with other drugs to combat regular, and persistent bacteria all at once.

Unfortunately, not enough research has been done and the mechanism for bacterial persistence is still unknown. If researchers are able to break the secret of persistence and develop a treatment to counter it, it could mean a great increase in the frequency with which active infections are completely eradicated.

Monday, January 17, 2011

TB Sheets



Van Morrison's TB Sheets is not only explicitly about Tuberculosis but is also quite possibly one of the most uncomfortable songs ever recorded.. Van Morrison was born in 1945 and the song is based on an experience he had as a young man - or at least this is the rumor.

There's a very good review of the song at Paste Magazine.

“T.B. Sheets” is one of the most real songs about death you’ll ever hear. As life saps steadily from the singer’s beloved, tuberculosis-ridden Julie, there is no trite drama, no nostalgic sugar coating or grand deathbed epiphany, but rather an “Is That All There Is?” fatalism—a mild, detached, slowly-suffocating bleakness.

What makes this track so moving and powerful—beyond its stark, unapologetic realism—is Morrison’s unflinching courage to deliver a story that spotlights a moment of such unabashed selfishness: While this girl is dying in front of his eyes, he actually has the nerve to snivel about his own problems, whining, in so many words, What about me? This is hard for me, too. Of course, this reminds us that we’re only human—even the selfless have their breaking points. It’s no surprise that Morrison fell apart after recording “T.B. Sheets,” so distraught after revisiting that dark place that he cancelled the remaining sessions.

The antiotic resistance

Although we will generally proceed forward in this course at a steady pace, covering a new disease and topic each week, there are some topics that overlap. For example in week 6 we will discuss nosocomial, or hospital acquired, infections. As we will see then the problem is made much worse by the problem of antibiotic resistance. This cartoon is correct - the best place to find antibiotic resistant strains of bacteria is in hospitals.

Sunday, January 16, 2011

TB Blues

Jimmie Rodgers, born 1897, was a country singer whose influence is probably best indicated by the three names by which he is often known: The Singing Brakeman, The Blues Yodeler, and The Father of Country Music. He died from Tuberculosis in 1933.

He sang two songs explicitly about TB: "T.B. Blues" in 1931 and “Whippin’ That Old T.B.” in 1932. He died from T.B. (from a lung hemorrhage) just two days after his last recording session. During the session he was so weak from T.B that he needed to rest on a cot between songs.

All those death metal bands can have scary names (Anthrax, Ebola, Cholera etc) but it takes real cojones to sing about about the disease that is killing you

I've been fightin' like a lion looks like I'm going to lose
I've been fightin' like a lion looks like I'm going to lose
Cause there ain't nobody ever whipped the TB blues
I've got the TB blues


Gee but that graveyard is a lonesome place
Lord but that graveyard is a lonesome place
They put you on your back throw that mud down in your face
I've got the TB blues




World Tuberculosis Day

The World Health Organization (WHO) organizes a World TB Day every year in order to raise awareness of the prevalence of the disease. The event is held every year on March 24, which is the anniversary of Robert Koch's discovery of the bacteria that causes tuberculosis. By raising awareness, the WHO hopes to "cut TB prevalence rates and deaths by half by 1215" (WHO website).
According to the website, WHO is endorsing different programs and tests which would allow for increased awareness and better treatment.
Check out the different links on the website, they're pretty helpful!http://www.who.int/mediacentre/events/annual/world_tb_day/en/index.html

Saturday, January 15, 2011

Antiobiotic resistance misconception

Doctors adjust the IV for a patient with MDR-TB at a government hospital in Maseru, Lesotho. From XDRTB.org

I think one of the most common misconceptions about antibiotic resistance is that because we have a number of antibiotics effective against most diseases then antibiotic resistance will only become a big problem when bacteria have become resistant to everything.

This is wrong because in most cases the drugs we have available range from cheap with few side effects to expensive with serious side effects. Because of this we often have big problems even before the bacteria are technically resistant to 'everything'.

So for Tuberculosis, for example, it goes something like this:

Tuberculosis (TB)
  • Cost of drug treatment: $10-$20
  • Course of treatment: 6 months
  • Side effects of treatment: generally minor but may include vomiting, nausea and loss of appetite.
Multi-drug-resistant Tuberculosis (MDR-TB)
  • Cost of drug treatment: up to $5,000 - $20,000
  • Course of treatment: 2 years
  • Side effects of treatment: side-effects are more serious and include hepatitis, depression and hallucinations.
Extensively drug-resistant Tuberculosis (XDR-TB)
  • Cost of drug treatment: cases have been dealt with individually - some have cost $500,000
  • Course of treatment: as long as it takes, many patients die
  • Side effects of treatment: severe, in South Africa many patients discontinued treatment stating that they would rather die.

Classic episodes

Okay repeats. I know there are so many posts in the archives now that most of you probably don't have time to delve into them so here, again, are some favorites on the topic of TB, antibiotics and antibiotic resistance.