Carriers

I recently came across this somewhat shocking story from 2008.


For most people, the idea of being judged insane and held in a 1950s asylum is the stuff of nightmares. But to be locked up when you are sane would be regarded as an appalling injustice.
And yet a BBC investigation has revealed that nearly 50 women were locked in an isolation ward in a mental asylum in Surrey - not because they had a mental illness - but because they carried typhoid and were deemed a public health risk.

...

They were held at Long Grove Hospital - a mental asylum in Surrey - which started admitting carriers of typhoid as early as 1907 and continued through the 1940s and 1950s. Once admitted, those women never left. 

...
One former nurse says that many of those women - admitted sane - deteriorated mentally, driven mad by the conditions they lived in. Others remained in full possession of their senses, despite enduring conditions such as solitary isolation.
...
It was 1992 when Long Grove finally closed.


The woman pictured above is Rosina Bryans, who was locked up for 60 years. SIXTY YEARS!

There's a twenty minute video at the BBC site that has a lot more information.

New Borrelia on the block

From the LA Times last week:
New Lyme disease-like infection is on the map in U.S.


There a new tick-transmitted spirochete in town, and this wily relative of the organism that causes Lyme disease is probably sickening more than 4,300 Americans a year with relapsing fevers and flu-like symptoms, according to a new report. The good news: A round of common antibiotics appears capable of vanquishing the newly discovered threat.

The organism, called Borrelia miyamotoi, was discovered in 1995 in Japan, but it was not until 2011 that disease hunters found and described evidence that it was making people sick in Central Russia. The organism was found in deer ticks in Connecticut in 2001 and in Northern California in 2006. So it was only a matter of time before the illness it causes was detected in American patients.

That time has come. The New England Journal of Medicine on Thursday published two reports documenting its arrival on U.S. shores. One is a case study of a confused and unsteady elderly woman stricken by Borrelia miyamotoi; the other reports on a broad sampling of blood from patients in New England, where Lyme disease is widespread, and suggests that Borrelia miyamotoi infection "may be prevalent in areas where Lyme disease is endemic in the United States."

The NEJM papers are:
Meningoencephalitis from Borrelia miyamotoi in an Immunocompromised Patient
We report a case of progressive mental deterioration in an older, immunocompromised patient, and even though Koch's postulates were not met, we posit B. miyamotoi as the cause, owing to its direct detection in cerebrospinal fluid (CSF) with the use of microscopy and a polymerase-chain-reaction (PCR) assay.
and
Human Borrelia miyamotoi Infection in the United States
The identification of B. miyamotoi antibody in 18 of our study patients, including seroconversion associated with symptoms in 3 patients, suggests that B. miyamotoi infection may be prevalent in areas where Lyme disease is endemic in the United States.

The Illustrious Dead

If you'd like to read more about how Typhus fever destroyed Napoleon's ambition then there's a recent book that makes the case - Stephan Talty's 'The illustrious dead':

When Napoleon invaded Russia in 1812, typhus ravaged his army, killing hundreds of thousands and ensuring his defeat, according to this breathless combination of military and medical history. After summarizing the havoc this disease wreaked on earlier armies and sketching Napoleon's career, the book describes his invasion of Russia with more than 600,000 men. Almost immediately typhus struck. Infected lice excrete the microbe in their feces, and victims acquire the disease by scratching the itchy bite. Talty describes the effects in graphic detail: severe headache, high fever, delirium, generalized pain and a spotty rash. Death may take weeks, and fatalities approached 100% among NapoleonÖs increasingly debilitated, filthy, half-starved soldiers. Talty makes a good case that it was typhus, not General Winter, that crushed Napoleon. Readers should look elsewhere for authoritative histories of NapoleonÖs wars and of infectious diseases, but Talty delivers a breezy, popular account of a gruesome campaign, emphasizing the equally gruesome epidemic that accompanied it.  (Publisher's Weekly review).

I haven't read this one but I think I'll add it to my reading list.

for something a little more immediately accessible you can read Insects,disease, and military history: the Napoleonic campaigns and historical perception. The version online is adapted from a paper of the same name in the American Entomologist. (1995)  41:147-160.

Bad news everyone..

 Hitting the news today is a report on a new strain of gonorrhea that is resistant to all available antibiotics.

Here's a link to the MSNBC article quoted below, but you can find hundreds of news reports on the story via google news.

For several years, public health officials have been concerned that gonorrhea, one of the most prevalent STDs in the world, might become resistant to the last widely available antibiotics used to treat it, a class of drugs called cephalosporins.  


Now, it has.

In the space of one week, infectious disease specialists have received a one-two punch of bad news that confirms those fears, including the discovery of a new, cephalosporin-resistant strain of the bacteria.

Insects, disease and history

If you are interested in history then there are a number of interesting articles at the 'Insects, disease and history' website: a site devoted to understanding the impact that insects have had on world history. This site focuses on the influence of insect-borne disease on history...

There are several articles on Typhus including, The Historical Impact of Epidemic Typhus , Typhus Fever on the Eastern Front in World War I and Insects, Disease, and Military History: The Napoleonic Campaigns and Historical Perception.

PNAS

Two relevant but rather different papers in the latest Proceedings of the National Academy of Sciences (PNAS).

In the first: Bacillus anthracis comparative genome analysis in support of the Amerithrax investigation, they describe how genomic analysis was used in the investigation of the 2001 anthrax attacks.

The paper describes how the Institute for Genome Sciences faculty and collaborators from the FBI found that the anthrax samples used in all the attacks were genetically identical. Later, another group of scientists -- also including Institute for Genome Sciences faculty -- would trace the anthrax spore used in the letters back to a flask of Bacillus anthracis and several samples taken from that flask. The primary custodian of the flask was Bruce Ivins, Ph.D., a scientist at a U.S. Army biodefense laboratory in Maryland. With this key investigative lead from the scientific team, the FBI used additional police work to conclude that Dr. Ivins was the perpetrator of the mail attacks. Dr. Ivins killed himself before the case could go to court. The FBI has since closed the Amerithrax investigation. (From a report at ScienceDaily)

In the second paper, Hybrid influenza viruses may have pandemic potential, which is relevant to this weeks discussion,  the authors describe how the H1N1 strain that caused the 2009 pandemic, but relatively few deaths, may yet turn out to be problematic. 

The H1N1 influenza virus that spawned the 2009 pandemic is now predicted to circulate as a seasonal flu. However, researchers fear it could once again present a major public health threat by recombining with the H9N2 virus, which is endemic to several bird species in Asia, and has infected pigs and humans. Yipeng Sun et al. explored this possibility by dissecting the H1N1/2009 and H9N2 influenza viruses, and systematically mixing their genes to generate 127 hybrid viruses. The authors then tested the hybrid viruses in mice to assess the likelihood that genetic reassortment between H1N1/2009 and H9N2 could create a virus of pandemic proportions. More than half of the hybrid viruses instantly infected mice and replicated as efficiently as did the parent strains. Eight of the hybrids proved more virulent and dangerous than did either of the two parent strains. Curiously, each of these eight strains carried a gene encoding part of the RNA polymerase, known as the PA gene, from the pandemic H1N1/2009 virus. The authors suggest that the pandemic PA gene may play a key role in the virus’s pathogenicity, and that screening H9 viruses for the gene might help identify influenza viruses that pose a public health risk.

Self experiment

 

Max Joseph von Pettenkofer's experiment with drinking cholera was part of a long tradition of self-experiment in medicine. Of course von Pettenkofer did not believe he would infect himself (and was fortunate in not doing so) but for the really serious self-experiment you deliberately infect yourself (and ideally then cure yourself). Hardcore.

This is exactly what an Australian, Barry Marshall, did in 1984. He consumed a petri dish of Helicobacter pylori bacteria to help prove his theory that stomach ulcers were not caused by stress (the conventional wisdom) but were actually an infectious disease caused by H.pylori. One of the reasons that his theory was widely rejected was that no-one thought bacteria could grow in the extremely acid stomach with a typical pH of around 1. We now know that there are several groups of specialized acidophilic, or acid-loving bacteria, some of which can grow in pH's less than 0.5. Not many bacteria can survive in the human stomach but a few, including H.Pylori, can not only survive but can grow.

In contrast to von Pettenkofer Dr Marshall was correct in his theory and, as a consequence developed a stomach ulcer which, fortunately, he was able to cure with antibiotics. Which we'll talk about next week. In 2005 Dr. Marshall and his collaborator Dr. Warren were awarded the Nobel Prize in Medicine "for their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease".

There's a nice interview with him here.

Whooping cough vaccination

A whooping cough epidemic was recently declared in California, with 910 recorded cases of whooping cough and 5 infant deaths reported as of June 15.
Whooping cough, a highly contagious bacterial disease, also known as pertussis, is generally a minor disease for adults but can be a very unpleasant, and even deadly, disease in infants and children.

Public health officials say California's lackluster immunization rates could be a factor in the epidemic spread of whooping cough, a bacterial disease expected to take its largest toll in the state in five decades.

California is one of only 11 states that does not require middle school students to receive a booster shot against whooping cough.

Breaking News

Just hitting the news today

Michael Jackson has a severe antibiotic resistant staph infection that he contracted during work to reconstruct his nose. The infection has spread and is inflaming his hands and face, or possibly his entire body, depending which news report you believe

He is currently receiving antibiotics via an IV drip at a Beverly Hills clinic, to treat the severe "staph" infection, similar to MRSA (which may actually be MRSA).

Syphilis, Yaws and Columbus

A network path for four informative substitutions shows that New World subsp. pertenue, or yaws-causing strains, are the closest relatives of modern subsp. pallidum strains.

Syphilis, caused by a spirochete bacteria, was first reported in Europe in 1495 and there have been a number of hypothese to explain its relatively recent appearance. I briefly mentioned the possibility that the Black Death may have played a role in its emergence.

For a long time the emergence of syphilis was associated with the discovery of the New World and is sometimes cited as being the only new disease to make the journey from New World to Old World (lots of diseases made the journey the other way, and diseases like smallpox and measles decimated the New World populations). But other diseases such as Yaws, caused by the same species of bacteria, have a widespread distribution in both the New and Old World.

A paper this week in PLoS Neglected Tropical Diseases provides evidence from a phylogenetic study that suggests that while other forms of the Treponema pallidum bacterium have plagued humans since early in our evolution, it emerged as venereal syphilis only when carried back to Europe by Columbus and his crew.

Food poisoning in space

Astronaut Heide Stefanyshyn-Piper holds the sealed bacteria flasks.

Next week we will talk a couple of times about what it is that actually makes us sick when we are infected with a bacteria. One of the most common ways that bacteria make us sick is when they either produce a toxin that they excrete (an exotoxin) or contain a toxin that may be released when the bacteria die (an endotoxin). A lot of the exotoxins are VERY toxic, some of the most toxic substances we know such as Botulinum produced by the bacteria Clostridium botulinum (see earlier posting 'Meet the Clostridiums'). In fact much food poisoning is a consequence of exotoxins. As you may have heard there is currently a Salmonella outbreak in the US possibly caused by Peanut Butter contaminated with Salmonella typhimurium. (You may want to check the recall details if you have "King Nut" or "Parnell's Pride" peanut butter).

All things considered you would think that Salmonella typhimurium would be about the last organism you'd want to take on a space flight. But no, intrepid scientists took samples of Salmonella typhimurium into space on a 2006 Atlantis mission. Curiously the bacteria became three times more virulent under the zero gravity conditions of space. SpaceDaily has quite a thorough report.

Although they used triple enclosed containers, and, I suppose, the consequences of dropping a container are less severe in zero gravity, the consequences of severe food poisoning in zero gravity just don't bear thinking about. Doh! Now I've gone and thought about it....

Meet the Clostridiums

In this class I try quite hard not to present an overwhelming variety of different diseases and microbes. But here on the blog anything goes. So for those of you who want to learn about more microbes, meet the Clostridiums.

First up, we've already mentioned. Clostridium perfringens as the causative agent of gas gangrene - a major cause of death in World War 1.

You might also have heard of Clostridium botulinum, or at least of the disease it causes - botulism. Botulism is a paralytic food poisoning that is fortunately rare. The bacteria grow on food and cause harm in people as we digest a toxin produced by the bacteria. The neurotoxin is one of the most powerful toxins known to man, a single microgram is lethal. It is also used (in minute doses!) in the cosmetic treatment known as Botox.

Clostridium tetani is the causative agent of tetanus. The symptoms, muscle spasms and difficulty swallowing are caused by a neurotoxin produced by the bacteria. Infection generally occurs through wound contamination, and often involves a cut or deep puncture wound. Infection can be prevented by immunization, and this is often successful even if given after the wound occurs. Which is why it's a good idea to get a tetanus shot after a deep cut or puncture wound. If you wait to see if an infection develops it is too late for immunization to be much use.

The final member of our happy little Clostridium family is Clostridium difficile. C. difficile, or just C. diff. is the latest, greatest threat in nosocomial infections and there have been numerous outbreaks lately. Try a google news search on Clostridium difficile to see where the latest outbreak is (Canada apparently). C. diff is an interesting bacteria because it is found as a natural part of the gut flora in a small fraction of people, usually with no problems. But if the usual gut flora is eradicated with broad spectrum antibiotics C.diff can greatly increase in numbers and release toxins that cause severe diarrhoea and death in some cases. Some new strains appear to be producing much more toxin. Hospitals are very good places to find people taking broad spectrum antibiotics and, apparently, are good at spreading C.diff around as well. There was an MSNBC article with the subhead ‘C. diff’ rivals MRSA as the next deadly bacteria threat, experts say' in May of this year.