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Zika Outbreak in the Amercas and now in Florida

20th Jan 2016 Diseases

A recent outbreak of a mosquito borne virus known as Zika has been the source of great public health concern in Brazil. It is estimated that 1.3 million cases of Zika have been identified since May of 2015.

The Zika virus is named after the Zika Forest in Uganda, where in 1947 the virus was isolated from a Rhesus monkey. It was not until 2007, that the first major outbreak of the Zika virus took place in Micronesia. Since that time additional large outbreaks have occurred in French Polynesia with over 10,000 cases identified in late 2013. The current outbreak in Brazil, is the largest ever in the Americas.

The virus is transmitted to humans by the Aedes aegypti mosquito. Once bitten by an infected mosquito, symptoms usually begin after an incubation period of three to twelve days. The CDC estimates that one in five who are bitten by an infected mosquito will develop clinical symptoms. Symptoms of the disease include the onset of a headache, rash, fever, joint pain(s), conjunctivitis and malaise. Clinically, the disease can appear very similar to dengue. For most, the disease process is mild and can last up to a week. Until recent, no deaths have been reported, Brazilian health officials and doctors are recommending that women avoid getting pregnant until after mosquito season. The virus has been linked to babies born with a rare neurological disorder in which there is incomplete brain development, known as microcephaly. The number of cases identified during this recent outbreak is over 10 times the amount from 2014. A number of recent infant deaths are being investigated to identify if there is a link.

The first case of Zika was identified in Puerto Rico last month. Public Health experts anticipated the spread of the virus into the southern United States by the spring, but we already have had 3 cases in Florida and one in Hillsborough county..

At present, there is no specific antiviral treatment for the Zika virus. Treatment is focused around supportive care including rest, consumption of fluids to prevent dehydration, and the use of acetaminophen.

Minimizing exposure to mosquitos is the only way to prevent the spread of the virus. The use of appropriate repellents, protective clothing covering the extremities, and the use of mosquito nets and screens are recommended to minimize the potential for infection.

 References:

Information accessed from www.cdc.gov/zika/index.html

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What is MRSA and why is it a growing problem?

14th Dec 2015 Diseases, Medical News

MRSA infections have generated extensive public concern as the problem of antimicrobial resistance continues to grow. MRSA or Methicillin-resistant staphyloccus aureus, is a complex bacterial infection that is resistant to many antibiotics. Infections with MRSA often begin as a simple skin sore and progress to something that is very harmful. The staphylococcus aureus bacterium is commonly found in the nose and skin. In fact, it is estimated that as many as 1/3 of the population is known to be colonized with staph without having a known infection.

Bacteria can enter the body through cuts or damaged skin leading to an infection that can often be life threatening. MRSA is spread from person to person through skin contact and from object to person when someone has an active case of MRSA. Staph aureus has been found to survive for more than 6-7 weeks on various materials and surfaces. Infections are often differentiated into two types: community acquired and healthcare acquired.

Symptoms of MRSA often arise from a small bump or an irritated area of skin. As infection develops and progresses, the area can become inflamed, painful, hot to the touch, and accompanied by a fever. As MRSA gets into the bloodstream further serious symptoms including dizziness, chills, confusion, swelling, chest pain, cough, difficulty breathing, and headaches may develop.

In the last few weeks, a well documented case of MRSA in a professional athlete has been widely reported in the media. New York Giants tight end, Daniel Fells, was diagnosed with MRSA several weeks ago after suffering an ankle injury. Since then, he has undergone six surgeries as antibiotic regimens have failed to improve his condition. Amputation of his foot was being considered.

Fells case is not the only one in professional sports. In fact, this has become a growing problem in sports such as football, baseball and MMA fighting. Statistics show that these trends are also increasing at the high school and collegiate levels as well.

In regards to risk factors, there are 5 “Cs” that are known to make it easier for MRSA to be transmitted:

  1. Crowding
  2. Contact – Skin to Skin Contact
  3. Compromised Skin – Open wounds
  4. Contaminated – Objects and surfaces
  5. Cleanliness – Lack of

 

Treatment of MRSA infections is highly dependent on the type of infection, location, severity of overall symptoms, and whether the specific strain of MRSA responds to antibiotics.

Preventative measures include keeping your hands clean by proper hand washing with soap and water. All skin cuts and open wounds should be kept covered with a bandage. Avoid sharing clothing, linens, and other personal items.

 

References:

Methicillin-resistant Staphylococcus aureus (MRSA) Infections, CDC. Updated 20 May 2014.

http://espn.go.com/new-york/nfl/story/_/id/13892490/new-york-giants-te-daniel-fells-sixth-surgery-fight-mrsa

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Where do we stand with preventing Breast Cancer?

14th Oct 2015 Diseases, Medical News

The month of October is about raising awareness of breast cancer and advocating for early detection. Approximately 1 in 8 women born in the U.S. are at risk for developing this disease. The big question is where do we stand with preventative efforts?

Statistics have shown that the incidence of breast cancer has increased by more than 20 percent worldwide since 2008. We still do not have a cure for breast cancer, but there is strong evidence to suggest that lifestyle and diet may play a large part in the disease process. A study published in the Journal of the American Medical Association (JAMA) in September 2015, found that those women who consumed a Mediterranean diet, which is rich in olive oil, had a significantly decreased risk of breast cancer over those who consumed a low fat diet. This study included more than 4000 women between the ages of 60 and 80 years old. What remains unclear is if the reduction in breast cancer was due to the olive oil alone or if the effect was from the overall diet.

In another study, published in the International Journal of Cancer, a link between metabolic syndrome and increased risk of breast cancer was suggested. Metabolic syndrome may include high glucose levels, high triglycerides, high blood pressure, low HDL (“good cholesterol”), and obesity. All of these factors are strongly tied to diet and lifestyle.

In the latest reported findings, taken from a study that is currently in progress, heavy doses of chemotherapy are no longer warranted in the early treatment of the most common type of breast cancer. This study includes more than 10000 women who have been previously diagnosed with breast cancer. Of those in the low risk group, 99% of survivors had no relapses within 5 years of diagnosis, while 94% were free of any invasive breast cancer. A U.S. company, Genomic Health, claims that their new genomic test can decide whether chemotherapy is warranted for a specific case of breast cancer and whether or not reoccurrence is likely to occur.

Based on current practice and research, it is believed that the risk of breast cancer can be lowered with 5 simple lifestyle changes:

  1.  Healthy diet that is low in processed foods and sugars
  2.  Avoidance of smoking
  3.  Maintaining a healthy weight
  4.  Avoidance of alcohol
  5.  Daily exercise

 

 

References:

Toledo E et al. Mediterranean Diet and Invasive Breast Cancer Risk Among Women at High Cardiovascular Risk in the PREDIMED Trial: A Randomized Clinical Trial. JAMA. 2015 Sept 14:1-9.

National Breast Cancer Foundation, Inc. – http://www.nationalbreastcancer.org/breast-cancer-awareness-month

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Influenza 101: This year’s flu and the next big concern

25th Sep 2015 Diseases, Viruses

It has been widely reported that this year’s flu vaccine is very ineffective. In fact, the CDC has now reported the vaccine effectiveness to be a dismal 18%. The reason for this is that the main virus that has been circulating, H3N2, is not included in this year’s vaccine. A universal vaccine is currently in clinical trials, but its effectiveness and release are currently unknown.

In review, there are three types of influenza or “flu” that affect humans (Type A, B, C). As we all know, the flu can cause symptoms that range from mild to severe including fever, sore throat, muscle pains, coughing, headaches, nausea, vomiting and lethargy. Type A influenza has been known to be associated with the worst outbreaks and cause the most severe disease. Wild birds are the natural host for this type of flu. While similar to the influenza virus, the avian form of influenza is from a different subspecies. All influenza that has occurred in birds is from the Type A subspecies. The avian flu has historically been lethal and has caused many deaths worldwide.

The ‘H’ in H3N2 refers to hemagglutin which is a glycoprotein that binds the virus to the host cell. ‘N’ refers to neuraminidase which is an enzyme found on the surface of the influenza virus that enables the virus to be released from the host cell. The numbers that accompany H and N refer to subtypes of the virus.

There have been several strains that have been associated with pandemics. H1N1, H2N2 and H3N2 subtypes were avian based. Newer subtypes of H1N1 include the swine flu.

In 2013, the emergence of H7N9 in China has raised concern for another worldwide pandemic. H7N9 is an avian based subtype but it has been reported that transmission from person to person may have occurred. There is a much larger mortality rate associated with H7N9 than with other subtypes. In fact, nearly one third of those infected during a 2013 outbreak died from complications associated with the disease. Some infectious disease specialists and researchers have laid claim that N7N9 could cause a worldwide pandemic, similar to the last one seen in 1918 which caused over 100 million deaths.

The first case of H7N9 in North America was reported earlier this year. A Canadian citizen tested positive for the disease upon returning home from Hong Kong in late January.

The underlying source for H7N9 appears to be from infected chickens that has spread rapidly among several provinces in China. There has been very limited reports of human to human transmission. The World Health Organization (WHO) is calling H7N9 one of the most lethal viruses seen. A vaccine is currently in clinical trials.

References:

http://www.cdc.gov/flu/avianflu/h7n9-virus.htm

http://www.scmp.com/news/world/article/1693111/vancouver-woman-diagnosed-h7n9-bird-flu-after-flight-hong-kong

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Cardiomyopathy in Friedreich’s Ataxia

18th Sep 2015 Diseases, Friedreich's Ataxia

A recently published study conducted through the New York Veterans Affairs Medical Center in Albany, looked at the association between Friedreich’s Ataxia (FA) and cardiomyopathy. While FA is known as a neurological disease, the most common cause of death in FA patients is cardiomyopathy. By definition, cardiomyopathy is a disease in which the myocardium becomes weakened or stretched resulting in decreased ability to pump blood to the rest of the body. As this progresses, arrhythmias and heart failure may result.

The study focused on 28 autopsy heart tissue samples from patients with FA. Additionally, 10 tissue samples were taken from healthy controls. Multiple measurements were made including X-ray fluorescence (XRF) of iron and zinc within the ventricle walls and interventricular septum, tissue frataxin, iron histochemistry, inductively-coupled plasma optical emission spectrometry (ICP-OES), and immunofluorescence of inflammatory markers hepcidin and CD68. Prior studies have focused on abnormalities related to left ventricular hypertrophy, dysfunction, and electrical abnormalities.

The tissue samples from hearts from FA patients showed evidence of hypertrophy and thickened walls. Muscle cells, known as cardiomyocytes were identified to be considerably larger in the control hearts. Additionally, the cardiomyocytes were surrounded by a layer of endomysium (fibrous connective tissue).

Further analysis of the tissue samples revealed a significant reduction in cardiac frataxin levels and higher levels of iron within the left ventricular wall and septum in FA patients. Furthermore, an abnormal number of CD68 reactive inflammatory cells was found in the hearts of FA patients. Cytosolic ferritin sequesters and stores iron to protect against free radical damage while hepcidin is a protein that plays a major role in iron regulation. Both of these markers were elevated in FA. The results of this study point have lead the researchers to believe that a strong iron expression seen in the cardiomyocytes might be a unique finding for cardiomyopathy in FA hearts. Since frataxin levels were low, the restoration of this mitochondrial protein and targeted anti-inflammatory therapy may be beneficial for those with FA.

The study was funded by the Friedrich’s Ataxia Research Alliance (FARA), National Ataxia Foundation, and the National Institutes of Health

References:

Koeppen AH, Ramirez RL, Becker AB, Bjork ST et al. The Pathogenesis of Cardiomyopathy in Friedreich Ataxia. PloS One. 2015 Mar 4;10(3).

Alboliras ET, Shub C, Gomez MR, Edwards WD. Spectrum of Cardiac Involvement in Friedreich’s Ataxia: Clinical electrocardiographic and echocardiographic observations. American Journal of Cardiology. 1986 Sept 58(6): 518-524.

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Sequencing of common antibiotics may prevent drug resistant bacteria

04th Sep 2015 Diseases

Drug-resistant bacteria has become widespread. The World Health Organization (WHO) in 2014 made a plea for nations to monitor antibiotic resistance as there are serious public health consequences that can beginning to occur. A global survey showed alarmingly high rates of drug-resistant E-Coli and other bacteria that are capable of causing serious infections.

A recent study published by an international team based out of the University of Exeter in the UK has shown that alternating common antibiotics may prevent drug resistance. For many years, researchers have focused on using a combination of antibiotics as ‘cocktails’ with the thinking that a synergistic combination may be one answer to this growing problem.

In this recent study, the investigators used erythromycin and doxycycline to treat a test-tube model of resistant E-Coli. The antibiotics were given individually, in combination, and then in sequence. When given in certain sequences, they found that the infection was cleared. In most cases, the antibiotics given individually or combined failed to work. The researchers believe that specific doses of antibiotics combined with a specific sequence can make the bacteria sensitive and reduce risk of resistance.

As this was an experimental model, further research is needed to look at different combinations of drugs, doses and sequences.

Only two new classes of antibiotics have been introduced in the last 30 years. There is an urgent need to develop new drugs and while at the same time minimizing the prescribing and over utilization of antibiotics. Recently, the CDC announced that a drug-resistant form of the bacteria Shigella has caused illness in over 240 people since May 2014. 90% of the samples tested were resistant to the antibiotic Cipro. With more than 2 million cases of antibiotic resistant infections in the U.S. annually, rapid development of technologies to identify and characterize resistant bacteria has become a priority.

References:

Fuentes-Hernandez A., Plucain J., Gori F., et al. Using a sequential regimen to eliminate bacteria at sublethal antibiotic dosages. PLOS Biology. 2015 April 8;13 (4).

National Action Plan for Combating Antibiotic-Resistant Bacteria- https://www.whitehouse.gov/sites/default/files/docs/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf

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A Lesser Known Tick-borne Illness: The Powassan Virus

28th Aug 2015 Diseases

Tick-borne illness in Florida and the U.S. has been on the rise. Lyme disease, Rocky Mountain spotted fever, and Babesiosis are some of the most widely reported diseases that occur from tick bites. Many have never heard of the Powassan virus, but it has the potential to cause more morbidity and mortality than these other tick borne illnesses.

The Powassan virus is spread by being bitten by an infected tick. The disease is named for the town in Ontario, Canada where the virus killed a young boy in the 1950’s. While the disease is found in the same type of tick that hosts Lyme disease, the Powassan virus is significantly faster acting and in many cases is untreatable.

At present there are six known species of tick that host the Powassan virus and are typically found in Canada, Minnesota and the northeastern U.S.. Since the virus was first identified in 1958, 70 cases have been reported. In reality, this number may actually be greater as there are no specific tests available for the Powassan virus and many may mistake it for Lyme disease.

There are no medications to treat the Powassan virus. Unlike Lyme disease which can take a couple of days before infection sets in, ticks infected with the Powassan virus can inject the virus within a few hours. Symptoms can be similar to a form of encephalitis and generally begin to show within one to three weeks after being bitten by an infected tick. Fever, vomiting, confusion, weakness, and headache are common symptoms reported. In severe cases, swelling of the brain, pareis, seizures, aphasia and altered mental status may be seen. It has been reported that the mortality rate is approximately 10%, however many of those that survive have permanent neurological complaints.

Fortunately, the number of reported cases and deaths associated with the Powassan virus is much less that what is to be expected considering the number of ticks that are infected.

While this disease has been occurring primarily in Canada and the northeast U.S., it is possible to see cases develop in other areas where conditions support tick populations. These tend to be in wooded areas. The use of tick repellents, long sleeves and long pants is advised. The CDC also advises that immediate bathing and skin checks should be conducted immediately after being outside.

References:

Center for Disease Control and Prevention. http://www.cdc.gov/powassan/index.html

Minnesota Department of Health. http://www.health.state.mn.us/divs/idepc/diseases/powassan/basics.html

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Are low levels of Vitamin D associated with the development of dementia?

14th Aug 2015 Diseases, Medical News

A research study from the University of Exeter, published in the Journal of Neurology found a strong relationship between the development of Alzheimer’s disease and other forms of dementia and low levels of Vitamin D. The study included over 1600 adults over 65 years old who participated in the U.S. Cardiovascular Health Study. Participants of the study had their blood samples collected at the start of the study and mental status was assessed nearly 6 years later. Adults who had moderate Vitamin D deficiency had a 53% increased risk of developing dementia of any kind and 69% risk of develop Alzheimer’s disease. For those who were found to be severely Vitamin D deficient, there was a 125% risk of developing dementia and 122% increased risk of developing Alzheimer’s disease.

For the purposes of this study, a Vitamin D level of less than 50 nmol/L appeared to be threshold at which the risk of Alzheimer’s disease and other forms of dementia increased. This study is the largest yet to identify this association.

What remains unknown is the true cause and effect of this. It is unknown if increasing levels of Vitamin D would actually lower the risk of Alzheimer’s or dementia. More than 5 million people in the U.S. are affected by Alzheimer’s disease as the most common form of dementia. Worldwide, it estimated than over 44 million suffer from some form of dementia and this number is expected to grow with an aging population.

The authors of the study concluded that further studies are needed to establish whether the consumption of certain foods or taking a Vitamin D supplement can delay or prevent the onset of Alzheimer’s and dementia. The main source of Vitamin D for many is exposure to sunlight. However, the aging process results in skin that is less efficient at converting sunlight in a usable form of Vitamin D. Therefore, further supplementation through diet may be necessary to achieve adequate levels.

A group from the University of Guelph in Ontario, Canada has recently developed a mobile tracking application (‘App’) to help calculate intake of Vitamin D from food sources and exposure to sunlight. Using this newer technology as a tool may help users identify if they are below levels of adequate Vitamin D intake and lead to healthier behaviors.

References: Littlejohns TJ, Henley WE, Lang IA, Annweiler C, Beauchet O, Chaves PH, Fried L, Kestenbaum BR, Kuller LH, Langa KM, Lopez OL, Kos K, Soni M, Llewellyn DJ. Vitamin D and the risk of dementia and Alzheimer disease. Neurology. 2014 Sep 2; 83(10):920-8.

Goodman S, Morrongiello B, Simpson JR, Meckling K. Vitamin D intake among young Canadian adults: validation of a mobile Vitamin D Calculator App. Journal of Nutrition Education and Behavior. 2015; 47(3): 242.

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Potentially fatal bacteria along the coast of Florida

07th Aug 2015 Diseases, Medical News

A potentially deadly bacteria has made it way to Florida beaches. The Vibrio vulnificus bacterium has infected at least seven people and killed two this year in Florida. The two fatal cases have occurred in Brevard and Marion counties.

The bacterium, which appears to be activated by exceptionally warm weather, normally does not pose a risk to a healthy person. However direct contact between seawater and any open cuts or wounds can cause infections and skin ulcers. Sickness can also develop from ingestion of seawater or from eating raw seafood. Abdominal pain, diarrhea, and vomiting are the primary symptoms from ingestion. Redness, swelling, fevers, and chills progressing to life threatening septic shock can occur from a wound infection.

Vibrio vulnificus is a salt requiring gram negative bacteria that is commonly found in marine environments. According to the CDC, bloodstream infections are fatal 50% of the time. Between 1988 and 2006, over 900 cases of Vibrio vulnificus infections were reported along the states that border the Gulf of Mexico. Thirty-two cases of Vibrio vulnificus infection were identified in Florida last year. It is estimated that over 85% of cases occur between May and October when the coastal waters are the warmest.

The diagnosis is made by history assessment and testing. Blood, wound, and stool cultures should be ordered for those who have a history of possible exposure and exhibit clinical symptoms. Medical management includes the use of antibiotics and monitoring of any open wounds. In rare cases, surgical debridement and/or amputation may be necessary for severely infected wounds with extensive soft tissue spread.

Prevention of infection focuses on avoiding entry into the water if any open wounds or cuts are present. Avoid eating raw shellfish. Boiling or frying shellfish for an extended period of time is recommended.

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Identification of Genes that are Associated with Type 1 Diabetes

18th Jun 2015 Diseases, Medical News

Genetic susceptibility to Type 1 diabetes has been an area of intensive research since the 1970s. Despite the literature identifying over 40 different genes that are associated with type 1 diabetes, there has remained missing pieces within the puzzle until now. A University of Florida research group headed by a genetics expert, published a recent study in the journal, Nature Genetic, has narrowed number of genes that are involved in type 1 diabetes.

Type 1 diabetes which is also called juvenile diabetes, as it can occur in children and teenagers, is an insulin-dependent type of diabetes. In Type 1 diabetes, the body attacks its own insulin producing cells of the pancreas known as islets. Without proper functioning islets, the body is unable to normalize blood sugar. As a result, the body’s own cells starve from a lack of glucose. This may result in damage to the eyes, kidneys, nerve cells and heart.

The Research team from UF collected data from over 27,000 people including those with type 1 diabetes and screened for differences in DNA that are involved in Type I diabetes.  Using a technique known as fine mapping, the team was able to narrow down the number of disease causing DNA variations which are known as Single Nucleotide Polymorphisms from the thousands to 5 or less. The findings are considered landmark and can now be used by clinicians and other researchers to direct treatment to prevent the onset of autoimmune disease. This can lead to the development of new treatments and therapeutic agents.

In addition to the research team from the University of Florida, researchers from the Massachusetts Institute of technology (MIT), Harvard University and the University of Cambridge in England were also involved.

According to Dr. Patrick Concannon, Director of the University of Florida Genetics Institute “it’s a game-changer for Type 1 diabetes”

 

Source:

 

University of Florida – March 2014

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