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As of this writing, the Centers for Disease Control (CDC) in Atlanta is strongly recommending that pregnant woman postpone travel to many countries across the world, including the popular Caribbean islands.  The CDC is taking these steps due to the possibility that these women may become are infected with a mosquito borne virus called Zika.  The World Health Organization (WHO) Director General Dr Margaret Chan, has said that Zika had gone “from a mild threat to one of alarming proportions” and expects the virus to spread through the Americas and affect between three million and four million people.

Eighty percent of individuals who are infected with Zika do not show symptoms.  However, when symptoms do occur, they can last up to a week or so and include fever, rash, pink eye, and joint pain. Some clinicians suggest that Zika virus infection may result in the autoimmune [against oneself] condition,  Guillain-Barre syndrome (GBS).  This is rare disorder where too much inflammation damages the nerve cells, causing muscle weakness and may lead to paralysis.

The greatest concern however right now is that health agencies “strongly suspect” that when a pregnant women is bitten by a mosquito that is carring the virus, that even if she does not experience symptoms, that her offspring may develop brain malformations.

This latest outbreak adds to concerns that infectious diseases are one of the top threats challenging our world—a major topic on the agenda of last week’s World Economic Forum world leader attendees.  Until vaccines or treatments are developed, viral infections such as Zika, Ebola, SARS (severe acute respiratory syndrome), and MERS (Middle East Respiratory Syndrome) remain a threat to the world’s population.

Currently, there are no commercially available vaccines or treatments for Zika.  Until recently the cost to develop a successful vaccine was far greater than what the manufacturers would recoup in vaccine sales.  However, development of a vaccine for Zika will likely now escalate since Zika has spread so widely, infecting over 1.5 million individuals and its being linked to neurological problems, especially in newborns.

In addition to a lack of vaccines and treatments for a multitude of viral diseases, another significant health-care crisis we are facing is treatment of infection by anti-microbial-resistant pathogens. As Dr. Keiji Fukudaof the World Health Organization has stated:  “We really hope to pull the world back from the brink where antibiotics don’t work anymore”.

When bacteria are stressed, for example by a killer antibiotic, their genetic material may change, mutate, so that they can tolerate and become resistant to such compounds.  The bacteria can then replicate easily and outgrow bacterial strains that were not resistant to the antibiotic.

Fifty percent of antibiotic prescriptions written by U.S. physicians are of no benefit to the patient, and when used to fatten livestock and poultry it gives bacteria even more opportunity to acquire antibiotic tolerance.

It is our immune systems that identify, destroy, and remove invading pathogens.   When our body recognizes that it has been invaded by foreign agents, a strong inflammatory responses is triggered to meet the onslaught of the pathogens.  White blood cells accumulate in the area to combat the invaders.  These immune cells release cytokines and other immune messages  recruiting more white blood cells in an attempt to “burn out” the infection. Without a powerful inflammatory response, we cannot limit or survive infections.

In the absence of drugs or treatments that prevent and control the growth of viruses and other microorganism the immune system must be optimized to protect the body against them.

 

www.cdc.gov/mmwr/index.html
www.scientificamerican.com/article/who-extremely-alarmed-by-zika-cases-could-reach-4-million/?WT.mc_id=SA_DD_20160128
www.wsj.com/articles/health-threats-spur-vaccine-hunt-1453337493
ecdc.europa.eu/en/healthtopics/zika_virus_infection/factsheet-health-professionals/Pages/factsheet_health_professionals.aspx
www.vox.com/2016/1/20/10795562/zika-virus-cdc-mosquitoes-birth-defects
www.wsj.com/articles/SB105768561135341800
www.cdc.gov/features/antibioticresistancethreats/
www.cdc.gov/media/dpk/2013/images/untreatable/img2_sm.jpg
www.bbc.com/news/health-35427493

Middle East Respiratory Syndrome (MERS) is a viral disease of the lungs that was first reported in Saudi Arabia in 2012 and has now spread to several other countries, including South Korea and the United States. Genetic material isolated from an individual that died of MERS was identical to genetic material found in one of his own camels. The infected camel possibly infected the owner and is responsible for the death of the man.

 People infected with the virus initially report mild symptoms of a cold, chills, body aches, sore throat, fever, difficulty in breathing, and a cough.  Some individuals report gastrointestinal issues such as diarrhea, nausea, and vomiting.  When symptoms become severe, death may follow failure of the lungs and kidneys.

Most of individuals that have succumbed to infection with MERS suffered with other medical conditions, such as diabetes, cancer, chronic lung conditions, heart, or kidney disease.

MERS and SARS

There is limited scientific information on MERS.  However, the MERS virus is in the same family of viruses as SARS, the virus that causes severe acute respiratory syndrome. Infection with this virus results in severe breathing difficulties which too frequently results in death. (Both the traveling businessman and his World Health Organization physician, Dr. Carlo Urbani who identified the infection as a new disease in the business person, died of the virus.)

 Although there are similarities in symptoms, two major differences between MERS and SARS are: a) MERS progresses to lung failure more rapidly than SARS and b) MERS affects older individuals more than it does younger people. [The high numbers of fatalities from MERS may be related to the older age of infected persons and the fact that individuals with other conditions are more susceptible to respiratory failure].

 Since so little is understood about the disease, people with diabetes, lung, kidney, and immune disorders should take precautions if they are exposed to infected individuals.

The Immune System and Infections

The only part of the body that protects us from infection is our immune system. The role of the immune system is to recognize threats from pathogens, stop, and then up regulate inflammatory responses to destroy the pathogens before they can multiply.

 When the immune system is recognizes invasion by pathogens, immune cells are triggered to produce antibodies and other immune factors, such as cytokines. Cytokines are proteins that help recruit immune cells into an area to help fight the battle, and orchestrate the protective immune responses.In SARS, an over-response of the immune system,  a “cytokine storm” occurs that too often results in the deaths of infected persons.  It is likely that infection with MERS triggers the production of high levels of cytokines, resulting in excessive inflammation and death.

Summary:

People with unbalanced immune systems are at higher risk of having severe symptoms when infected with pathogens.  It is essential that the immune system always be in balance, in homeostasis for optimal protection from disease.

The inflammatory response to infection has to be a controlled, limited response. There must be enough of an immune response to defend the body against disease, but not so great an inflammatory response that the body is harmed.


www.cdc.gov/coronavirus/mers/
www.nejm.org/doi/full/10.1056/NEJMoa1401505
www.nlm.nih.gov/medlineplus/ency/article/007192
www.cdc.gov/coronavirus/mers/
www.nejm.org/doi/full/10.1056/NEJMoa1401505

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