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Tag Archives: Infectious Disease
ANALYSIS: MULTIRESISTANT BACTERIA THAT OUTSMART ANTIBIOTICS (VIDEO)
Antimicrobial resistance is one of the greatest medical challenges of our time. Among the causes are industrial livestock farming, poor hygiene in hospitals, and the misuse of antibiotics. This documentary looks at approaches to fighting multiresistant strains of bacteria.
Each year 33,000 people in Europe die after becoming infected with bacteria that are resistant to antibiotics. Hygiene specialist Dr. Ron Hendrix has been working for years to prevent outbreaks of infectious disease in hospitals. Dr. Hendrix says that he and other experts in the Netherlands recognized early on that they’d have to fight the spread of bacteria just as actively as they would the actual infection.
Hendrix has convinced a number of German hospitals to re-open their diagnostic laboratories, as well. In the early 2000s, many of these labs had been shut down as a cost-cutting measure. And farmers in Denmark voluntarily chose to sharply reduce their use of antibiotics, after evidence showed that intensive livestock farming caused multiresistant bacteria to multiply.
Infectious disease specialist Dr. Patrick Soentjens was able to convince Belgium’s health ministry to allow the use of “phages” to treat stubborn antimicrobial resistant pathogens. Phages are special viruses that kill bacteria. Dr. Soentjens is certain that this well-known, but largely forgotten option could save many lives. Belgium has become the first western European country where phages have been officially recognized as a legitimate medical treatment.
‘INFECTIONS’: HOW WE EXPERIENCE INTERACTIONS WITH MICROORGANISMS
The RNA molecule is central to life. It is the information molecule of the Pandemic SARS CoV 2 virus, whose Messenger RNA specifying Spike proteins is the basis of 2 recently-released vaccines.
“RNA Life” is the leading theory for the Origin of Life itself, more than 3 Billion years ago. DNA evolved as the blueprint information molecule in cellular life, but the ubiquitous RNA may well have become the first viruses.
The stage was set for the ongoing battle of life: Parasite vs. Host, Pathogen vs. Target, but recent research reveals a much more nuanced picture. Viruses and bacteria can be BENEFICIAL as well as deleterious. We now speak of the MICROBIOME, usually referring to our host of resident BACTERIA, and the VIROME referring to all of our indwelling VIRUSES.
INFECTION is how we experience our interaction with microorganisms, their benefits unseen. Bacteria, viruses and parasites have always been with us, increasing in impact as Paleolithic man crowded into agricultural settlements.
Enlarging cities became more dense, favoring spread of infection and PLAGUES. The Bacterium, Yersinia Pestis,emerged in Roman times,
causing the Justinian plague, and resurfaced in the 14th C. as the Black Death. Viral Plagues, including Smallpox, were devastating during European adventures into the New World.
Malaria, a one-cell Eukaryotic Parasite, may be the greatest killer of all time. Modern Sanitation and improving medication have lately pushed bacterial infections into the background.
Viral infections such as Influenza and most recently Covid have become the Modern face of infection. Many Viruses reduce Immunity, however, paving the way for bacteria to invade: Haemophilus influenzae, a bacterium, may have caused much of the mortality of the 1817-1918
Flu epidemic.
IV drug usage has facilitated the spreading of the viruses causing Hepatitis and AIDS. The immune-compromising nature of the latter has reinvigorated TB and Syphilis, both bacterial infections. Only a few years ago, bacterial infection was thought to be conquered by antibiotics, and viral infection contained by Vaccines.
Microorganisms are constantly evolving, however, and often share their resistance factors. Infection is no more a thing of the past than War. The Battle continues.
–Dr. C.
VIDEOS: DIAGNOSING AND TREATING COVID-19 (MAYO)
Dr. Stacey Rizza, an Mayo Clinic infectious diseases specialist, discusses the various ways COVID-19 is diagnosed and treated.
COVID-19 can be diagnosed several ways when looking for active infection.
“The most common way that testing is done is with a swab into the nose or into the nasal pharyngeal area,” says Dr. Stacey Rizza, a Mayo Clinic infectious diseases expert.
“This polymerase chain reaction (PCR) test is essentially a test looking for the genetic material of the virus.” If it’s positive, it means that person is infected with SARS-CoV-2, the coronavirus that causes COVID-19.
COMMENTARY:
Dr. Stacey Rizza from Mayo Clinic gave the standard Academic recommendations for Covid Testing and treatment. I will comment on how this differs from the testing recommendations of Dr. Michael Mina from the Chan school at Harvard and the actual treatment given to Donald Trump as we speak.
I agree with the latter recommendations, and route that I would opt for, were I to catch Covid 19. TESTING, if it is to be Epidemiologically effective should offer results that are rapidly available so as to reduce spreading of the virus and treatment delay. One trouble with PCR- based tests is that they are slow. Another trouble, according to Dr. Mina, is that if they run for 40 cycles for maximum sensitivity, they may pick up viral shedding that is too minor to be infective, and may cause unnecessary precautions, such as quarantining. If they run for 35 or even 30 cycles to show only infective, actionable cases, they take several days, and even then labs do not usually report the number of cycles run, but only yes or no, positive or negative.
The RAPID TESTS detect viral protein are available within hours. They are less sensitive, but in Dr. Mina’s view, this can be a virtue, since only definitely infected patients are identified. They are cheaper, and can even be done on site. Frequent testing more than makes up for decreased sensitivity. Most tests currently available use only specimens from nasal swabs, which are uncomfortable.
SALIVA is almost as sensitive, and has one additional virtue, when it comes to testing school children. If school children are organized into learning “pods”, They can all spit into a common collector, and the pod tested preemptively, at least twice weekly. If positive The entire pod is individually tested to find who is positive. Of course if a full 20 kids are in a pod, The sensitivity of the protein test may be insufficient for positive to survive a 20-fold dilution, but this can be empirically worked out. Twice weekly testing vs. every other week is much better for reducing the number of the pod members infected at time of discovery, as the NYT has illustrated.
TREATMENT given to Donald Trump has so far consisted of more than Remdesivir. He is also receiving Corticosteroids, plus an experimental double antibody mixture, derived from both Covid Convalescent serum, and monoclonal antibodies from a “humanized” murine source. The antibodies should theoretically be given early. The corticosteroids are generally not given until a bit later, but with the reported drop in O2 sats, he may be later in the disease than we are led to believe. To my knowledge, he is not receiving his tweeted Hydroxychloroquine- azithromycin combination.
If I were infected, at age 88, I would also like the antibody treatment, but most likely would not be allowed to get it.
–Dr. C.
Dr. C’s Journal: A Little Bit About “Energy & Fatigue”
Sometimes I wake up in the morning with a feeling of RELAXED ENERGY. My mind is clear, I have no fatigue, and believe once more that the world is wonderful, and it’s great to be alive.
I St-re-tch, exercise my hands (I have Osteoarthritis, and they are stiff), take out my Nite guard ( I grind my teeth at night and would otherwise wear them away), take my beta blocker eye drops ( to lower my intraocular pressure) and wash down my Eliquis ( an anticoagulant to prevent stroke from my Atrial Fibrillation) with 16 oz. of water, while thinking about all of the delights awaiting me.
Yes, my body was in better shape 60 years ago; but I had much more responsibility then, and much less discretionary time. All things considered, I like to believe that I am happier now.
The KEY is to stay in GOOD HEALTH. GOOD SLEEP is critical, but it cannot be had by willpower alone. As I have discussed previously, you need a bedtime routine, good SLEEP HYGIENE.
You also need a…….. GOOD DIET. with lots of fruits, vegetables and whole grains. Fatty, spicy foods will stay in your stomach and bother you at night, particularly if you eat Late. I like to finish eating by 5 PM. Late dinner is also likely to produce GERD, and maybe Sleep Apnea.
GOOD EXERCISE is also critical. If you are not tired at the end of the day, it is hard to get good sleep. I always seem to sleep better on the day when I walk the hills for an hour, which is 3 days a week. Try not to exercise within 2 hours of bedtime. Assuming that you have a good base of SLEEP, DIET and EXERCISE, there are other mechanisms that can foul things up. INFLAMMATORY conditions often cause fatigue.
The most common inflammatory diseases are OBESITY, METABOLIC SYNDROME and DIABETES. OBESITY is the defining disease of our EXCESSIVE SOCIETY, where there is too much of everything, and excessive consumption is relentlessly advertised everywhere.
External correction is probably a pipe dream, since there is no will even to Tax Sugar-containing Beverages, the “low hanging fruit” of dietary excess. Internal correction is all that is left, and that takes WILL POWER, also in short supply.
INFECTIOUS DISEASES are a subset of inflammatory conditions. COVID 19 is the poster child of infection, and FATIGUE is one of the hallmarks of the disease. Interleukins, like TNF-alpha, IL-1, andIL-6 are some of the defense factors which cause the fatigue. AUTOIMMUNE Diseases like Rheumatoid Arthritis and Lupus are also associated with fatigue-producing interleukins.
Fatigue even has its own flagship disease, CHRONIC FATIGUE SYNDROME. Chronic viral disease has been suspected as the cause of this condition, and inflammatory cytokines may be elevated. This condition, and the similar GULF WAR SYNDROME are still poorly understood. Several CFS patients were sent to me when I was in practice, and I had some success in getting them to exercise regularly, which seemed to help. CANCER is another category of diseases where Fatigue is prominent.
Inflammation plays a role in these diseases, which also drain energy substrates from the Patients body; Cancer cells have a high metabolic requirement. MEDICATIONS, Cancer meds especially, but a variety of other Drugs are associated with FATIGUE. I went through MY MEDICATION LIST. Lo and behold, 3 of them are associated with fatigue.
Finasteride is a relic of my prostate operation, recommended to keep it from growing back. It causes fatigue, probably because of its ANTITESTOSTERONE effect. At least I can still pee, and am not bald. I take METFORMIN because of its fame in prolonging life. Its mechanism is that of interacting with the Sirtuin system, and increasing the inefficiency of mitochondria. Isn’t this surprising?
Like many other things in physiology, you place a stress on the body, and the body responds by improving its performance. If you are fatigued, you exercise. Respecting the body works with drugs as well. If you are drinking a ton of coffee and stop it, after a few weeks you will feel less fatigued.
And when you ARE FATIGUED, you drink a LITTLE coffee, and it wakes you right up. Caffeine works by displacing ADENOSINE, which causes Fatigue as it increases through the morning, peaking at SIESTA (or tea) time,at about 2 PM. OMEPRAZOLE, which I take to prevent HEARTBURN, also is related to fatigue especially if it blocks MAGNESIUM for long enough. DEPRESSION overlaps with fatigue, as does SLEEPINESS, to increase the complexity of the situation.
Many chronic LUNG, KIDNEY and LIVER diseases are associated with fatigue as a secondary concern. STAY HEALTHY!
–Dr. C
TELEMEDICINE: Obstetrics & Gynecology Services
The following list contains preventive services that may be done via telehealth (from ACOG.org):
General Health
- Alcohol screening and counseling regarding alcohol use
- Anxiety Screening and referral*
- Counseling regarding aspirin to prevent CVD and CRC
- Blood pressure screening (if patient has appropriate resources available such as a blood pressure cuff)
- Contraceptive counseling, discussion of methods, and prescribing contraceptives that do not require an in-person visit such as intrauterine devices or implants*
- Depression screening and referral
- Fall Prevention counseling
- Counseling regarding folic acid supplementation
- Healthy diet and activity counseling
- Interpersonal and domestic violence screening and discussion of available resources*
- Obesity screening (if patient has appropriate resources available such as a scale)
- Substance use assessment (drug use)
- Tobacco screening and cessation counseling
- Urinary incontinence screening*
Infectious disease
- HIV risk assessment*
- Sexually Transmitted Infection prevention counseling*
Cancer
- Counseling and possible prescribing of medications to reduce breast cancer risk
- Risk assessment for BRCA testing
- Skin cancer counseling
Pregnancy and postpartum
- Breastfeeding services and supplies*
- Postpartum contraceptive counseling, discussion of methods, and prescribing contraceptives that do not require an in-person visit such as intrauterine devices or implants
- Depression screening and referral
- Counseling regarding folic acid supplementation
- Interpersonal and domestic violence screening and discussion of available resources*
- Preeclampsia prevention with low-dose aspirin
- Preeclampsia screening (if patient has appropriate resources available)
- Tobacco screening and cessation counseling
*WPSI recommendation. For more information about each recommendation, please see our WPSI Recommendation page.
Download Well-Woman Care Chart
Read this May 4, 2020 “Women’sHealth” article for information about what a Telemedicine Visit is like
Doctors Without Waiting Rooms 