The World Health Organization recently declared monkeypox a global public health emergency – with cases being reported in many different countries, including here in the United States. Our expert explains what exactly the virus is, the symptoms and how it spreads.
For more information about monkeypox, please visit https://cle.clinic/3ABwZTH
Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.
Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems.
Rabies has been known since ancient times, and continues to produce thousands of deaths each year, primarily in Asia and Africa, almost invariably from the bite of an infected animal. There is usually at least a 2-3 week incubation period, while the virus is traveling up the nerves to the brain. This allows a period of time for a prophylactic vaccine treatment. Once symptoms actually develop, however, the disease is almost universally fatal.
Rabies is present as a Reservoir in wild animals. For this reason, flavorful baits laced with oral rabies vaccine are often sprinkled throughout endemic areas near human settlements, an expensive, although cost effective treatment. A bite from any wild animal is worrisome, but, in the United States, Bats are the main source of infection. The last fatal case of rabies in the United States occurred in an Illinois man who awakened with a bat on his neck. He refused Rabies vaccine and was dead within two weeks.
Dog bite used to be the most common source of rabies in America, but this is no longer the case, due to almost universal Rabies vaccination in American dogs. In India, however, the biggest problem is still dogs, which amazingly have recently been protected by law. India accounts for approximately 1/3 of the worlds rabies fatalities.
The development of rabies vaccine is an interesting story. It was first developed by Louis Pasteur and given in 1885 to a 12-year-old boy who had been mauled by a rabid dog.
The vaccine was prepared from the spinal cord of a rabbit who had the virus growing in his nervous system. Rabbits are very susceptible to rabies, and repeated rabbit passage increases the virulence of the virus. The virulence can be diminished by drying out infected tissue in the air, and Pasteur used a piece of spinal cord from an infected animal which was dried in the air for several days. The boy was given multiple doses of the vaccine over as many days, and survived. This technological achievement occurred before anybody even knew what a virus was. These invisible, infectious sources were called “filterable viruses”, since the infectious agent could not be strained out of the blood plasma by passing it through a filter which effectively removed bacteria, much larger entities.
The Rabies virus has been very clever over the millennia. It modifies the behavior of its victim towards irritability and aggression, which makes transmission of the virus more likely. It is highly concentrated in the salivary glands, increasing the likelihood that the aggressive animal’s bite will transmit the virus.
If you or an acquaintance are bitten under suspicious circumstances, be sure to get the vaccine, which is now been perfected and inactivated so that side effects are most acceptable, considering the almost universal fatality of the disease.
—Dr. C.
The IGA immune system comprises approximately 2/3 of all the immune cells in the body. Intestinal tract, respiratory tract, and skin are all exterior surfaces and are required to hold the environments’ many pathogens at bay.
IGA is one of several classes of immunoglobulins, the others being Gamma M, Gamma E, and several sub classes of Gamma G. They each have different structures and functions, but all have the basic underlying mechanisms of antigen presentation, clonal expansion, heavy chain and light chain dimers and specificity.
Mucosal gamma A occurs in pairs, with a junctional J chain and a secretory piece; The latter serves as a type of receptor on the cell surface; Imagine millions of gamma A combining sites waving on the surface of respiratory and intestinal epithelium waiting for pathogens to come along. Once combined with the virus or bacterium, they are shed into the mucus and eliminated before the virus can get to the mucosal cells.
With an IM injection of COVID-19 vaccine, all of the immunoglobulin classes except for Gamma E respond, with the earliest anybody at four or five days and peaking at 11 to 12 days. Gamma A in the serum occurs as a single antibody, as opposed to the secretory IGA which occur in pairs. Gamma G and M reside in the serum, and do not occur in any significant amounts in the mucus, leaving secretory gamma A alone to directly face the outside world.
Nasal immunization should theoretically be the route of choice for respiratory viruses. There is a vigorous response not only in the production of mucosal secretory IGA, but also in the production of serum immunoglobulins including IgG. However, the Titanic of medical practice turns very slowly. Part of the problem is probably tradition; immunizations have always been given by subcutaneous or intramuscular injection.
When a substance is injected, you know that it’s in the body in a precise amount, the tissues are very vascular, and the pick up rate is known, and it works well. With IM immunizations, people may get sick, because the lining membranes are not protected, but the immunized person rapidly produces huge amounts of IgG which usually keeps the infection under control. Covid is unique in its ability to evade the innate immune system, and multiply rapidly before the humoral immune response is adequate. Also, Covid Immunity wanes rapidly, aided by the fact that Covid is always changing it’s outer form.
There are more than a dozen nasal Covid vaccines being investigated, and the early studies on hamsters and mice showed a robust mucosal antibody production as well as a serum IgG production at least as great as intramuscular injection.
There are, however, several problems. An attenuated, live COVID-19 vaccine would theoretically be the best, since the virus itself is able to get into the cells and start replicating. However, lack of experience makes the medical profession fearful. There are a huge number of “do not give to” warnings on the only currently approved nasal vaccine, which is an attenuated influenza virus. There are worries about immunodeficient people, older people, pregnant people and about the possibility that the attenuated virus will go into the central nervous system via the olfactory system.
There are practical concerns as well. Viral vector vaccines may stimulate an amnestic response to the vector that excludes the vaccine from entering the cells. The nasal vaccine might be swept away with the mucus. How much is the vaccine will remain in the nasal tissues? Will patients have any confidence in the vaccine since it’s just a spray in the nose? Will it be abused, since literally anybody could administer the nasal vaccine.
The bottom line is that of the many vaccines in trial, not a single one is expected to be approved until the early fall. Interestingly, Pfizer is working with an mRNA nasal vaccine. DNA nasal vaccines are also being tried, since DNA is a more stable molecule. A number of adenoviral vectored vaccines are in trials.
The nasal route for immunization is so promising that I believe we will eventually have nasal vaccines, hopefully tailored for current viral variants.
Nasal antibody administration, or a small molecule drug that will combine with Covid are being looked at, but since they do not produce more than transient effects, I doubt if they will be very popular. Carrageenan is an approved substance that ties up viruses, and might have a chance to succeed as a nasal spray treatment.
Pills are so much for more familiar to people as a treatment device, and seem more attractive to drug companies. I do not believe that nasal sprays will replace them as the staple of outpatient medical treatment.
—Dr. C.
Viral hepatitis is an infection that causes liver inflammation and damage. Inflammation is swelling that occurs when tissues of the body become injured or infected. Inflammation can damage organs. Researchers have discovered several different viruses link that cause hepatitis, including hepatitis A, B, C, D, and E.
In a very good article, the Journal ‘Science’ has collated a lot of basic science regarding aerosol transmissions in viral infection generally, and Covid-19 in particular.
Early in the epidemic, I thought that large droplet transmission, which fell to the floor, and was transmitted by fomites and hand autoinoculation into the respiratory membranes, was more important. The main thesis of the article is that it is not large droplets, but aerosol particles that mainly transmit.
The secondary assertion is that aerosols can be up to 100 µm microns in diameter and still be transmitted by inhalation. they also stated that particle size of equal or less than 5 µm contain more virus particles than all the larger particles put together in spite of the greater mass of the larger particles . Normal speaking creates about 1000 aerosol particles per minute, And normal breathing about 7200 aerosol particles per liter of exhaled air. Coughing is more sporadic and tends to produce the larger droplets which don’t stay airborne as long, but I wouldn’t count on it.
There is a tremendous difference between individuals as to the number of particles they generate. It’s estimated that 10 to 20% of individuals account for 80 to 90% of the virus.
Slide number two deals with viral load and infectivity which is a function of the pH value, electrical charge, and other characteristics of the virus. An important point is that even though there is lots of viral RNA, that doesn’t mean that the virus is infective. Once again there’s a tremendous difference between the infective viable virus content of the aerosols from infected patient to patient. He stated that in one room with two Covid patients, they were 6 to 74 TCID/50 per liter, which means you’re almost certain to be infected if you don’t have a mask that filters out the virus, or some kind of purification in the room.
Slide Three was very interesting to me. The persistence in hours graphed against the aerosol particles size. 100 µm particles stay in the air only about five seconds, 5 µm particles stay in the air for 30 minutes, and one micrometer particles will stay in the air for 12 hours or more.
The fourth slide talks about factors affecting the distribution of indoor aerosols. There may be certain parts of the room where the particles congregate , depending on the ventilation type, whether natural, mechanical or filtered, flow patterns within the room, and indoor filtration and killing devices such as ultraviolet light.
Mention is made of the CO2 level in the room as a measure of air circulation. There is a higher CO2 in the air with lots of people and poor ventilation. The recommendation is that 7-8 ppm is about the highest acceptable level, and the possibility of using a portable HEPA filter would not be a bad idea for people frequenting indoor restaurants. Of course, outdoor air with its breezes, dispersion, less humidity, higher ultraviolet and usually Greater dispersion of people is preferable to indoor contact.
Some other interesting points are that children produce less aerosol particles because they have a smaller number of bronchi. I thought the bacteria were less likely to be aerosol transmitted than viruses, but they state that the R0 of tuberculosis can be as high as 4.3, vs. 7-8 for covid. The typical tuberculosis bacillus is relatively large, and yet is only 2 µm in length, well within the size of an aerosol particle.
The common cold is the most common human disease in the world. So, why haven’t we found a cure yet?!
Called human rhinoviruses, these respiratory viruses measure between 15 to 30 nanometers in diameter, making them some of the smallest types of viruses out there. And it’s partly thanks to the viruses’ genetic makeup that they’re so good at replicating.
Human rhinoviruses travel like most other respiratory viruses via nasal secretions, which can be released through sneezing, or through contact with fomites, which are surfaces like a keyboard or a doorknob that can help spread the virus from one person to another. From there, all it takes is for a hand to touch one of the body’s mucous membranes like the eyes, nose, or mouth and bam — the virus has gained entry.
Soon after infection, coughing, sneezing, headaches, a mild fever and body aches can soon follow. And these symptoms may easily be confused with those of the flu. But unlike the flu, where symptoms start quite suddenly, it can take a couple of days for cold symptoms to fully develop. And they usually last anywhere from 7 to 14 days.
The skin is the protective barrier between the inside of our bodies and the outside world of microorganisms, parasites and toxins. It is often the site of inflammation and infections.
In past times, before the advent of cleanliness and antibiotics, mankind was plagued by erysipelas, boils, carbuncles, and other severe infections of the skin, which are rarely seen now. The beta hemolytic streptococcus and Staphylococcus aureus were ubiquitous in the past, and mostly are contained today.
Severe Infections presently require some skin abnormality, immune deficiency, neglect, animal bite or other breach of skin integrity to be a problem. Antibiotic resistance, however, is allowing some organisms like MERSA to make a comeback.
ECZEMA. or Atopic Dermatitis, was common in my medical practice. This condition weakens the skin barrier, allowing Staphylococcal infection to gain a foothold. In my day, If there were a flare of eczema severity, antibiotics would often help. Leg edema and swelling. such as from heart failure, especially coupled with diabetes and blood vessel disease is also an invitation to infection, such as cellulitis.
Redness, swelling, warmth and pain- the classic rubor, tumor, calor and dolor- as well as swollen local lymph nodes and fever often betray infection of the skin. Please see the recently posted infographic on celulitis.
IMMUNE DEFICIENCY raises the likelihood and risk of severe skin infections. Infection from “flesh-eating bacteria”, often beta hemolytic streptococci in deep tissue planes , is a medical emergency. Immediate surgery is often needed.
Disproportionate PAIN after injury or surgery is often a clue. Certain age groups have characteristic skin infections, such as the scalded skin syndrome of infants, and the acne of adolescents. Viruses, molds, and arthropods can also infect the skin.
Viruses, such as herpes in particular can simulate bacterial infection. Ringworm from fungi is easy to distinguish, but arthropod bites, and especially bee sting can look very much like bacterial infection. Scabies and mite infestation are so itchy as to be distinct.
Topical antibiotics applied on skin breaks like cuts or breaks are useful in preventing infection. These ointments and creams are like “artificial skin”. Once again, prevention is key.
It’s one of the tiniest machines on the planet — about a hundred times smaller than the average cell. It’s so small that no scientist can spot it through a typical light microscope. Only with an electron microscope can we see its spiky surface. It’s not alive, and it’s not what most of us would think of as “dead.” This teensy machine seems to survive in a kind of purgatory state, yet it has traveled across continents and oceans from host to host, and brought hundreds of nations to a standstill. Despite its diminutive size, the novel coronavirus, dubbed SARS-CoV-2, has seemingly taken the world by surprise with its virulence.
Doctors Without Waiting Rooms 