Not Your Father's Syphilis

I just finished reading Robert Harris' An Officer and A Spy which fictionalizes The Dreyfus Affair, a horrible miscarriage of justice that occurred in post Franco-Prussian War France. 

There was only one mention of an infectious disease in the novel and it involved Colonel Jean Sandherr, the head of counter-espionage for the French military responsible for the false case against Alfred Dreyfus.

Harris describes Sandherr as suffering from general paresis caused by syphilis. This complication occurs in late stage syphilis in which the invading spirochete, Treponema palladium, has caused a chronic meningitis that leads to degenerative changes in the brain. 

Every so often, I get consulted on a case of an elderly individual being worked up for dementia because, as part of that workup, a syphilis test is ordered and returns positive. While I've never seen a case of general paresis, these individuals have "late latent" syphilis and undergo treatment (which never really changes the course of their dementia). 

Common in earlier eras, this stage of syphilis is quite rare today. However, the earlier stages of syphilis still abound and, in recent years, the bacterium has become tech-savvy as it has now begun to use social-networking sex apps to find new victims. It seems to have found success  as cases doubled between 2005 and 2013, primarily in men who have sex with men.

At least there's no worry about syphilis being bewildered in the modern digital world because included in the internet of everything are the every resilient STDs. 

Chikungunya Gets Its Green Card

It comes as no surprise that autochthonous chikungunya has occurred in Florida. The simple maxim that must be kept in mind with respect to vector borne diseases is: if a competent vector exists in areas in which imported cases are occurring, it is only a matter of time before local vector populations contract the pathogen.

Florida is an area hospitable to Aedes mosquito and has been plagued with locally-transmitted dengue for several years. As chikungunya shares many of the same characteristics of dengue, it is no surprise that it has found welcome in Florida. 

Intensified efforts to control the vector, which is already ongoing for dengue, will likely occur. However, it may be exceedingly difficult to eradicate chikungunya if it has thoroughly settled in local Aedes population.

For a great overview of these issues see this recent NEJM piece by Fauci and Morens. 

Lions, Tigers, & Bears or Anthrax, Smallpox, & Bird Flu

Today it was announced that the recently discovered smallpox vials contained viable virus that was infectious. This is not too unexpected given that these were freeze-dried specimens.

However, the other piece of news that accompanied this announcement was that, over the last decade, there were 5 lapses in which dangerous pathogens, including the H5N1 influenza virus, were sent improperly to other laboratories from the CDC. The revelation of these incidents has prompted CDC to cease operations at two labs and impose a "moratorium" on specimen shipping from some CDC labs. 

What strikes me as the most important part of the story, however, is the issue of the Select Agent Rules. After the anthrax attacks of 2001 there was a major effort by the US government to impose strict control on the laboratories doing work on certain pathogens that were particularly dangers (hence, select agents).

Many university laboratories, including the ones in my own institution, struggled to meet these requirements. I personally know of one tularemia researcher who had particular difficulty meeting all the regulatory requirements to receive a non-virulent strain of the bacterium.

This laxity by some government personnel gives the impression that although university labs work diligently to comply with such regulations, their government counterparts have not exerted the same level of diligence. The belief that a two-tiered system exists coupled with the lapses that have occurred is something that could harm the public's confidence in this vital research and potentially jeopardize it -- a scenario that is more dangerous than finding decades-old smallpox vials.

Who Left Their Smallpox in the Closet?

The revelation that 6 vials of smallpox--the only human disease mankind has eradicated--were found in an FDA storage room at the NIH will likely grab headlines and spark concerns of a smallpox outbreak. However, I do not anticipate this event will amount to much. 

As is widely known, smallpox was eradicated from the planet in the 1970s and vaccination soon stopped. This cessation of vaccination has rendered most of the population susceptible to smallpox...if it were to return through an accidental lab release or deliberate attack--a major concern for those in the fields of biosecurity and bioterrorism.

In the post-eradication era, the known stocks of the virus are kept in secure locations at the CDC in Atlanta and the Vector Institute in Novosibirsk (Russia). The retention of the virus has sparked continual debate at the World Health Assembly regarding whether these stocks should be destroyed or retained. 

Further testing remains to be performed to determine whether what was found at the NIH was viable virus and the fact that it was freeze-dried may have preserved infectivity. Indeed, the vials have tested positive for smallpox DNA and the next step will be to assess whether the virus can be cultivated in culture. Nevertheless, though these vials do not pose any risk to the general public, the fact that forgotten stores of the deadly virus exist in the US makes it all the more possible that such remnants exist in other parts of the world. 

Another Tangle with Norovirus

I hate norovirus. This entity, which seems to seek me and my sweet type-O blood out, has infected me again.  I'm not in anyway unusual, this virus causes 20% of gastroenteritis cases. 

As someone who has had norovirus a few times, I've been able to recognize the tell-tale warning signs that something explosive is about to come. First, I usually have a sense that my stomach is not emptying fully. This is the result of the virus' action to ensure it has enough projectiles to hitch itself onto to make its way to another host. Next, hyper-salivation. Then, the run to the bathroom to vomit violently--this often just starts like a flick of the switch. Chills and muscle aches and pains usually follow.

Today, I was ready (or so I thought). As soon as I felt that delayed emptying sensation, I took an anti-emetic medication. However, it was too little too late. Though, it has kept the vomiting at bay for now.

Norovirus is so successful because of its contagiousness--when someone vomits they are a super spreader whose vomitus remains infectious. Additionally, the virus is resistant to standard cleaning agents (e.g. alcohol), making clean up challenging. 

I wish there was a vaccine.