So before having my pituitary surgery, I went for a pre-operative assessment at the hospital, which mainly involves blood tests, sitting around in waiting rooms, and being asked lots of questions by nurses. It also involves being swabbed for MRSA.
MRSA stands for methicillin-resistant Staphylococcus aureus, which basically is any form of the Staphylococcus aureus bacteria which has evolved resistance to standard antibiotics. It's no more virulent than your standard S. aureus bacteria, just harder to treat - and many people carry it around on their skin or in their nose or throat without suffering any adverse effects.Unsurprisingly, it's very bad news in hospitals; if it infects open wounds it can cause potentially fatal blood poisoning or endocarditis. So, before you're admitted to hospital they swab you to find out if you're carrying MRSA.
So far, so standard; that all happened last time I had pituitary surgery. The difference was that this time, about twenty minutes after I'd done the swabs, a nurse dashed into the room where I was chatting to the surgeon, handed me a bottle and a piece of paper, and dashed out. Upon closer examination, it was a bottle of octenisan, which is an antimicrobial body wash used to eradicate MRSA . No-one seemed clear on whether or not I actually had MRSA on my skin or not - it was only when I got into the hospital for surgery a week later that I found out I had been MRSA negative. It seems all the neurosurgery patients had been given the body wash, as a precautionary measure.
And my god, was it a hassle. It would probably be fine for lots of people, but I own precisely two towels and two sets of bed linen, and the "eradication protocol" requires not only that you use the body wash every day, but that all linen, clothes, towels etc. are freshly laundered too. This meant a hell of a lot of laundry every time I got home in the evening; on top of which, you have to leave the body wash on your skin for at least a minute, which required quite a lot of bravery in our icy cold bathroom.
Obviously I'd much rather go through all the hassle than end up infected by MRSA, or give it to anyone else - but my word it has made me resolve to buy some more towels...
Showing posts with label infectiousness. Show all posts
Showing posts with label infectiousness. Show all posts
Tuesday, 22 January 2013
Monday, 30 July 2012
IMFW: A Functional Cure for HIV?
Exciting news that a French research study may have found a way to allow HIV-infected people to avoid developing full-blown AIDS. In the study, newly-infected patients were treated with antiretroviral drugs very soon after acquiring the infection, which is quite unusual, and after three years of treatment they were able to stop their medication and remain well. It's a functional cure, which isn't quite a "cure" in the traditional sense; they still have the virus in their bodies - it's just kept at extremely low levels. And it only works if the infection is caught quickly. But it's a strong indication that antiretrovirals should be given as soon as possible after initial infection.
Wednesday, 29 February 2012
Happy Rare Disease Day 2012!
Happy Rare Disease Day 2012! Yes, it's that jolly time of the year again, when families across the globe gather together to celebrate the myriad exciting ways in which the human body can baffle trained physicians. This year is extra special, as the fifth international Rare Disease Day falls on the 29th February, the rarest calendar date of them all. The event focuses on extending solidarity, both between patients with different rare diseases, and with society at large.
I already have a rare disease (in fact, I technically have two: TSH-oma, and hypermobility syndrome, which is now classified as a subtype of Ehlers-Danlos Syndrome. But although my hypermobility causes joint pain, it also gives me nice soft skin, so I guess you have to take the rough with the unusually smooth). I am aware, however, that many of my more healthy readers may be feeling a little left out of the rare disease jamboree today. Most rare diseases are genetic - and it's very difficult to know in advance whether you're harbouring the kind of genetic anomaly which will allow you to get better aquainted with the medical profession. So, in the interests of this year's Solidarity theme, and in case you really are that desperate to join in, I have prepared a list of my top four rare diseases that you don't need mad genes to develop. All you have to do is pick one, and get infected:
1. The Bubonic Plague
In the West, bubonic plague is now extremely rare, although the plague killed millions in the Middle Ages. Globally there are about 1000-3000 cases reported by the WHO every year. Modern antibiotics are an effective treatment if administered quickly.
Upside: This one has a pleasingly retro feel. There's nothing like walking into a conference of medieval scholars and announcing you've survived the Black Death.
Downside: Gangrene of the extremities, seizures, vomiting blood and extreme pain.
Will I die? Mortality is 1-15% in treated cases. In untreated cases, it can be up to 90%.
How do I catch it? Usually through being bitten by an infected flea.
2. Guinea Worm Disease (Dracunculiasis)
Warning: this disease is available for a limited time only.
A global eradication effort began in 1980. In 1986, guinea worm was endemic in 20 countries, with 3.5 million cases across the world every year. In 2011 only four countries were still endemic for guinea worm disease, with 1,060 cases globally.
Upside: If you time it right, you could be one of the last people in the world to have dracunculiasis. And there's got to be a certain number of TV interviews in that.
Downside: After catching it, guinea worm has an incubation period of a year before the worm starts to travel down through the leg, causing immense amounts of burning pain, fever, nausea and monitoring. It then emerges from the skin. There's no treatment and the only way to remove the metre-long worm is to wrap the live worm around a stick and slowly wind it out - a process which can take months. And frankly: eew.
Will I die? Unlikely. Risks are that the wound where the worm emerges may become infected, or if the worm is broken as it's being pulled out of the skin, it may putrefy inside the limb.
How do I catch it? Drink water contaminated by water fleas which are host to guinea worm larvae - still available in South Sudan, Ethiopia, Chad, and Mali!
3. Kuru (Laughing Sickness)
The last known sufferer of kuru died in 2005, so catching this one may be tricky. Kuru was an epidemic amongst the Fore tribe of Papua New Guinea, due to their cannibalistic funeral practices, but unknown elsewhere. It's believed that the disease originated with an individual who spontaneously developed Creutzfeldt-Jakob Disease, a degenerative neurological disease caused by proteins called prions. When his or her body was consumed after death, the disease spread amongst the Fore, and there was a continuous cycle of new infections as sufferers were eaten after dying from the illness. Once cannibalism stopped, the disease began to die out, but because it can have a very long incubation period, new cases cropped up every now and again until 2005.
Upside: The last known sufferer died in 2005. A new patient would be a medical celebrity.
Downside: Everyone would know you're a cannibal. Oh, and you would slowly completely lose control of your body, develop severe tremors and emotional instability, become unable to speak or swallow, become incontinent, and acquire sores and necrotic ulcers.
Will I die? Yes. There is no cure. The good news is that you may have an incubation period of up to 40 years before symptoms develop. The bad news is that you will die about a year after that.
How do I catch it? You need to eat part of the body of someone with the disease (preferably the brain, if you can get it), or allow broken skin to come into contact with the blood or brain matter. Or you could inject yourself with it. But where's the fun in that?
4. Brain-eating Amoeba (Naegleria fowleri)
This is a nasty little unicellular parasite which is actually pretty common in warm, stagnant freshwater worldwide, but can invade the central nervous system via the nose, and then into the brain where it causes primary amoebic meningoencaphalitis.
Upside: You'd definitely make it into the local paper. Only 300 confirmed cases had ever been recorded in the medical literature by 2008.
Downside: Headache, vomiting, delirium, seizures and irreversible coma.
Will I die? Almost certainly. As of 2008 the in-hospital case fatality rate was 97%.
How do I catch it? Your best bet is swimming in infected water, or preferably by using a neti pot; weirdly, water that is safe to drink may not be safe to irrigate your nose with. But remember: the brain-eating amoeba has to get a long way up inside your nose before there's a chance of infection, so if at first you don't succeed, try again.
For more information on rare diseases in the UK: http://www.raredisease.org.uk/
I already have a rare disease (in fact, I technically have two: TSH-oma, and hypermobility syndrome, which is now classified as a subtype of Ehlers-Danlos Syndrome. But although my hypermobility causes joint pain, it also gives me nice soft skin, so I guess you have to take the rough with the unusually smooth). I am aware, however, that many of my more healthy readers may be feeling a little left out of the rare disease jamboree today. Most rare diseases are genetic - and it's very difficult to know in advance whether you're harbouring the kind of genetic anomaly which will allow you to get better aquainted with the medical profession. So, in the interests of this year's Solidarity theme, and in case you really are that desperate to join in, I have prepared a list of my top four rare diseases that you don't need mad genes to develop. All you have to do is pick one, and get infected:
Top 4 Rare Non-Genetic Diseases
1. The Bubonic Plague
In the West, bubonic plague is now extremely rare, although the plague killed millions in the Middle Ages. Globally there are about 1000-3000 cases reported by the WHO every year. Modern antibiotics are an effective treatment if administered quickly.
Upside: This one has a pleasingly retro feel. There's nothing like walking into a conference of medieval scholars and announcing you've survived the Black Death.
Downside: Gangrene of the extremities, seizures, vomiting blood and extreme pain.
Will I die? Mortality is 1-15% in treated cases. In untreated cases, it can be up to 90%.
How do I catch it? Usually through being bitten by an infected flea.
2. Guinea Worm Disease (Dracunculiasis)
Warning: this disease is available for a limited time only.
A global eradication effort began in 1980. In 1986, guinea worm was endemic in 20 countries, with 3.5 million cases across the world every year. In 2011 only four countries were still endemic for guinea worm disease, with 1,060 cases globally.
Upside: If you time it right, you could be one of the last people in the world to have dracunculiasis. And there's got to be a certain number of TV interviews in that.
Downside: After catching it, guinea worm has an incubation period of a year before the worm starts to travel down through the leg, causing immense amounts of burning pain, fever, nausea and monitoring. It then emerges from the skin. There's no treatment and the only way to remove the metre-long worm is to wrap the live worm around a stick and slowly wind it out - a process which can take months. And frankly: eew.
Will I die? Unlikely. Risks are that the wound where the worm emerges may become infected, or if the worm is broken as it's being pulled out of the skin, it may putrefy inside the limb.
How do I catch it? Drink water contaminated by water fleas which are host to guinea worm larvae - still available in South Sudan, Ethiopia, Chad, and Mali!
3. Kuru (Laughing Sickness)
The last known sufferer of kuru died in 2005, so catching this one may be tricky. Kuru was an epidemic amongst the Fore tribe of Papua New Guinea, due to their cannibalistic funeral practices, but unknown elsewhere. It's believed that the disease originated with an individual who spontaneously developed Creutzfeldt-Jakob Disease, a degenerative neurological disease caused by proteins called prions. When his or her body was consumed after death, the disease spread amongst the Fore, and there was a continuous cycle of new infections as sufferers were eaten after dying from the illness. Once cannibalism stopped, the disease began to die out, but because it can have a very long incubation period, new cases cropped up every now and again until 2005.
Upside: The last known sufferer died in 2005. A new patient would be a medical celebrity.
Downside: Everyone would know you're a cannibal. Oh, and you would slowly completely lose control of your body, develop severe tremors and emotional instability, become unable to speak or swallow, become incontinent, and acquire sores and necrotic ulcers.
Will I die? Yes. There is no cure. The good news is that you may have an incubation period of up to 40 years before symptoms develop. The bad news is that you will die about a year after that.
How do I catch it? You need to eat part of the body of someone with the disease (preferably the brain, if you can get it), or allow broken skin to come into contact with the blood or brain matter. Or you could inject yourself with it. But where's the fun in that?
4. Brain-eating Amoeba (Naegleria fowleri)
This is a nasty little unicellular parasite which is actually pretty common in warm, stagnant freshwater worldwide, but can invade the central nervous system via the nose, and then into the brain where it causes primary amoebic meningoencaphalitis.
Upside: You'd definitely make it into the local paper. Only 300 confirmed cases had ever been recorded in the medical literature by 2008.
Downside: Headache, vomiting, delirium, seizures and irreversible coma.
Will I die? Almost certainly. As of 2008 the in-hospital case fatality rate was 97%.
How do I catch it? Your best bet is swimming in infected water, or preferably by using a neti pot; weirdly, water that is safe to drink may not be safe to irrigate your nose with. But remember: the brain-eating amoeba has to get a long way up inside your nose before there's a chance of infection, so if at first you don't succeed, try again.
Wednesday, 22 February 2012
IMFW: Poliomyelitis
Long time no Interesting Medical Fact of the Week! In fairness, this is the first time in several months in which I have failed so abjectly to produce an IMFW on a Monday. I don't have any excuse at all, so without further ado:
Today's Interesting Medical Fact of the Week is focusing on Poliomyelitis, commonly known as polio. When I was a child, the combination of the name of the illness and the fact that the vaccine is delivered on a sugarlump meant that I had a vague conception of polio as a round, white germ with a hole in the middle. At least I didn't think of it as a kind of posh horsey bacteria.* Or a car.
Quick recap of polio: it's a highly infectious viral disease. About 90% of people who are infected will not have any symptoms. 5% will have only very mild symptoms, like a cold or 'flu. 1% will have a more serious episode of 'flu-like symptoms, often with muscle stiffness and meningitis. And only about 0.1% of cases will develop paralytic polio, in which the virus attacks the central nervous system and produces the "classic" polio symptoms which most people would recognise: the muscles of one or more limbs become extremely weak and finally paralysed. In cases where the virus invades the bulbar region of the brainstem, it may cause difficulty breathing, speaking, and swallowing.
Although there are vaccines for polio, there is no cure. Patients who are unable to breathe independently can be kept breathing using a negative or positive pressure ventilator until they have recovered, although in some cases polio survivors may need to use one of these devices for the rest of their lives. About half of patients with paralytic polio do recover completely, but around a quarter are left with significant permanent disability.
Since a global effort to eradicate polio began in 1988, the number of annual cases of polio being diagnosed has reduced by 99%. The initial eradication initiative aimed to eliminate polio by the year 2000; twelve years later, the disease is still clinging on in a few countries and is still considered endemic in Afghanistan, Pakistan and Nigeria. The last case in India was in January 2011, and the country is hoping to be certified as free from endemic polio shortly.
Efforts to eliminate the disease in these countries have been hampered by instability, as well as rumours in Nigeria that the vaccination effort was a Western conspiracy to spread HIV and sterilise Nigerian girls. Vaccination was banned for several years, leading to a massive upsurge in infections in Nigeria and the transmission of polio back into neighbouring countries. Vaccination boycotts have also taken place at various times in India; and in Pakistan and Afghanistan the Taliban have issued fatwas against polio vaccination.
In 2011 there were 649 cases of polio reported worldwide, with over half of these from polio-endemic countries, compared to around 350,000 in 1988.
___________________________________________________
*Not least because it's a virus.
Today's Interesting Medical Fact of the Week is focusing on Poliomyelitis, commonly known as polio. When I was a child, the combination of the name of the illness and the fact that the vaccine is delivered on a sugarlump meant that I had a vague conception of polio as a round, white germ with a hole in the middle. At least I didn't think of it as a kind of posh horsey bacteria.* Or a car.
Quick recap of polio: it's a highly infectious viral disease. About 90% of people who are infected will not have any symptoms. 5% will have only very mild symptoms, like a cold or 'flu. 1% will have a more serious episode of 'flu-like symptoms, often with muscle stiffness and meningitis. And only about 0.1% of cases will develop paralytic polio, in which the virus attacks the central nervous system and produces the "classic" polio symptoms which most people would recognise: the muscles of one or more limbs become extremely weak and finally paralysed. In cases where the virus invades the bulbar region of the brainstem, it may cause difficulty breathing, speaking, and swallowing.
Although there are vaccines for polio, there is no cure. Patients who are unable to breathe independently can be kept breathing using a negative or positive pressure ventilator until they have recovered, although in some cases polio survivors may need to use one of these devices for the rest of their lives. About half of patients with paralytic polio do recover completely, but around a quarter are left with significant permanent disability.
Since a global effort to eradicate polio began in 1988, the number of annual cases of polio being diagnosed has reduced by 99%. The initial eradication initiative aimed to eliminate polio by the year 2000; twelve years later, the disease is still clinging on in a few countries and is still considered endemic in Afghanistan, Pakistan and Nigeria. The last case in India was in January 2011, and the country is hoping to be certified as free from endemic polio shortly.
Efforts to eliminate the disease in these countries have been hampered by instability, as well as rumours in Nigeria that the vaccination effort was a Western conspiracy to spread HIV and sterilise Nigerian girls. Vaccination was banned for several years, leading to a massive upsurge in infections in Nigeria and the transmission of polio back into neighbouring countries. Vaccination boycotts have also taken place at various times in India; and in Pakistan and Afghanistan the Taliban have issued fatwas against polio vaccination.
In 2011 there were 649 cases of polio reported worldwide, with over half of these from polio-endemic countries, compared to around 350,000 in 1988.
___________________________________________________
*Not least because it's a virus.
Monday, 13 February 2012
IMFW: Schistosomiasis/Bilharzia
In today's installment of Interesting Medical Fact of the Week, we're going to be looking at schistosomiasis, also known as bilharzia, bilharziosis or snail fever. Never heard of it? After malaria, schistosomiasis is the second most devastating parasitic disease in tropical countries, and yet it can be controlled and easily treated with just one dose of a medication called praziquantel. One dose of praziquantel costs 18 US cents - that's about eleven pence. In the West, it's mainly used as a dewormer for cats and dogs.
Schistosomiasis is a disease caused by parasitic worms called schistosomes, which are carried by freshwater snails and then release larvae into the water. The larvae may then infect people when the water comes into contact with human skin; for example through swimming or washing. These parasitic worms then live in the veins near the bladder or intestines, laying eggs which can seriously damage the intestines, liver, bladder, and lungs. The eggs are then excreted, and will hatch in freshwater where they go on to infect new freshwater snail hosts. And so, the cycle continues.
Over 200 million people are estimated to be infected with this disease, of whom about 20 million will suffer severe consequences. Schistosomiasis is a chronic disease, and as such doesn't usually kill, but rather weakens the sufferer and leads to long-term ill-health; nevertheless, the WHO cites statistics suggesting that over 200,000 deaths per year are due to schistosomiasis in sub-Saharan Africa alone. In populations which are particularly vulnerable to malnutrition or dehydration, it is more likely to be a killer disease.
Symptoms of chronic bilharzia usually develop one to two months after the initial infection, and include fatigue, kidney and liver disease, bloody urine, bladder dysfunction, and diarrhea; there is also an increased risk of bowel cancer in infected persons, and the illness weakens the body's resistance to other infections. There is also an acute form of schistosomiasis, however, also known as katayama fever, which presents with a fever, muscle ache, liver enlargement, lymph node enlargement, abdominal pain, breathing difficulties, diarrhea and painful urination. In many cases, people infected with schistosomiasis may be largely asymptomatic except for fatigue.
It's an illness which westerners only tend to come into contact with on backpacking holidays and is most prevalent in sub-Saharan Africa, China, Brazil, the Middle East, the Caribbean and Southeast Asia. About half of all people who have swum in Lake Malawi test positive for schistosomiasis, yet many travellers are completely unaware that they may be putting themselves at risk of this disease by swimming or wading in freshwater. Every year, there are around 100 cases of the disease diagnosed in England, Wales and Northern Ireland among people who have travelled abroad.
There is no vaccine for schistosomiasis, and the main aim of disease prevention efforts is to eliminate the snails which act as hosts for the parasite. Various techniques have been used to this end, including treatment of water with copper sulphate, niclosamide, gopo berry, and the introduction of (or augmentation of existing populations of) freshwater crayfish. The tragedy of this disease is that many vast irrigation and dam schemes have been built in Africa and elsewhere which have contributed to the spread of the disease, despite the fact that UN guidance was available from the 1950s onwards, detailing how such schemes could be built to minimize the problem and make it difficult for snails to colonize the water.
Schistosomiasis is a disease caused by parasitic worms called schistosomes, which are carried by freshwater snails and then release larvae into the water. The larvae may then infect people when the water comes into contact with human skin; for example through swimming or washing. These parasitic worms then live in the veins near the bladder or intestines, laying eggs which can seriously damage the intestines, liver, bladder, and lungs. The eggs are then excreted, and will hatch in freshwater where they go on to infect new freshwater snail hosts. And so, the cycle continues.
Over 200 million people are estimated to be infected with this disease, of whom about 20 million will suffer severe consequences. Schistosomiasis is a chronic disease, and as such doesn't usually kill, but rather weakens the sufferer and leads to long-term ill-health; nevertheless, the WHO cites statistics suggesting that over 200,000 deaths per year are due to schistosomiasis in sub-Saharan Africa alone. In populations which are particularly vulnerable to malnutrition or dehydration, it is more likely to be a killer disease.
Symptoms of chronic bilharzia usually develop one to two months after the initial infection, and include fatigue, kidney and liver disease, bloody urine, bladder dysfunction, and diarrhea; there is also an increased risk of bowel cancer in infected persons, and the illness weakens the body's resistance to other infections. There is also an acute form of schistosomiasis, however, also known as katayama fever, which presents with a fever, muscle ache, liver enlargement, lymph node enlargement, abdominal pain, breathing difficulties, diarrhea and painful urination. In many cases, people infected with schistosomiasis may be largely asymptomatic except for fatigue.
It's an illness which westerners only tend to come into contact with on backpacking holidays and is most prevalent in sub-Saharan Africa, China, Brazil, the Middle East, the Caribbean and Southeast Asia. About half of all people who have swum in Lake Malawi test positive for schistosomiasis, yet many travellers are completely unaware that they may be putting themselves at risk of this disease by swimming or wading in freshwater. Every year, there are around 100 cases of the disease diagnosed in England, Wales and Northern Ireland among people who have travelled abroad.
There is no vaccine for schistosomiasis, and the main aim of disease prevention efforts is to eliminate the snails which act as hosts for the parasite. Various techniques have been used to this end, including treatment of water with copper sulphate, niclosamide, gopo berry, and the introduction of (or augmentation of existing populations of) freshwater crayfish. The tragedy of this disease is that many vast irrigation and dam schemes have been built in Africa and elsewhere which have contributed to the spread of the disease, despite the fact that UN guidance was available from the 1950s onwards, detailing how such schemes could be built to minimize the problem and make it difficult for snails to colonize the water.
Monday, 5 December 2011
IMFW: Arms for A Leper?
Leprosy. As no doubt you already know, it's primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract...
Ok, no. There are two things everyone knows about leprosy:
1. It's highly contagious.
2. Your bits fall off.
Interestingly, as it turns out, neither of these facts are actually true. Whilst it used to be thought that it was highly contagious, and sufferers were banished to live out the rest of their days in leper colonies, around 95% of people are naturally immune to the disease - it's possible that in the earlier days of medicine, it was sometimes confused with syphilis, hence the fear of infectiousness. Oddly enough, you can, however, catch it from armadillos.
Leprosy doesn't cause people to lose limbs or digits, but it does affect the nerve endings and impairs peoples' ability to feel pain. This means that people with leprosy tend to injure themselves easily, not realise, and then the wounds become infected, resulting in tissue loss. Fingers and toes can also become shortened due to loss of cartilage in joints.
To this day, despite high natural immunity and the availability of effective treatments, many sufferers around the world are forced to live in leper colonies even after they've been cured, because of the fear and misconceptions surrounding the disease.
Ok, no. There are two things everyone knows about leprosy:
1. It's highly contagious.
2. Your bits fall off.
Interestingly, as it turns out, neither of these facts are actually true. Whilst it used to be thought that it was highly contagious, and sufferers were banished to live out the rest of their days in leper colonies, around 95% of people are naturally immune to the disease - it's possible that in the earlier days of medicine, it was sometimes confused with syphilis, hence the fear of infectiousness. Oddly enough, you can, however, catch it from armadillos.
Leprosy doesn't cause people to lose limbs or digits, but it does affect the nerve endings and impairs peoples' ability to feel pain. This means that people with leprosy tend to injure themselves easily, not realise, and then the wounds become infected, resulting in tissue loss. Fingers and toes can also become shortened due to loss of cartilage in joints.
To this day, despite high natural immunity and the availability of effective treatments, many sufferers around the world are forced to live in leper colonies even after they've been cured, because of the fear and misconceptions surrounding the disease.
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