Saturday, April 16, 2016

The Week in Infectious Diseases

This past week the Centers for Disease Control confirmed that Zika virus can cause microcephaly in those born to mothers infected with Zika. We don't know why it does so, but for now it causes us to consider several things:

  1. Those areas where the Aedes mosquito carries Zika--a lot of good vacation spots and the site of this summer's Olympics--are probably riskier places to go if you are a woman currently or planning to become pregnant. If your plans will take you to the American topics this year the CDC has a Travel Medicine section to assist with specific advice.
  2. It is too early to tell, but the warming Earth may lead to advance of the Aedes mosquito's range northward. Don't panic, but stay tuned. Expect that public health authorities will be monitoring for this in 2016. It reminds us of the importance of funding for public health and the importance of getting state budgets ready on time.
  3. Birth control and access to pregnancy termination vary a lot by country and politics. It will be interesting to see what happens in Latin American and Caribbean countries, many of which have strict laws against either or both practices. It is easy to think of these things in the abstract. When disease threatens, I wonder if it will cause women to become more politically active--especially in those countries. I wonder if the reality of Zika may cause some to think differently about medical technology and family planning.
  4. Nature is always at work, busy birds and bees...and viruses. Evolution can inspire fear, but it can also inspire change. It may be that the common good could require a lot more cooperation, both abroad and at home. Nurse researchers Meaona Kramer and Peggy Chinn observed that one way we know our world (and our world is the health business) is socio-politically. In short: one can't effectively divorce our health from our politics. In a society, we share diseases together, or we learn to stay healthy together. 
...Including, the "Society" Inside Us

Late in 2015 Egija Zaura and her colleagues in Amsterdam reported that the human microbiome--the league of bacteria that live inside our guts--can be affected for up to a year after a single course of antibiotics. Ciprofloxacin ("Cipro") had the longest-lasting effect in this study. Ira Flatow of NPR's Science Friday frequently has stories about this microbiome, and what we are learning about it, how it affects everything from digestion to mood, immunity, and general health. Even short courses of antibiotics can lead to development of bacterial resistance. 

Recently I was updating material for a course I teach and had to update my array of "superbugs" that have emerged in the last year. Mostly, these won't immediately affect the average person. Hospitalized persons are most at risk (which doesn't make us feel great about being in the hospital!), although I've been seeing more methicillin-resistant Staph infections in the office in the last few years. 

I will use antibiotics if necessary, but many times antibiotics aren't needed. Now we have even better reasons to use caution with these drugs that seem so harmless otherwise. Fortunately, herbalism, homeopathy, and nutrition can be used to help the body back to health and also relieve some symptoms. So far these things have not shown any negative interactions with the gut, but it's an area where a lot more research could be done.

Full citation: from McGraw, M. citing Zaura E, Brandt B, et al. Same Exposure but Two Radically Different Responses to Antibiotics: Resilience of the Salivary Microbiome versus Long-Term Microbial Shifts in Feces. mBio. 2015. 

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