Thursday, April 26, 2012

Can we prevent Infectious Diseases?

Pathogens in the human milleu

From the procrustean bed of thought, where cause and effect arise from the common thread of desire and become embroiled within the thrill, frustration, anger and ultimately joy, we have eloped with the idea of ease and flexibility. By that I mean, we have given up the rigor of evaluation and validation to the pseudo-science of correlative fiat. You know like the one that says, “ It is and therefore it is.” Something one would encounter in the Doctrines of a fist and a hammer.

The power of intuitive understanding will protect you from harm until the end of your days. ~ Lao Tzu

Allow me this progression of thought. So saying, we can control all infectious disease is like saying we can or should eliminate all other "irritating," and "useless,"  forms of life, save of course the human kind. Is that possible? You mean there would be no antelopes loping on the Serengeti nor any giraffe craning to eat the leaves from a tree or the dog wagging its tail at being pet, or the cat purring at your feet? “Oh come on, you scream! You must be joking and you're not even Feynman!"  What has infectious disease got to do with the animals?”

Why, a lot. Maybe more then one can contemplate in the 3-pound universe.

So let me set the stage for what will turn out to be a mind-exploring axiom of "this is this and that is that." (Back to "Flounder," the cute little fish from "The Little Mermaid") Any idea how many infectious agents that can get into the human body and create disease? Hmm.

So here goes a revelation in its stark dangerous clarity. There are about 1415 pathogens (euphemistically called because they cause pathology or disease) that cause disease within the human body. “Wow!” you say, “that’s a lot!” Uh huh. Exactly what I was thinking. They go from parasites, fungi, bacteria to viruses and all other critters in between. Of course by virtue of truthful scientific discourse, we are not counting prions. You know those tiny pieces of proteins that have a proclivity to attach themselves to the brain and nerves and create hideous forms of diseases called, “Kuru,” “Bovine Spongiform Encephalopathies” to human named versions of debilitating and deadly ones like the “Cruetzfeld Jakob Disease.” Even these prions called PrPc which are a natural normal product in the brain can with spontaneity morph into PrPsc that creates the havoc. Most cases however have been detected where the feed has contained the mashed up remains of a diseased cow, but sporadic cases without a direct cause do exist, as recently determined in the State of California. Although that is a fascinating story in itself, we will concern ourselves only with those live agents of human destruction.

The other day, a teenager, son of a friend developed a remitting fever that made him lethargic and weak for days. The vigor of his age distilled from him as much energy it could muster for almost two months and then it let go as he collapsed into a heap. Meanwhile he went through an armada of diagnostic tests, including a PET/CT scan, which showed a lump in the middle of his chest. A barrage of consultants arrived on the scene and determined what should be done. Ultimately given the bizarre nature of his illness, the horses of common sense raced forward and someone asked if he (the patient) had been in close proximity to an animal. “Why yes,” he said in his fading weak monosyllabic tone. “my cat!” And thus “Cat Scratch Disease” was diagnosed and treated. Yet given the poor young teen who had, had a valve replacement some ten years ago, the “scratch” from the cat with it’s venomous pathogen had traveled from the skin into the lymph glands and thence to the blood vessels ultimately ending up on the porcine valve, causing a well known phenomenon of a subacute bacterial endocarditis (a valvular infection). This complication after the requisite antibiotic therapy of 6-weeks, required a 10-hour surgical replacement. But true to his youth and courage, he survived and since has blossomed.

So the cat was the vector of this awful adventure. So why am I telling you this? Because, 61% or 864 of those 1415 pathogens causing disease are transmitted via the animal vector. Ok simplistically, those beautiful animals that we love to kiss, hold, and whose company we enjoy and those that we pet, or farm or create food from, or the insects, mosquitoes and ticks we swat off our backs on hot humid days, or flick off the skin when on the mountains or in the tree-lined valleys or partake in our meals that from the bounty of the oceans or the little and big birds that fly in the sky or the gracefully galloping four-legged ones that have boundless energy when not in headlights, all those and others carry on, or within themselves, these tiny creatures that have made a habit since time immemorial to have a feast on our cells and sinews. These viruses, bacteria, parasites and fungi live in harmony with many of these animals waiting for a chance to propagate within the largesse of the human body.
HBV image

For instance take the Hepatitis virus. It was discovered in 1967 by a Dr. Baruch Blumberg from University of Pennsylvania. Since it’s discovery, it has evolved through modification of its DNA in as few as 20 of its 3400 base pairs, into many variants (sub-genotypes) within different variants (genotypes). How does that happen? One might ask. The answer is quite elementary. Its called a selection bias. Remember the Darwinian dictate of “the survival of the fittest?” Well to survive, the virus mutates, ever so slowly. Some might call it a "glacial pace." In fact the rate is 0.00053 per nucleotide per year. So a 0.1% mutation of the viral genome could take many years. In the evolutionary scale of time

that has different connotations, especially when it is exposed to the various immune systems of the human body, the environment and as a result of the vaccines we create to prevent the infections.

So we prevent one type and it transforms into another type ~ tit for tat. Some types of these newer modified versions are more virulent then others. Some have the proclivity to live inside the humans for a very long time giving rise to the chronic infections and others are more civil and surreptitious and lie quietly inside the cell without revealing themselves to the body’s immune defenses; so called occult infection~ all in the name of survival, which would be counterproductive for its propagation. The hepatitis virus needs the liver (Hepar) to survive and prosper, thus adaptation is their evolutionary dictate whereby the virus grows slowly and finds means to transfer to a newer host, via assorted means of transference.

By the way, so you should know, the hepatitis virus came from the Woodchuck and the Ducks way before they invaded the humans. In fact a recent study puts this virus at 6-million years in age. Way much older than the human race that seems to blossom at 2 ½ million years and the oldest modern human being is aged back to 400,000 years.  Currently 1/3rd  the population of the world or 2 and one half billion is considered infected with hepatitis B virus and about 300-400 million suffer with chronic form of Hepatitis B infection.

HIV image

And what have we here in the most developed and civilized society, but the making of a modern day “plague” scourge with the HIV infection. While the world and the Gallo’s of this world determined this illness in the early 1980s, the virus seemed to have found a stable state of existence in the Rhesus monkeys. Only when the HIV virus found a new host to invade and determined the ease of spread, did it fire on all cylinders. It has shown a remarkable predilection for mutation and that is what had miffed the scientific crowd. But all in all, now there seems to have developed a quiet peaceful coexistence. This has been mitigated by the antiviral agents that have worked against the Integrase, Protease and the Retroviral transcriptase enzymes that the virus uses to propagate. Yes there are new cases of infections but the initial catastrophic death-rate has declined dramatically to the hopes of many. And with newer antiviral medicines, better understanding of the transmission modes and the HIV virus' desire to survive, a long coexistence is in progress and maybe not with the same rampant predilection for massive replication. Don’t forget, the first DNA dictate of the virus is also  the same as a human's ~to survive. So if the HIV kills everyone it infects, eventually it will run out of hosts and its population will decline. So it merges and evolves and sheds and placates and grows patiently and survives.

Speaking of the HIV subtypes. These are also called the PTLV or Primate T Lymphotropic viruses. In other words these viruses exist in the primate population (e.g. monkeys) and have "jumped" via contact into the humans. Another example of this virus is the HTLV-1 virus which in its diploid form is also known as BLV or bovine lymphotropic virus, (as in cows) The HTLV-1 causes Lymphomas and Leukemia and is prevalent in the Cameroon, Asia and Southeastern United States. It is linked to about 5000-6000 cases a year. It transmits in humans via contact, mostly blood borne and through breast-feeding. So you see the original HTLV-III now called HIV and its other counterparts are inter-species transmitted entities. These viruses are patient. They evolve to the pressures over a period of prolonged time, but once having that which not having ultimately makes them infectious to humans.

The ecosystem of life is a wonderful case study of evolution. Maybe we should all study it a bit more.

We cannot rid ourselves of all infectious disease. The diseases once considered eradicated keep making a comeback; Polio ( ), Measles ( ),
Mumps ( ),
Whooping Cough ( ) and even
Smallpox ( ). The viruses evolve to survive.

So the experts proclaim it is the lack of universality of vaccination for these "outbreaks." Maybe to some extent that is true, but when the virus takes on another face, it is not the vaccine but the mutant evolving to forge its own destiny.
Esherchia Coli O157:H7

Remember the Ecoli (Esherichia Coli) ( ) and  ( ). This little common critter has evolved into a more dangerous little bug (EColi O157:H7). It can kill and does kill humans. It is also a mutant of the original more docile version that sometimes lives peacefully inside the human alimentary tract.

Shallow understanding from people of good will is more frustrating than absolute misunderstanding from people of ill will. ~ Martin Luther King Jr.

Oh and who can forget the H1N1 virus that was to decimate the population of the world through spread. Well it didn't respond to the bell-ringing. And now of course, the humans, given our need to understand have created a H5N1 version in the laboratory that can perform a cross species jump from birds into humans and these fine laboratory technician scientists have published their data on this elegant feat of genetic manipulation. I only have one question for those smart literati. WHY? ( ) Maybe the historical lessons from the H1N1 (Spanish Flu of 1918) is too remote a historical fact to tickle their fancy, but if ever there was a reference for reverence, it is that outbreak that cost over 100 million lives. Yet the bungy-jumping junky crowd continues its trip into the adventure land of thrills and spills.

So when some hot-shot expert opines to the multitudes, “Infectious Disease is a never event,” he or she is not quite in tune with life, not quite in tune with reality and certainly not in tune with the facts.
Is the "expert's claim" in or outside the "Court of Reality?" You be the judge.

"You cannot be Serious" ~ John McEnroe

The noblest pleasure is the joy of understanding. ~ Leonardo Da Vinci

A gratitude to Ignaz Simmelwies

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