Bet Your Bottom Dollar that Tomorrow There'll Be Pus and Infection

Today, working as infectious disease physician (as opposed to my other roles), I rounded on 38 inpatients--quite a lot for me. I anticipate the next few days will bring the same sort of volume. 

It wasn't one particular infection I was seeing; influenza has diminished in activity and there are no outbreaks. I think that the higher number of consultations is reflective of the growing appreciation of the value of an infectious disease physician in improving outcomes in those with severe infections, as has been shown. 

What I did see today was a cornucopia of infections that challenged me intellectually and reinforced my passion for the field. Cytomegolovirus (CMV), Nocardia, and Staphylococcal prosthetic valve endocarditis were some of today's stars. Antibiotic resistance and C.diff always has an overshadowing supporting role in all I do. 

The beauty and allure of infectious disease is that after all that today, I can't wait to see which bugs I get to battle with tomorrow.

Anthrax Guest Starring on House of Cards

On one of the episodes in the 2nd season of House of Cards there is a white powder incident at the US Capital, causing a lockdown. In the episode, the lockdown lasts for hours while the powder is tested and ultimately revealed to be a mixture containing flour (wheat) and talcum powder. It was stated that pesticide on the wheat caused a false positive on initial tests, requiring the longer lock down of the area while confirmatory tests were performed.. There were several references to anthrax, which was actually released from an envelope in the Capital in 2001, in the dialogue. 

White powder incidents abounded after the events of 2001 and still continue to this day--witness the Super Bowl's corn starch incident. What is often overlooked is the amount of law enforcement, public health, and clinical resources that are absorbed--and diverted from other functions--in the response to these incidents. Much like a bomb threat, a white powder incident can't be ignored as both anthrax and ricin have been sent in the mail. 

TB: Treating Humans as Matter

The biopic of brilliant Nobel Prize winning physicist Richard Feynman, Infinity, not only portrays the awesome power of his genius, but also the struggles he faced dealing with the fatal illness of his wife.

In the 1930s and 40s, the diagnosis and treatment of infectious diseases was very rudimentary--in some ways, it still is--and Arline Feynman's illness was sequentially labeled typhoid fever and Hodgkin's Disease, before the final diagnosis of tuberculosis was made.

It was not until 1946 that the first trials in humans of streptomycin--the discovery of which generated much controversy (see Experiment Eleven)--took place.  In the pre-antibiotic era in which the events of the movie take place, tuberculosis was a major killer that literally consumed the bodies of its victims, hence its alias "consumption". In the absence of treatment, or with highly resistant forms of the illness, it can still kill in its original manner. 

I can't imagine how someone of Feynman's ability and intelligence must have felt watching this simple microbe kill his wife. 

Speaking of the power of the atomic bomb in the movie, Feynman quotes fellow physicist Isidor Rabi as saying the bomb treated humans like matter--a description equally fitting for tuberculosis. 

The Real Crazy Train: Measles

Yet another large measles exposure occurred in this country as the result of an unvaccinated individual contracting the illness while in Asia. 

The patient, who is a college student in California, rode a public transportation train and potentially exposed thousands of individuals to the virus, which can be deadly in select cases.

This incident has several aspects that worth highlighting:

• Though measles has been nearly eradicated from the US that is not the case in the rest of the world
• Unvaccinated individuals, who may have a relatively low (but not zero) risk of contracting the disease in the US, are at a high risk of infection when traveling to areas in which measles is still present and human populations are not immunized to a high degree, i.e. herd immunity has not been achieved
• Measles is extremely contagious and if exposed individuals were not adequately vaccinated, for personal reasons or because they are less than 1 year of age, they may contract measles

The bottom line: Measles is too contagious of a disease for the human population to become lax about.

I Sense Your Skin

Tonight, I attended one of the meetings of the University of Pittsburgh School of Medicine's "Bug Club". The members of this club are largely 1st and 2nd year Pitt med students who have a general interest in infectious diseases, especially of the tropical flavor.

The focus of the meeting tonight was on schistosomiasis, an awesome disease caused by a parasitic worm that jumps between humans and snails. 

One of the most intriguing aspects of this disease is how the worm finds its human host. Schistosomes emerge from snails in freshwater and, after finding a human, penetrate human skin to begin the process of infection. To detect that a human is in their environ, the organism "smells" human skin, i.e. the molecules on the skin of a human (e.g. linoleic acid). This attraction is so great that it sometimes prompts them to reverse the direction in which they are swimming.

Such an awesome proclivity--and "desire"--to infect humans by microbes is what makes my job as an infectious disease physician so much fun. I get to battle these things!