Hypothermia Can Happen Anytime

27 02 2012

Dr Mary Beth Koslap-Petraco, PKIDs’ advice nurse practitioner, says hypothermia can happen anytime of year, and it’s nothing to mess around with. What to do and not do, should it happen to you.

Listen now!

Right-click here to download podcast (6 min/3 mb)

Ask Emily

23 02 2012

Why does our skin break out in a rash with some viral infections like measles or Fifth disease?

These sorts of rashes are technically known as viral exanthems (the word derives from the Greek word “exanthema,” meaning “breaking out”).

The skin responds to infection with a rash for one of three reasons: the infectious agent releases a toxin that causes the rash, the infectious agent damages the skin and causes a rash, or the immune response results in the skin outbreak.

The skin responds in only a few ways to these challenges, although the pattern of the response can vary from virus to virus (bacteria and some other infectious organisms can also trigger a rash).

The response is the body’s attempt to deal with the presence of viral particles that find their way to the epidermis, or skin. In general, the upshot of the immune response is an area of inflammation. Because viruses cause a systemic or body-wide infection, viral rashes often cover much of the body.

Although the basic pathway to the rash is similar among viruses, the specific pattern of the rash can help distinguish the virus involved. For example, Fifth disease, so-named because it was the fifth virus in a series to be identified as causing a rash, produces a “slapped-cheek” ruddy appearance on the face and may cause a lacy, rather flat rash elsewhere on the body.

A measles rash, on the other hand, starts as an eruption of raised or flat spots behind the ears and around the hairline before spreading body-wide.

One thing to recognize is that not every rash is a viral rash or a benign viral rash, although most viral rashes will resolve on their own. Usually, a fever accompanies a viral rash. If a rash develops, you should be aware of the following warning signs that signal a call to your doctor:

  • If you suspect you have shingles. This highly uncomfortable rash tends to trace along the nerve routes under the skin but can spread out from those, as well. Starting antivirals within the first 24 hours may ward off a more intense recurrence or a permanent pain syndrome called postherpetic neuralgia.
  • If you suspect measles. Infection with this highly contagious virus should be reported immediately.
  • What you think is a rash from a severe allergic reaction or a rash that arises coincident with taking a new medication.
  • The rash accompanies a high fever, spreads rapidly, and starts to look like purple bruising. This pattern is indicative of meningitis.
  • Any rash involving a very high fever, pain, dizziness or fainting, difficulty breathing, or a very young child or that is painful.
  • Any rash that you find worrisome, including for reasons of persistence or timing with something such as exposure to infection, a new medication, or new food.

Do you have a question for Emily? Send it to: pkids@pkids.org

By Emily Willingham

Image courtesy of HowStuffWorks

Athlete’s Foot (and what to do about it)

16 02 2012

Dr. Mary Beth Koslap-Petraco, awesome nurse practitioner, explains what it is, how to prevent it, and, if that fails, how to treat it!

Listen now!

Right-click here to download podcast (5 min/2.5 mb)

The Flu Ends with U. Get a flu vaccine, Not the flu.

13 02 2012

(CDC has something to say about the flu and vaccination. Welcome, CDC!)

The holidays have come and gone, the gift returns are complete, and New Year’s resolutions are underway. But did you cross “get a flu vaccine” off your to-do list? If not, it’s not too late.

Last year, the flu peaked in February. The timing of influenza outbreaks is unpredictable. They can occur as early as October and as late as May. The Centers for Disease Control and Prevention (CDC) recommend that everyone 6 months of age and older get a flu vaccine to protect themselves and their loved ones from the flu.

Vaccination is particularly important for people at high risk of serious flu complications including young children under the age of 5, but especially those under the age of 2 years, pregnant women, people 65 years and older, and people with chronic medical conditions like asthma, diabetes, or heart disease.

The steps to protect yourself from flu are simple.

1. Educate yourself about the flu at http://www.cdc.gov/flu
2. Find where to get a flu vaccine using the flu vaccine finder http://www.flu.gov/
3. Get vaccinated and encourage your friends, family and coworkers to do the same.

Remember: The Flu Ends with U. Get a flu vaccine, not the flu.

The Numbers of Malaria

9 02 2012

Seems strange now, but malaria used to be considered a cure for neurosyphilis and, in certain young people, a cure for psychiatric disorders. The belief that malaria cured neurosyphilis was so strong that, in the 1920s, a Nobel Prize was awarded to Julius Wagner-Jauregg for the therapy.

Times changed. The therapy fell out of favor and we moved on. Now we consider malaria to be the scourge that it is and the battle to end it is on all fronts.

To better understand the scope of this parasitic disease, the Bill and Melinda Gates Foundation recently funded a look at new data and the implementation of new computer modeling which allowed researchers to look at malaria over a thirty-year span.

Findings indicate the death rate from malaria in 2010 was twice as high as we thought. The World Health Organization (WHO) originally estimated 655,000 deaths, but worldwide there were actually 1.24 million deaths from malaria.

This number is a drop from a high of 1.82 million deaths in 2004, so, although the current number is high, the good news is death rates from malaria are falling. It’s hard to look at a number so large and call it anything like good news, but from a public health perspective, it is.

I’ve seen malaria in the form of a convulsing, vomiting, feverish young woman being cared for by her increasingly scared and desperate husband. It is not an infection for which we can take a couple of aspirin and wake up refreshed.

The numbers infected are huge. The CDC estimates there are three to five hundred million cases each year with, as noted above, over a million deaths.

We all know that one person actually can make a difference. Do you want to do something? World Malaria Day is coming up in April. Start now, figure out what you and your friends would like to do, and do it. You can find ideas and resources on World Malaria Day’s website.

By Trish Parnell

Image courtesy of YoHandy

Contact Sports and Skin Infections

6 02 2012

(Welcome to guest blogger Rebecca Kreston, MSPH and thanks, Rebecca, for sharing this post from your blog: bodyhorrors!)

In honor of one of the most lucrative American events that happened just yesterday, I thought I’d explore sports and infectious diseases. Specifically, contact sports and skin infections!

Since starting this blog, I’ve gathered that readers just love reading about transmissible skin infections, so what could be better than watching the Super Bowl and knowing just exactly what kind of diseases could possibly be smeared between the players of the Patriots and Giants?

There is a glut of infectious diseases that one can acquire from dabbling in combat or contact sports such as American or Aussie-style football, rugby, wrestling, and sumo. In fact, skin infections are the most common injury associated with all sports (1). All that body bashing and face-to-face smearing in contact sports does wonders for spreading skin or cutaneous infections. A number of these ailments are common to us non-athletic mortals—athlete’s foot, jock rash and ringworm (or tinea corporis). Two diseases in particular, with the marvelous potential to initiate larger epidemics within and beyond the locker room, form the focus of this article.

Herpes gladiatorum is a wonderfully evocative name used to describe an athlete’s infection with herpes simplex virus 1 (HVS-1), a terribly contagious virus that many have the misfortune of being acquainted with; it’s estimated that 65% of people will become infected with the virus by the time they reach their 40s (2). Symptoms can include painful, blistery cold sores on the face and neck, along with a sore throat, infected lymph nodes and malaise.

It’s a tricky little bugger of a virus. It can remain dormant, hiding away in nerve cells known as sensory ganglia, only to spring out on one’s face or genitals during periods of physical or emotional stress or, say, when you’re sunbathing in tropical locales on vacation. It has an uncanny sense of knowing when to erupt at the most inappropriate of times, though I’ve been unable to track down any research examining the molecular basis of how it goes about conducting this remarkable mechanism.

Most people rightfully assume that HSV-1 infection is a rather personal, intimate matter: we hear about transmission between a mother and her child, between romancing couples and so on. This makes sense considering that it’s spread by respiratory droplets or direct contact with infected lesions; you’ve really got to get up close and personal in someone’s face if you want to get a sense of what HSV-1 infection feels like (2). But given social situations with a generous amount of skin-to-skin contact with many individuals—sports, for instance—the virus will happily engage in a bit of unplanned host-hopping. As such, it has a frustrating tendency to erupt into outbreaks in sports team and during competitions.

Many athletes may sport micro-abrasions and skin breaks stemming from turf burns, powerful body-to-body collisions, facial stubble or beard burn, and shaving. Depending upon the level of protective clothing and gear, these athletes can experience substantial exposure with their opponent’s infected HSV-1 lesions, not to mention the respiratory droplets, spit and mucus that may transmit other types of infections. Charming! Among teammates, a grab-bag of infections can also be spread by sharing towels, water bottles, clothing, equipment, and hygiene and cosmetic products.

HSV-1 is considered to be particularly endemic in rugby players due to the style of the sport and the lack of protective gear (3). Its rampant presence in rugby leagues has earned it the moniker “herpes rugbiorum” or “scrum pox” (“scrum strep”, caused by the bacterium Streptococcus pyogenes, can also plague rugby players).

In rugby, the “scrum” is a type of huddle maneuver used to return the ball into play. It is a sensational way to spread HSV-1: players in the forward position interlock their heads with their opponents in facing rows before the ball is launched between them. These forwards are the most likely of their teammates to contract scrum pox due to their prominent role in scrums and the increased prospect of serious face-to-face contact. The fact that rugby players do not use protective gear, including helmets, exposes a greater part of their body to physical contact and further increases their risk.

HSV-1 regularly rears its ulcerous face on wrestlers as well. A research group checking serum samples from wrestlers to determine previous HSV 1 exposure found that 29.8% of college wrestlers had reported previous HSV infection (4).

The level of intimacy required in grappling almost makes it inevitable that something is going to be transmitted between two athletes, whether that be sweat, saliva or HSV-1. Indeed, in a 1989 outbreak in high-school wrestling camp for boys, 34% of participants were diagnosed with HSV-1 (5). Lesions commonly appeared on regions of the body most likely to encounter direct skin-to-skin contact with their opponents – 73% on the head, 42% on the extremities and 28% on the trunk of the body.

How do you tell if a wrestler is right or left-handed? Check which side of their face, head, neck and arms has the greatest amount of lesions. Athletes will tend to prominently use the most powerful sides of their body, regardless of which sport, and it will be this side that can receive the greatest amount of skin-to-skin contact with opponents.

Getting a touch of HSV-1 and sharing it with your teammates may be the least of an athlete’s problems. In 2003, a ghastly outbreak of methicillin-resistant Staphylococcus aureus (MRSA) emerged during a college football camp in Connecticut (6). Ten players were infected, of whom two required hospitalization. The infection was discovered to have spread due to the combination of body shaving and turf burns from the artificial grass. Infections were most commonly located at the elbow, thigh, hip, chin, forearm and knee, parts of the body most likely to incur abrasions on the turf. Those players with turf burns had a seven-fold risk of acquiring MRSA infection than those who emerged from scrimmage and active play unscathed (6). Cornerbacks and wide receivers were particularly susceptible due to their frequent body contact during drills and scrimmage play.

A quick browse through the research literature pulls up dozens of MRSA outbreaks like this. In 2002, two college football players in Los Angeles were hospitalized due to MRSA infection (7). A one-year surveillance of a football team at an unnamed major university in the southeastern United States found that 19% of the players showed evidence of nasal colonization of the bacteria at the end of the football season; though the high prevalence of MRSA among these men did not yield any active skin and soft tissue infections, it goes to show how endemic of a problem this really is (8). In 2007, six football players on a Brooklyn high school football team showed evidence of MRSA skin and soft tissue infection; the players had just recently returned from a preseason training camp (9). The infections were serious enough that they generated abscesses requiring surgical incision and drainage.

MRSA colonization of football players is apparently becoming so commonplace that some researchers have suggested using them as human sentinels for public health surveillance of outbreaks within the surrounding community (10). It is regrettably becoming a rather conventional type of emerging infection in athletes.

These infections aren’t just unseemly looking but can be disfiguring, have long-lasting effects within the body and can temporarily disqualify an athlete from practice and competition to prevent localized outbreaks. Hell, some of them can kill ya! These outbreaks can ruin seasons for the team while for salaried athletes, these kinds of infections have serious economic, professional and personal repercussions. Medical professionals recommend that players abstain from play until they’ve started antiviral medications or antibiotics, they are free of systemic symptoms – fever, malaise and lymph node swelling – and until any moist lesions have subsided. Seems reasonable, no?

Infectious diseases are always context specific and spread through particular practices. In the case of contact sports, there are several variables at play that help to spread some nasty infections. While there isn’t a lot we can do about changing how a sport is played (or can we?), coaches and referees can keep an eye out for athletes who seem ill or are showing visible evidence of infection. Fighting against poor hygiene practices and ensuring that wounds are cleaned and dressed immediately can also keep these kinds of sticky situations in line. Game on!

A mission statement and guidelines on how to deal with herpes gladiatorum from the Sports Medicine Advisory Committee at the National Federation of State High School Associations.
Wrestlers filed a “herpes lawsuit” in 2008 against their coach and trainer holding them responsible for a localized HSV-1 outbreak.
In 2008, researchers discovered a unique herpes strain that only affects sumo wrestlers.

1. BB Adams. (2010) Skin Infections in Athletes. Expert Rev Dermatol. 5(5): 567-577
2. R Sharma et al. (2011) Herpes Simplex in Emergency Medicine. Accessed online on Feb 2, 2012. Link.
3. BB Adams. (2000) Transmission of cutaneous infections in athletes. Br J Sports Med. 34(6): 413–414
4. B.J. Anderson (2008) Managing Herpes Gladiatorum Outbreaks in Competitive Wrestling: The 2007 Minnesota Experience. Curr Sports Med Rep. 7(6): 323-7
5. Belongia EA, Goodman JL, Holland EJ, et al. (1991) An outbreak of herpes gladiatorum at a high-school wrestling camp. N Engl J Med. 325(13): 906-10
6. EM Begier et al. (2004) A High-Morbidity Outbreak of Methicillin-Resistant Staphylococcus aureus among Players on a College Football Team, Facilitated by Cosmetic Body Shaving and Turf Burns. Clin Infect Dis. 39(10): 1446-1453
7. DM Nguyen et al. (2005) Recurring Methicillin-resistant Staphylococcus aureus Infections in a Football Team Emerg Infect Dis. 11(4): 526-32
8. CB Creech (2010) One-year surveillance of methicillin-resistant Staphylococcus aureus nasal colonization and skin and soft tissue infections in collegiate athletes. Arch Pediatr Adolesc Med. 164(7): 615-20
9. Centers for Disease Control & Prevention (CDC). (2009) Methicillin-resistant Staphylococcus aureus among players on a high school football team–New York City, 2007. MMWR Morb Mortal Wkly Rep. 58(3): 52-5
10. B Barr, M Felkner & PM Diamond. (2006) High school athletic departments as sentinel surveillance sites for community-associated methicillin-resistant staphylococcal infections. Tex Med. 102(4):56-61

Rare Diseases Matter

2 02 2012

(We welcome David Bradley Science Writer as our guest blogger. Thanks, David!)

Pharmaceutical research and development has improved our quality of life and boosted life expectancy significantly over the last few decades.

We are living longer, healthier lives thanks to medical science. Although there are concerns about drug resistance and so-called superbugs, vaccination, antibiotics and antiviral drugs are incredibly successful at keeping diseases at bay and reducing significantly the risk of death from infection following a surgical operation.

In addition, important medical advances have made cancer treatable and reduced the risk of dying from heart disease significantly. The emergence of diseases of old age, such as Alzheimer’s disease, reflect not a failure on the part of medicine, but the fact that so many people reach old age rather than dying young of the illnesses to which our ancestors succumbed for lack of medicine.

There remain, nevertheless, many lesser-known and rare diseases for which there are no treatments. The US Rare Diseases Act of 2002 defined rare diseases based on prevalence. Any condition afflicting fewer than 200,000 people in the US (about 1 in 1,500) was labeled rare.

The Europeans by contrast defined these diseases based on how much of a threat to life they represent. Whatever the definition, the pharmaceutical industry is beginning to home in on these rare diseases, which is obviously good news for sufferers.

Orphanet, which as the name might suggest is an online portal for information about rare diseases and orphan drugs, suggests that, “There is no disease so rare that it does not deserve attention.”

Moreover, just because a disease is labeled rare does not mean that there are not large numbers of people affected. There might be 10,000 patients with any given “rare” disease in the US alone. The numbers might be in the millions if we consider worldwide incidence.

Orphanet’s Segolene Ayme told me: “The true prevalence of rare diseases is unknown, there is no source of data at population level.” In fact, the data are often skewed towards more conservative estimates of disease incidence, although for some genetic diseases, the numbers may truly amount to a few dozen people rather than tens of thousands.

The list of rare diseases is vast and continues to grow as new health problems are identified for the first time as distinct diseases and disorders. On that growing list are Aarskog syndrome, Gaucher’s disease, tyrosinemia type 1, Kahler’s disease, Q fever, Takayasu arteritis , Waardenburg anophthalmia syndrome and Zygomycosis.

Andreas Zaby of the Berlin School of Economics and Law, in Germany, has analysed the impact of legislation aimed at stimulating R&D into these and other diseases. He says there is a great deal of room for improvement in addressing the problem of rare diseases and suggests that the creation of expert networks could help. He adds that specialist care facilities and reference centers for research and treatment are urgently needed if medicine in these areas is to move forward.

Coordination by the World Health Organization could be the answer to helping medical science tackle a vast range of diseases, each of which afflicts a limited number of people but taken as a whole cause misery and suffering for millions worldwide.

Rare Disease Day is 29 February. Let’s all make some noise for those who are too often ignored.

Image courtesy of rarediseaseday.org