The Trouble With Some Microbes . . .

7 02 2013

Our battle against bacteria is tilting in our favor. After all, we have vaccines and antibiotics on our side. That doesn’t mean we can get cocky. It’s tilting, not surrendering at our feet.

But we’re still struggling to find ways to kill viruses once they’ve infected us.  At best, we can sometimes control them.

Although we can kill viruses on our bodies and other surfaces with disinfectants, it’s difficult to kill them when they’re living inside our cells.  When we’re infected with a virus, it takes up residence in one of our cells and uses the cell’s machinery to reproduce itself.

Developing a drug that will kill the virus without disrupting the intracellular machinery of uninfected cells is no easy task. It’s like playing Jenga—eventually the whole structure will collapse.

Bacteria, on the other hand, generally live outside of our cells and are easier targets.

There are some bacteria that have developed a resistance to not just one drug, say for instance penicillin, but to many such drugs.  They’re known as multi-drug resistant microorganisms such as streptococcus pneumoniae and mycobacterium tuberculosis, germs that we thought were very much under control and are now surging back into the population.

One major factor in preventing us from understanding the world of microbes is the size of that world.

The folks at the University of Georgia College of Agricultural and Environmental Sciences put bacteria into perspective this way, “Bacteria vary somewhat in size, but average about 1/25,000 inch.  In other words, 25,000 bacteria laid side by side would occupy only one inch of space.  One cubic inch is big enough to hold nine trillion average size bacteria—about 3,000 bacteria for every person on earth.

“Bacteria make up the largest group of micro-organisms.  People often think of them only as germs and the harm they do.  Actually, only a small number of [the thousands of different] bacteria types are pathogenic (disease-causing).  Most are harmless and many are helpful.”

Neal Rolfe Chamberlain, professor at the Kirksville College of Osteopathic Medicine, explains viruses in this manner, “Viruses are very small forms of life.  In fact, people still argue over whether viruses are really alive.  Viruses range in size from about 20 to 300 nanometers (nm).  A nanometer is 0.000001 of a millimeter.  A millimeter is 1/25 of an inch.  So in other words, you can place 25,000,000 nanometers in an inch.  If the biggest virus is 300 nm then you could fit 83,333 of that virus in an inch.

“Viruses are major freeloaders.  They cannot make anything on their own.  To reproduce they must infect other living cells.  Viruses infect bacteria, parasites, fungi, plants, animals, and humans.  No one escapes them.  If you have had the flu, chickenpox, measles, a common cold, mono, a cold sore, or a sore throat you have been infected by a virus!”

Some viruses, like HIV and hepatitis C, tend to develop strains that can resist mono drug therapy (treating the patient with one drug at a time).  We have to try and control the viruses with combination, or “cocktail” drugs (treating the patient with several drugs at once), although even that approach does not always work.  Some viruses can keep mutating until we’ve run out of drugs to try.

All this is to say that fighting microbes is seldom a simple task, and seemingly one that is neverending. For example, we have a whooping cough vaccine, but new strains are popping up and new vaccines are needed for this astoundingly infectious microbe.

We will never be rid of our tiny co-inhabitants on this world, and anyway, most of them we want to keep around. It’s those others . . . wouldn’t it be nice to have a jail for nasty microbes?

By PKIDs’ Staff





Antibiotics and When to Use Them

30 07 2012

Summer has its share of illnesses, but for most physicians, the “illness season” begins to ramp up in the fall. Colds, sore throats and ear infections, among other illnesses, are much more common.

Patients come to the doctor’s to get better, and for many years that has meant leaving the office with a prescription for antibiotics. Many illnesses were treated unnecessarily, and as a result, antibiotic resistance has increased.

Antibiotics first came into widespread use in the 1940s and revolutionized medical care. Bacterial illnesses, such as pneumonia, strep throat, bladder infections, etc. could now be treated. Within a few years, however, bacteria resistant to penicillin were already present.

Antibiotics kill sensitive bacteria, but resistant ones can survive and multiply. Through the years, antibiotics that used to work for infections become less effective.

While antibiotics work against bacteria, they do not treat viruses. Viruses cause the majority of infections (colds, many sore throats, influenza, most coughs). In many cases, however, antibiotics are prescribed for viruses. This leads to increasing bacterial resistance.

Why are antibiotics overused? The answer is multi-fold. Parents often come to the office with an expectation that they will be given something to make their child better. Doctors want to help people.

In the early years of my practice, it was common to treat for an “early” ear infection, or sometimes, “to head off the illness.” Our knowledge of the natural history of illnesses has advanced. We used to think that if a cold produced yellow or green drainage, this was an indicator of sinus/bacterial infection. Now we know that discolored drainage is a normal part of an illness that may last 10-14 days. Some ear infections will clear up on their own. Sore throats that are not caused by strep do not need an antibiotic.

When antibiotics are needed, the most specific antibiotic is best. Some antibiotics are “broad spectrum.” They kill many bacteria, not just the ones causing the infection. Many of these are newer antibiotics, and while they might be more convenient, taste better, etc, they may be more than is needed, hastening antibiotic resistance.

The advantages of using antibiotics wisely are many. Short term, there will be fewer side effects (diarrhea, rashes, stomach ache), and long term, hopefully, when antibiotics are needed for a serious bacterial infection, they will be more effective.

So, when your doctor says, “Good news, they don’t need an antibiotic,” it really is good news.

By Dr. Katherine Vaughn

Image courtesy of AJC1





Ask Emily

26 04 2012

What’s the deadliest infectious disease ever and what currently is the most deadly infectious disease?

The answer to this question is more complex than simply counting up numbers of people who die from infection. For example, diseases like measles and smallpox have proved to be far deadlier in some populations—such as Native Americans—than in others, because of population differences in disease resistance.

Another variable is intensity of the illness a pathogen causes. Influenza comes in many forms of virulence, and as the Spanish flu pandemic of the early 20th century made clear, even that virulence can vary depending on specific population features; the Spanish flu, which took an estimated 50 million lives, killed the young most relentlessly.

Even an individual disease vector can wax and wane in terms of how virulent it is or which tissues it invades. For example, Yersinia pestis, the bacterium responsible for the infamous Black Death that swept through Europe in the 14th century, may vary over time in its virulence and is far more deadly when transmitted as an aerosol to lung tissues than when it invades the lymph and causes the bubos that characterize it.

Another issue is, how do we calculate “deadliest?” Is it in terms of sheer overall numbers, or do we calculate it in terms of how many people it kills among the number infected? For the sake of addressing this question, let’s talk about both.

Historically, in terms of sheer numbers, the deadliest diseases were smallpox, measles, tuberculosis, plague (e.g., the Black Plague), and malaria. According to a handy Website, the Book of Odds, which calculates odds for us, measles has killed about 200 million people worldwide in the last 150 years and still kills hundreds of thousands in the developing world. Thanks to vaccines, the odds of contracting measles in the United States today are very low unless you are an unvaccinated person living in areas where vaccine uptake is low.

The story on smallpox is similar—it may have killed more people by percent or sheer numbers than any other infectious disease in history, including 300 million in the 20th century alone by some estimates. Yet smallpox as an infectious disease no longer exists thanks to its total elimination through vaccine campaigns.

Thus, along with the plague, smallpox and measles have, for millennia, been the historical killers of humans and would still be among the deadliest infectious diseases today were it not for vaccines. What we have left are some old killers on the list—tuberculosis and malaria—and a newer entity, HIV, the virus that causes AIDS.

We have yet to develop efficient vaccines against any of them. According to USAID, in terms of absolute numbers of deaths, AIDS kills the most people each year, with 2.8 million AIDS-related deaths in 2004, followed by tuberculosis and malaria.

Indeed, AIDS and tuberculosis are often co-conspirators in death, as infection with the HIV virus makes people 20 to 30 times more likely to develop active TB with TB infection. Research for vaccines against HIV and malaria has been feverish but as-yet incompletely successful, one reason these diseases remain the top global killers.

But what about the deadliest disease in terms of how many of infected people die? In the absence of effective treatment, HIV might be one candidate. But the ones that come first to mind are the viruses that cause fast-moving hemorrhagic fevers, such as the Marburg or Ebola viruses.

The Marburg virus, named for the location of the first outbreak and a virus that may reside without symptoms in fruit bats, has caused death rates as high as 90% in some areas, although the average is 23–25%. It is a filovirus, in the same viral family as the five Ebola viruses. One of the Ebola viruses, Ebola-Reston, is perhaps the most notorious of the hemorrhagic fever viruses, having led to death rates as high as 89% in outbreaks.

A near-100% mortality rate is about as deadly as an infectious agent can be if that’s the measure of “deadly” we’re using.

By Emily Willingham

Image courtesy of Wikimedia Commons





Rotavirus At Any Age

1 03 2012

Dr. Mary Beth Koslap-Petraco, PKIDs’ advice nurse practitioner, fills us in on the reach of rotavirus. Any of us can be at risk.

Listen Now!

Right-click here to download podcast (7 min/3.5 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





Safer Sex (We Hope)

19 01 2012

Warning: This article contains explicit sexual information. It has been adapted from a piece written for PKIDs’ Pediatric Hepatitis Report. We encourage young people to talk with their parents and healthcare providers about safer sex and abstinence before becoming sexually active. The methods of disease prevention described in this post are not guaranteed to work. You may practice safer sex and still acquire an STD.

Anyone can become infected with a sexually transmitted disease (STD). CDC estimates that 19 million new infections occur each year, almost half of them among young people ages 15 to 24.

Many people are unaware they have an infection. Some diseases that can be transmitted sexually may also be transmitted during the birthing process, or through a blood transfusion. You may be living with hepatitis B or herpes or human papilloma virus (HPV) and not know it.

For maximum prevention, teens and adults should either abstain from sex or always practice “safer sex,” although abstinence is the more sure method of STD prevention.

What Is Safer Sex?

Safer sex means taking action to make sure no one gets their partner’s blood, semen or vaginal fluids in their body. Similarly, safer sex means you make sure your own body fluids don’t enter your partner.

With safer sex, no body fluids enter a vagina, anus or mouth (during vaginal, anal or oral intercourse) or come into contact with mucous membranes, such as around the eyes, gums, or nostrils.

The best way to prevent body fluids from reaching someone during intercourse is to use a condom. A condom is a sheath that fits over the penis. It can be made of latex (the safest condom available), plastic or animal tissue. It is also called a rubber, safe or jimmy.

Today, nearly as many women as men buy and carry condoms. It catches a man’s semen before, during and after he ejaculates. Some condoms have a nipple-shaped tip to hold the semen so it does not spill out.

Experts consistently recommend latex because some animal tissue, such as lambskin, has pores small enough for sexually transmitted viruses or bacteria to pass through. Polyurethane condoms break more often than latex.

A study cited by Planned Parenthood observed heterosexual couples where one partner was HIV-infected and the other was not for an average of 20 months. It found:

  • None of the uninfected partners among the 124 couples who used condoms consistently and correctly for vaginal or anal intercourse became infected with HIV.
  • About 10 percent of the uninfected partners (12 of 121) became infected when condoms were used inconsistently for vaginal or anal intercourse.
  • Of the 121 couples that used condoms inconsistently, 61 used condoms for at least half of their sexual contacts and 60 rarely or never used condoms. The rate of infection was 10.3 percent for the couples using condoms inconsistently and 15 percent for couples not using condoms.

In short, nothing guards against STDs like a latex condom and other safer sex practices. Spermicidal foams and jellies, diaphragms, implants and other devices do not block body fluids and may not kill all of the harmful bacteria and viruses in your partner’s secretions.

The female condom fits inside the vagina like the diaphragm and also covers the vulva. It is a pouch with flexible rings that is inserted into the vagina. It has the advantage of not requiring a man to maintain an erection during use. Although it is not as effective as the male condom, the female condom is an option for women who want some protection against viral hepatitis, STDs and unintended pregnancies.

The birth control pill, IUDs, vasectomies, tubal sterilizations and other methods of birth control offer great protection against pregnancy, but no protection against STDs. Many people use latex condoms along with these birth control methods for the best protection against both pregnancy and sexually transmitted infections.

Even Oral Sex Requires a Condom

Oral sex may not get one pregnant, but it can still transmit disease.

It is safer to put a condom on the penis before beginning oral sex to guard against secretions that may carry infection. It is important not to get secretions or semen in the mouth. A sore throat or small cuts on the gums may serve as entryways for viruses.

Vaginal secretions can also carry viruses, especially if a woman is having her period. Latex condoms can be cut with a scissors up the middle for oral sex on the vulva or anus. Latex dams or squares, which are thicker than plastic wrap and more likely to resist tearing, may be used. Latex gloves also provide STD protection.

Proper Use of Condoms

A condom just might save a life, and should be treated like the valuable tool it is. Store condoms in a cool, dry place. Long exposure to air, heat or light makes them more breakable. Do not store them continually in a back pocket, wallet, purse or glove compartment.

Check the expiration date to make sure the condom is fresh and safe. Throw away condoms that have expired, been exposed to heat, carried around in a wallet, or washed in the washer or dried in the dryer. If they appear dry, stiff or sticky, toss them. If there are any doubts about a condom, buy a new one.

Condoms usually come rolled into a ring shape. They are individually sealed in aluminum foil or plastic. When opening the condom package, do it carefully to avoid tearing the condom.

To minimize mistakes, both partners should know how to put on and use a condom. Planned Parenthood Federation recommends learning in a safe place free of pressure or frustration. Practice on one’s own penis or on a penis-shaped object like a ketchup bottle, banana or cucumber.

To ensure maximum protection, never use a condom twice and always put a new condom on an erect penis before there’s any genital, anal or oral contact.

If intercourse has already begun, pulling out and putting on a condom right before ejaculation may be too late for protection against STDs and pregnancy.

The male should put on a condom as early as possible at the very beginning of sex play rather than waiting until his partner is ready for penetration. It’s also a good idea to have extra, new condoms around in case a condom is put on too soon or if he loses his erection.

A condom is like a sock, with a right and wrong side. First, unroll it about half an inch to see in which direction it is unrolling. Then put it on. If a male has not been circumcised, pull the foreskin back first. It should unroll easily down the penis. If it starts off on the wrong side, try again with a new condom. Don’t be afraid to practice ahead of time.

Hold the tip of the condom gently between the fingers as it rolls down. This keeps out air bubbles or pockets that can increase the chance of a condom breaking. It also leaves space at the end for the semen. Roll the condom down as far as it will go.

Anal intercourse increases the chance of STDs tremendously, because there can be small tears or bruises in the anus during sex, which makes one tremendously vulnerable to bloodborne infections like viral hepatitis and HIV.

For anal intercourse, lots of lubrication is helpful. Using a water-based lubricant is also helpful for vaginal intercourse. The lubricant goes on after the condom is put on, not before, or else it could allow the condom to slip off easily. Add more lubrication often. Dry condoms break more easily than properly-lubricated ones.

Using lubricant will make things go smoother and give added protection. Lubrication is especially helpful for women when they have intercourse for the first time, or if there is a tendency for soreness.

Always use a water-based lubricant (such as KY Jelly, Astroglide, Aqua Lube, Wet, Foreplay, or Probe) because oil breaks latex. Don’t use vaseline, hand creams or lotions as a lubricant. Also, treatments for yeast infections may contain oil and may break latex.

After ejaculation, hold the condom at the bottom of the penis so it doesn’t slip off. Try to pull out while still erect or hard. The condom comes off only after the penis is completely out of the partner.

Use a condom only once.

Never use the same condom for vaginal and anal intercourse.

Talk Contraception Before the Heat of the Moment

It may be embarrassing to talk to a partner about contraception and condoms, but it’s essential, and should be done before a sexual situation begins. Don’t wait until the heat of passion takes over. It can overwhelm good intentions.

Be honest about feelings and needs. Silence is not a virtue in this situation. Talking about condoms will make it easier for both partners. It can help create a relaxed mood and make sex even more enjoyable and safe.

Embarrassment should not become a health risk and increase chances of infection. It’s important for partners to be open and share health concerns and sexual health history.

By PKIDs staff





Pink Eye!

12 01 2012

Evening time. Your little moppet is fed, bathed, and snuggled ‘neath her blanket. You bend to kiss her nose and then, because your mother did the same, you gently press your cheek against your child’s and exchange butterfly kisses.

This is also known as giving (or getting) the gift of pink eye.

In case you haven’t yet experienced it, pink eye is when your eye becomes pink or red because it’s irritated or inflamed.

We all have a thin membrane that covers the inside of our eyelids and the whites of our eyes – it’s called the conjunctiva. When it becomes inflamed or irritated, we have a case of conjunctivitis. Also known as pink eye.

Lots of non-infectious agents can irritate the conjunctiva and cause our eye to get pink. If we’re allergic to pollen or pet dander, that can give us pink eye. Sometimes the chlorine in pools will do the same.

We can also pick up a bacterial or viral infection that results in pink eye and is infectious, easily spreading person to person. That’s the one that is the gift of the butterfly kiss, should one of the eyes doing the kissing be infected.

Prevention is easy, mostly it’s about not touching your eyes with unclean hands and not sharing any items that have been near an infected person’s eye, such as pillowcases, towels, makeup. You get the idea.

If you have pink eye, do all of the above, and don’t use the same eye dropper or bottle on infected and uninfected eyes, as it’s a good way to ensure both of your eyes become infected. And, CDC says to stay out of swimming pools.

Treatment of conjunctivitis depends entirely on the cause of the irritation. If it’s viral, the symptoms are treated and antivirals may be used for severe cases.

Bacterial infections will probably receive antibiotics and treatment to alleviate the discomfort.

It’s best to check with your provider for specifics, and to make sure and revisit the clinic under these circumstances noted by CDC:

  • Conjunctivitis is accompanied by moderate to severe pain in the eye(s).
  • Conjunctivitis is accompanied by vision problems, such as sensitivity to light or blurred vision, that does not improve when any discharge that is present is wiped from the eye(s).
  • Conjunctivitis is accompanied by intense redness in the eye(s).
  • Conjunctivitis symptoms become worse or persist when a patient is suspected of having a severe form of viral conjunctivitis—for example, a type caused by herpes simplex virus or varicella-zoster virus (the cause of chickenpox and shingles).
  • Conjunctivitis occurs in a patient who is immunocompromised (has a weakened immune system) from HIV infection, cancer treatment, or other medical conditions or treatments.
  • Bacterial conjunctivitis is being treated with antibiotics and does not begin to improve after 24 hours of treatment.

One of the best methods of disease prevention (and not just pink eye) is to keep our hands clean and not touch our noses, eyes, or mouth.

I have to confess that, although my teenager no longer tolerates butterfly kisses, my tweener loves them. As long as the whites of her eyes remain, well, white, we will share that bedtime ritual. But, I do perform a quick inspection as I’m leaning in, just in case.

By Trish Parnell

Image courtesy of littlenelly