Apollo 18: Contagion on the Moon?

The movie Apollo 18, a sci-fi movie that portrays a horrific mission to the moon, addresses some important microbiological and infectious disease matters (albeit in a highly fictionalized manner). In the film, astronauts on a moon mission are infected/infested by an extraterrestrial pathogen.

The scenario of a contagious disease in space raises very difficult questions, some of which have been the subject of actual prior work in this field. Some fascinating questions include:

• Does being in space where sterilized food is consumed change one's microbiome to render one hypersusceptible to infection (either extraterrestrial or upon return to Earth)? The historical answers to this question and the possibility of astronauts being at a risk from a "fatal kiss" are discussed in the book Good Germs, Bad Germs.
• What would be the concept of operations in an extraterresterial infection (see Michael Crichton's The Andromeda Strain)?
• How does one handle a potentially contagious illness in an astronaut in space? 
• Is there bacterial life on other planets, asteroids, etc? Would they resemble earthly extremophile bacteria?

While movies such as this are pure fiction, they do serve to focus attention on the ubiquity of microbes and their ability to infect us in myriad scenarios. 

Starve the Flu, Have a Fever

An interesting new study published in the Proceedings of the Royal Society B (summarized in The New York Times) , using mathematical modeling tools, suggests that medications that reduce fever may amplify the ability of the virus to spread. 

Fever, as unpleasant and disabling as it is, serves two purposes with respect to infectious disease.

1. Usually, microbes are unable to reproduce at the higher temperature that characterizes fever.
2. The unpleasantness of fever often limits social contacts, starving the microbe of new hosts to infect. 

Consequently, when fever is controlled the propensity of the microbe--in this case influenza--is enhanced by 1-5%. Taken at a population level such a minor increment can translate into a substantial number of added cases. 

The results of the study while intriguing and logical, must be placed into context. Fever, though usually benign, can have serious consequences such as febrile seizures in children and increasing the metabolic demand, which could prove dangerous in someone with compromised cardiac or pulmonary function. 

Bottom line: Be cognizant that reducing fever helps the virus but may be a necessary action when the entire context of the patient is taken into account.

Would Penguins Taste like Chicken to Bird Flu?

In the movie Mr. Popper's Penguins there's a scene in which the main character and his family are "rescuing" a group of penguins from the zoo. As they leave, they yell something to the effect of "arctic bird flu infectious disease emergency!" to facilitate their escape. 

While penguins can contract influenza, they are not the main concern with respect to a future bird flu pandemic as their exposure to humans is minimal. 

Currently, mankind is faced with dual threats from avian influenza: H5N1 and H7N9 (though other avian strains have kept into humans). These viruses, contracted by poultry exposure, have extremely high mortality rates but have not been able to spread efficiently between humans--the precondition for a pandemic.

H7N9 has been a relatively new threat that emerged in 2 waves in China (with subsequent cases imported to Taiwan) beginning last year. To date 238 cases have occurred with 57 deaths. This past week, China reported 45 new cases. 

In its latest risk assessment, the WHO anticipates more human cases possibly tied to the celebrations associated with the Chinese Lunar New Year celebrations, which will involve larger scale transportation of poultry. The ability of the virus to gain the ability to spread from human to human is unlikely.

Unfortunate for us, viruses like H7N9 reside in bird species with which humans have regular contact and not penguins--no offense to the natural or Pittsburgh variety. 

Polio Wars: Dying for Vaccination in Pakistan

I discussed, in a prior post, the progress of the global polio eradication effort. Last year marked a major setback in the eradication effort as 9 countries reported 389 cases. Though not even a month old, 2014 has already seen 4 cases occur--all of which are located in the North Waziristan region of Pakistan. 

It is no accident that Pakistan remains the biggest obstacle to polio eradication given the continued murderous violence Taliban Islamists direct at polio vaccinators. Since July of 2012, 33 individuals associated with the vaccination effort have been killed. 

The contrast between those who are working to improve human life by working to eradicate one of mankind's scourges from the planet and those who seek to relegate mankind to a state in which polio is allowed to spread with abandon couldn't be starker. 

Treating Anthrax in 2014

It's been almost 13 years since the anthrax attacks of 2001 and, not suprisingly, medical care has advanced during that time. Accordingly, the CDC has released new guidelines for the treatment of anthrax. 

Several important highlights include:

• Attention to the coagulation defects that occur with anthrax with the goal of keeping fibrinogen levels above 100 and avoiding pharmacological thromboprophylaxis
• Emphasis on the drainage of pleural effusions--a procedure linked to improved outcome
• Carryover of the recommendation for 60 days of post-exposure prophylaxis
• Delineation of anthrax with possible meningitis from anthrax without possible meningitis
  • In cases where meningitis is a possibility the recommendation to use 3 drugs with high CNS penetration, 1 of which should be a protein synthesis inhibitor (ciprofloxacin, meropenem, and linezolid)
  • In cases where meningitis has been ruled out the recommendation to use 2 drugs, 1 of which should be a protein synthesis inhibitor (ciprofloxacin + linezolid)
• Use of an anti-toxin therapy such as raxibacumab (or anthrax immune globulin--not FDA approved)

Overall, the guidelines are highly evidence-based and consistent with standard infectious disease and critical care practice. Hopefully, when followed the 45% mortality rate experienced in 2001 would be significantly diminished (in the cases that have occurred in the US since 2001, no patient has died).