A Book Not To Neglect

I had the opportunity to see Dr. Peter Hotez speak when I was an infectious disease fellow about 6 years ago. What initially sparked my curiousity about this innovative physician was that one of my mentors at the time, Dr. Tara O'Toole, who was soon to become the Department of Homeland Security's Undersecretary for Science and Technology, had spoken very highly of him. At the time I was immersed in understanding the concepts biodefense and wondering in what way this hookworm maven would impact my understanding of biodefense and national security.  

Needless to say Dr. O'Toole was right (as usual) about Dr. Hotez and I learned quite a lot from his lecture. 

I recently got the chance to read his book Forgotten People, Forgotten Diseases: the Neglected Tropical Diseases and their Impact on Global Development. The book is devoted to detailing the main historical, clinical, and epidemiological features of the major NTDs--a cast of characters that includes hookworm, ascariasis, onchocerciasis, schistosomiasis and others. His discussion of toxocariasis in the US is especially fascinating.

The main strength of this book is not just that Dr. Hotez provides subject matter expertise, he leverages that expertise to integrate the knowledge of these diseases with what he knows about the locales in which these diseases are endemic. What Dr. Hotez argues, quite effectively, is that these diseases represent major barriers to economic development. In effect, individuals afflicted with these disease die earlier and/or are less productive. When entire regions are infected, the effects are magnified. 

Importantly, Dr. Hotez highlights the fact that such diseases are often coincident with civil wars and  factional fighting--something I think is instrumental in why these diseases persist (something I plan to write more on).

There's much more to say about this book and I recommend it.

If Darwin Met Pasteur and Koch

When I get into arguments on evolution--unfortunately a frequent occurrence in my hometown--I reflexively point to microbes and their impressive ability to evolve new properties literally right before one's eyes (viz. antimicrobial resistance) as incontrovertible evidence of the veracity of evolution by means of natural selection.

I have often wondered how much further mankind's knowledge would be if the genius Darwin had the microbial world to draw from when identifying the earth-shattering facts he did. 

An esteemed group of microbiologists has picked up Darwin's mantle and written a collection of essays that melds Darwinian principles with cutting edge microbiology. The collection is appropriatley entitled Microbes and Evolution: The World Darwin Never Saw. The essays in this book, by making bold new integrations, furthers the philosophy of biology and provides a plethora of ideas to spend hours chewing. 

The essays have varied topics but each illustrates the simple elegance of evolutionary machinery at work on the 3 kingdoms of life (Archae, prokaryotes, and eukaryotes) alike. For an infectious disease physican who hasn't delved enough into "pure" (non-medical) microbiology, the book was a treasure trove.

I highly recommend it.

Is Your Microbiome Giving You a Hangover?

Hangovers are multifactorial events induced by alcohol consumption. The causes include dehydration and hypoglycemia. However,  in light of the results of a fascinating new research study, I wonder if hangovers (like almost everything else) are partly an infectious disease.

What Bala and colleagues at the University of Louisville discovered is that when healthy adults binge drink, they have transiently increased levels of endotoxin--a bacterial product--in their blood. This result is likely due to the effect alcohol has on the barrier functions of the gut which normally keep bacteria from translocating into the blood stream. When these products enter the bloodstream, they set off an inflammatory cascade. 

I wonder what role this inflammation has in the physical symptoms experienced during a hangover. Maybe the oft-reached for ibuprofen and naproxen may actually be dampening the inflammation.

The general lesson I draw is, since we are compromised of more bacterial cells than human, any perturbation of the homeostasis achieved with our microbiome  is likely to have repercussions for our overall health status.

Solving the Riddle of EBV: A Review of Cancer Virus

In Cancer Virus: The discovery of the Epstein-Barr Virus, the book I recently finished, one of the most intriguing anecdotes recounted is how Michael Anthony Epstein attended a lecture by Denis Burkitt. For those who know anything about Epstein-Barr Virus (EBV), the cause of infectious mononucleosis, the importance of these two individuals meeting is obvious as it launched a revolution in virology that lead to EBV being established as the first human tumor virus. 

To recount the major points of the story: Burkitt was a surgeon working in Africa who noticed a peculiar jaw tumor that had specific pathologic findings and a specific geography; Epstein was a researcher working on animal tumor viruses along with Yvonne Barr (see this Youtube clip of her in 2014). The ending of the story is no surprise: EBV was established as a causative factor--when coupled with malaria--in the development of Burkitt's lymphoma. 

Similar stories established EBV's role in nasopharyngeal carcinoma, certain types of Hodgkin's Disease, post-transplant lymphoproliferative disease (PTLD), and HIV-associated CNS lymphomas.

This book, written by EBV researchers Dorothy Crawford, Ingolfur Johannessen, and Alan Rickinson, provides a comprehensive picture of how the science, medicine, and epidemiology were integrated together. The result was a fundamental reshaping of the thinking in virology and oncology. It is obvious that the authors' expertise in the field greatly benefited the historical narrative account they provided. 

Control of tumor viruses through vaccination, as is done with the human papillomavirus (HPV) and hepatitis B virus (HBV), can be viewed as derivative applications stemming from understanding EBV.  For making that giant inductive leap and for their pathbreaking integrations Burkitt, Epstein, Barr, and their many collaborators (who included Nobel laureate Harald zur Hausen as well as Werner and Gertrude Henle) deserve adulation.

CDC Anthrax Exposure: Likely a Contained Biosafety Lapse

Today it was announced that 75 individuals were possibly exposed to anthrax on June 13 while working at the CDC. The exposure is the result of an inactivation procedure not being performed properly. While many questions remain to be answered, a few points regarding anthrax are important to keep in mind:

1. The actual risk of contracting anthrax after an exposure like this is probably very low. As such, of the 75 individuals possibly exposed only 7 are believed to have significant exposures.
2. There is effective post-exposure prophylactic treatment available. Antibiotics such as ciprofloxacin and doxycyline coupled with 3 doses of the vaccine is the recommended regime. 
3. None of the 10,000 exposed in 2001 who were given post-exposure prophylaxis--and poorly complied with it--developed anthrax.

The questions surrounding this exposure will undoubtedly mount as such a biosafety lapse raises serious concerns. However, I do not anticipate that even one case of clinical anthrax will result.