Is Nano Silver Ebola's Snake Oil?

George Washington's last days in which he was bled (maybe to death?) 

Every time an outbreak of a new lethal disease occurs, there is a search for effective medications. In some cases, drugs in development are available for early use, their potential effectiveness extrapolated from animal use. In other cases, existing drugs are repurposed based on pharmacology coupled to projected efficacy based on the characteristics of the pathogen (e.g. same viral family, etc).

However, history abounds with false cures more likely to cure than harm. Strychnine, mercury, and blood-letting are historical examples. In fact, blood letting is thought to have played a role in the death of George Washington who was suffering from a throat infection.

Unfortunately, the modern era is not free from such ill-fated efforts. Like the false cure forsythia hawked by Jude Law's tech-savvy blogger character in the movie Contagion, snake oil salesman come in all forms. In the 2000s, South African President Mbeki and his health minister "Dr. Beetroot"--in the midst of their nation's large HIV burden--repudiated scientifically validated and life-saving antiretrovirals in favor of lemon juice, beetroot, and garlic. You don't have to just imagine the consequences of this and the horrific "Virgin Cleansing Myth".

So when news reports emanating from the West African Ebola outbreak describe dubious therapies, it comes as no surprise. High dosages of salt and "Nano Silver" (on which I was interviewed in this article) are just the newest incarnations of a very old phenomenon.

While I laud efforts to find countermeasures against disease, basic biological plausiblity and following the rules of logic are a precondition to any true advance. 

Is North Carolina's Ebola Quarantine Justified?

I'm puzzled by the announcement that asymptomatic individuals returning to the Charlotte area from Liberia are being quarantined for a period of 21 days because of concern they may be incubating Ebola.

Several important questions that I think need to be answered include:

• Is this a "voluntary" quarantine or is it mandated? What is the penalty for breaking it?
• Who is the governing authority? Mecklenberg County or the state of North Carolina?
• Where will these individuals be confined to? Their homes? A facility? 
• Since Ebola is not casually transmitted what is the evidence that such a quarantine would be effective?
• If this is to be taken as a precedent are all CDC officers deployed to West Africa to be quarantined upon return as well? 
• It's OK to fly, but not to freely move about Mecklenberg County?
• Why was this action never undertaken with travelers to prior Ebola outbreaks, Lassa Fever outbreaks, or to the Middle East (where the more contagious MERS circulates)?

Authorities say this quarantine order is being issued "out of an abundance of caution" but it does not excuse taking actions without an actual risk-based justification. To me, this quarantine delivers a mixed message to a public desperate for clarity on the actual transmission risk of Ebola. 

A True Doomsday Pathogen?

Today, while rounding on infectious disease patients, I came face to face with a deadly killer for which I had no treatment to offer.

It wasn't Ebola. 

This killer lurks within the US, can spread person to person with ease, and can cause whole hospital units to shut down.

Its name: XDR Acinetobacter.

Because many of the infections this pathogen causes occur in elderly chronically Ill nursing home patient, it doesn't grab headlines. It should for it is a harbinger of the future if antimicrobial resistance continues and current strategies in the treatment of infectious diseases, reliant almost exclusively on broad spectrum antimicrobials, are not rethought.

So while more flashy diseases may turn heads, the serial killer in the shadows continues its work.

Would You Like Some Mycobacteria with Your Tramp Stamp?

People often forget that one of the most crucial components of the immune system is the skin. Though it is less intricate and flashy as antibodies, complement, neutrophils, lymphocytes, and, one of my favorites, natural kill cells, the skin is an essential barrier that stymies many pathogens.

This fact is why Band-Aids are important. 

Anything that causes a breach in the skin--be it a laceration, an IV, or a puncture--is the equivalent of leaving the door open to pathogens. 

One ornate welcome mat recently in the news is the tattoo. Tattoos, when applied with dirty needles, have been associated with hepatitis C infections but a recent advisory was issued warning of the possibility of infection from certain bacterially-contaminated  tattoo inks. In particular, non-tuberculous mycobacterial infections are the main risk. It is thought that dilution of inks with tap water introduces bacterial contamination. Mycobacterial infections are particularly hard to diagnose and often require prolonged courses of treatment. 

I once heard the expression "peeing on the birthday cake" and it seems to be a particularly apt way to describe what the inconsiderate Mycobacteria are doing to people's tattoos. 

HIV, Ebola, & Wild Child Emerging Infectious Diseases

I was asked a really interesting question on a recent TV interview. I was asked about what lessons from HIV can be applied to Ebola. That I think about HIV a lot might seem strange given that it is now a completely treatable "chronic" infectious disease and not an explosive mysterious emerging infection. 

But, HIV had its wild-child phase and it is the arguably the most successful emerging infectious disease ever. 

HIV-1 spilled into humans from chimpanzees around the dawn of the 20th century, probably in Cameroon, and at first was likely a disease of bush-meat hunters and their close contacts who contracted the virus when butchering chimpanzees. Once industrialization connected these once remote areas to each other HIV-1 found a means to propagate amongst humans through sexual contact and the disease exploded. 

The disease trickled on, accruing victims without notice. I always think if infectious disease physicians would have noted this trickle of patients before it became a worldwide epidemic decades later, it could have been contained (to some degree). 

There's a story I've heard about a physician, Dr. Bila Kapita, recognizing the presence of the AIDS-defining illness Kaposi's Sarcoma in Kinshasa in 1975 and noting its presence in prior hospital records. I think this anecdote illustrates that if you look hard enough, you can find low-level "viral chatter" transpiring. 

Ebola is similar in many respects. These explosive outbreaks represent stuttered forays into the human population and burn out because the virus is not efficiently transmitted between humans. 

Studying these stuttered starts of emerging pathogens is what it means to be "tracking zebra".