At this time of year many of us turn our thoughts to ancient times, whether to the second century BCE (for the Maccabees and Hanukkah), the first century CE (Jesus and Christmas), or other wintertime traditions even dating back to 10,000 BCE and celebrations related to the winter solstice. A recent article turned my thoughts to a little earlier time in antiquity, around 7000 BCE. But first ....
WHO Cholera Update
New reporting from WHO is a bit depressing, given that cholera is controllable with good sanitation, plus we have effective vaccines and treatments available. Worldwide cases this year, as of November 24, increased 37% compared to last year. So far, we are up to 733,956 cholera cases and 5162 deaths from 33 countries across five WHO regions. WHO cites multiple factors for the increase, including vaccine shortages, climate change, conflict, mass displacement, and natural disasters including floods.
Avoid Bats**t
Among other things to avoid, bat guano is not a healthy choice. Researchers at the University of Rochester reported 2 fatalities from histoplasmosis traced to bat guano used as fertilizer for marijuana plants. Both were adults with underlying medical conditions. Infection with Histoplasma capsulatum usually is asymptomatic but can become symptomatic and severe with massive exposure or in persons with high risk factors such as immunosuppression.
Avian Flu
Though not wanting to contribute to over-dramatization of our ongoing saga of influenza A H5N1 in poultry and cows, the count of human infections is still increasing slowly, now at 64 cases nationally. Most importantly, we still have no evidence of human-to-human transmission, and it remains mostly a relatively mild infection in humans. Probably the biggest impact we all see is in the price of eggs.
This past week we saw confirmation of severe disease in a human. It occurred in an adult with significant underlying medical conditions who had exposure to dead and ill birds in a backyard flock. Genomic sequencing of the person's flu strain suggested its likely origin as being from avian as opposed to bovine origin. Front line health care providers should take this as a reminder to inquire about exposure to birds, both wild and domestic, and to cows as a routine part of evaluation of flu-like illness.
Please Consider Antiviral Therapy for Influenza
This past week I consulted on a child hospitalized with pneumonia who had a mild respiratory illness testing positive for influenza about 10 days previously. The child hadn't received flu vaccine this season, and the urgent care physician who diagnosed flu did not prescribe treatment for influenza. I don't know if oseltamivir treatment would have prevented the hospitalization, which could have been a separate illness, but the case did remind me that many providers are not using the tools at our disposal to help prevent adverse outcomes from flu.
A recent multicenter study revealed that about half of children hospitalized for influenza did not receive antiviral therapy. Various factors were associated with receipt of therapy.
As a reminder, we have a total of 4 drugs approved for treatment of influenza: oseltamivir (Tamiflu) and baloxavir (Xofluza) are oral agents. Other options are intravenous peramivir and inhaled zanamivir. While anti-influenza treatment works better in the first 2 days of illness, there is still benefit from treatment started later. Also, there isn't much point in testing for influenza if you're not going to treat it!
WRIS
We are well into winter respiratory infection season now, largely driven by RSV and influenza. I'd encourage everyone to look into the status for your own location at the CDC website.
Ancient Times: The Origins of Syphilis
We've seen a lot of controversy (and shouting) the past few years regarding the origins of covid. A recent archeologic study on the origins of syphilis and other treponemal diseases caught my eye. Although I'm not aware of any shouting matches around this origin controversy, it's noteworthy that the answer still is a bit up in the air. The study used genome analysis of multiple specimens and provides convincing evidence that treponemal diseases originated in the Americas. Their findings, along with many others, suggests that we can blame Columbus for bringing syphilis to Europe but not vice versa as some have postulated.
I should remind everyone that there are 3 forms of human disease caused by Treponema pallidum: T. pallidum pallidum (syphilis), T. pallidum pertenue (yaws), and T pallidum endemicum (bejel). (Pinta, the mildest human treponematosis, is caused by T. carateum.)
Regardless of whether you celebrate this holiday season based on traditions from the time of winter solstice recognition and the origins of treponemal disease or the more recent and more common religious and secular traditions (remember Festivus?), I wish everyone a wonderful time the next few weeks.
Courtesy of https://commons.wikimedia.org/wiki/File:Festivus_Pole.jpg.
