Nosocomial Hepatitis C

Via ProMED-mail: everybody is reporting on the multi-incident iatrogenic transmission of hepatitis C at a clinic in Nevada. (Here, for example, is the report from Fox5 News, Las Vegas.) The Southern Nevada Health District site has a FAQ with graphics of the smoking syringe:

Following a joint investigation with the Nevada State Bureau of Licensure and Certification (BLC) and with consultation from the Centers for Disease Control and Prevention, the health district determined that unsafe injection practices related to the administration of anesthesia medication might have exposed patients to the blood of other patients.

Cure Your Own Cancer

Via plime: the AP reports on a Duke University student working to find a cure for his own rare form of cancer:

Chordoma — the cancer Josh learns he has — is a one-in-a million disease. Just 300 people get the terrible news each year, not even one per day. It strikes all ages, at different spots along the spinal column. The tumors can be removed, but the cancer is relentless. Chemotherapy doesn’t work. Life expectancy is around seven years.
The MRI shows Josh’s tumor is in a tough spot, in a bone inside his skull. It extends onto his brain stem and wraps around several arteries. There are two surgeries, then weeks of recovery in the hospital. He and Simone pass the time reading whatever they can about the disease.
There isn’t much. The massive apparatus of medical research — pharmaceutical companies, foundations, universities, government agencies — is utilitarian. High-prevalence diseases are at the front of the line, rare ones like chordoma usually at the back.
But then, a stroke of good fortune. It turns out that the only researcher in the country with a grant to study chordoma happens to be at Duke, working in a VA lab across the street from campus.

Josh later cuts back on his research activities in favor of the Chordoma Foundation which he and his mother founded to better organize research into chordoma. The article also mentions a few other patient-researchers.

Acromegaly in the News

Via pilme: the Daily Mail reports on a chance meeting at a restaurant that led to a diagnosis of acromegaly, a rare condition that affects 3 people in a million.

The life-saving handshake happened on December 6, when lifelong friend Rob Thompson brought Dr Britt to an Italian restaurant Mr Gurrieri runs in Canary Wharf.
"I came out to meet them at the door. My friend, Rob, brought Chris along for the first time," he said.
"We shook hands and I sat them down at the table. He didn't say anything to me at the time but he turned to Rob as soon as he sat down and said 'I'm sure he has acromegaly, I can tell you. I'll stake my career on it.'
"Rob didn't tell me straight away. He came in two days later and was really nervous about telling me.
"I got straight on the internet. I read down the lines and saw the word 'tumour'. That word is frightening, especially when it has to do with the head.
"I went to my GP with everything I could print off from the internet and waved it under his nose.
"He looked it up and said he wasn't sure but would send me off for a blood test and MRI scan. They came back positive for acromegaly."
The condition, in which a tumour grows on the pituitary gland, causes an increase in growth hormones that can cause giantism in children.
In adults, it causes soft tissues to be deposited in the hands and growth of the skull bones.

Pesticide Dumplings

Via plime: the AP reports on the discovery of pesticide in Chinese dumplings imported into Japan:

Officials said Japanese authorities were recalling millions of bags of dumplings and other foods made by Tianyang Food Processing Ltd., the Chinese company that Japanese officials implicated in the earlier incidents.
A day earlier, China's product safety agency announced that tests on the ingredients of Tianyang dumplings — from the same batch sent to Japan — found none of the insecticide cited by Japanese authorities, said the country's General Administration of Quality Supervision, Inspection and Quarantine.
Investigators detected the insecticide methamidophos on the six bags of Tianyang dumplings over the weekend, a Hyogo prefecture (state) police official said on condition of anonymity, citing policy.
The official said that one of the bags had two tiny holes in it, and that investigators were checking whether the dumplings inside were contaminated.
The dumplings were the same type blamed for sickening 10 people, some of them seriously, in central and western Japan in December and January.

Progressive Inflammatory Neuropathy

Via ProMED-mail: the AP reports that the CDC has given a name to the pork-inhalation autoimmune disease contracted by workers at a couple of slaughterhouses:

Minnesota officials said they were broadening their investigation to thousands of former employees at the Quality Pork Processors Inc. plant in Austin, going back a decade to when a powerful compressed air system was installed to remove brain tissue from pig heads.
Investigators have been trying to determine whether pig brain tissue, sprayed into the air as droplets during removal by the compressed air system, was inhaled by workers and made them sick.
If further investigation proves their theories true, they will have identified a rare, new condition that could shed light on a whole family of poorly understood disorders in which the body's immune system attacks the nerves or the sheath that surrounds them, the Star Tribune reported.

You'd think after mad cow, they'd be a little more careful about aerosolizing livestock brains, but no. PlagueBlog recommends avoiding all pork, short or long.

Indonesia Hits 100 Again

Via ProMED-mail: Reuters reports that Indonesia has hit its hundredth bird flu death.

A 23-year-old Indonesian woman from East Jakarta has died from bird flu, taking the country's death toll to 100, according to a report from Indonesia's bird flu information centre on Monday.
The woman died on Sunday and two separate laboratory tests confirmed she contracted H5N1, the report said.
Earlier on Monday, a 9-year-old Indonesian boy who had tested positive for bird flu died, the health ministry said in a statement.

World's First Blood-Type Conversion

Via plime: AFP reports on a girl who changed blood type after a liver transplant.

Demi-Lee Brennan was aged nine and seriously ill with liver failure when she received the transplant, doctors at a top Sydney children's hospital told AFP.
Nine months later it was discovered that she had changed blood types and her immune system had switched over to that of the donor after stem cells from the new liver migrated to her bone marrow.
She is now a healthy 15-year-old, Michael Stormon, a hepatologist treating her, told AFP. Stormon said he had given several presentations on the case around the world and had heard of none like it.
"It is extremely unusual -- in fact we don't know of any other instance in which this happened," Stormon told AFP from the Children's Hospital.

Cholesterol Still Good For You

Via Half Sigma again: a New York Times editorial on cholesterol never having hurt a fly. Gary Taubes explains how cholesterol got its undeserved bad reputation:

In the 1950s, two hypotheses competed for attention among heart disease researchers. It had been known for decades that cholesterol was a component of atherosclerotic plaques, and people who have a genetic disorder that causes extremely high cholesterol levels typically have clogged arteries and heart attacks. As new technology enabled them to look more closely at lipoproteins, however, researchers began to suspect that these carrier molecules might play a greater role in cardiovascular disease than the cholesterol inside them. The cholesterol hypothesis dominated, however, because analyzing lipoproteins was still expensive and difficult, while cholesterol tests were easily ordered up by any doctor.
In the late 1960s, biochemists created a simple technique for measuring, more specifically, the cholesterol inside the different kinds of lipoproteins — high-density, low-density and very low-density. The National Institutes of Health financed a handful of studies to determine whether these “cholesterol fractions” could predict the risk of cardiovascular disease. In 1977, the researchers reported their results: total cholesterol turned out to be surprisingly useless as a predictor. Researchers involved with the Framingham Heart Study found that in men and women 50 and older, “total cholesterol per se is not a risk factor for coronary heart disease at all.”
The cholesterol in low-density lipoproteins was deemed a “marginal risk factor” for heart disease. Cholesterol in high-density lipoproteins was easily the best determinant of risk, but with the correlation reversed: the higher the amount, the lower the risk of heart disease.
These findings led directly to the notion that low-density lipoproteins carry “bad” cholesterol and high-density lipoproteins carry “good” cholesterol. And then the precise terminology was jettisoned in favor of the common shorthand. The lipoproteins LDL and HDL became “good cholesterol” and “bad cholesterol,” and the lipoprotein transport vehicle was now conflated with its cholesterol cargo. Lost in translation was the evidence that the causal agent in heart disease might be abnormalities in the lipoproteins themselves.
The truth is, we’ve always had reason to question the idea that cholesterol is an agent of disease. Indeed, what the Framingham researchers meant in 1977 when they described LDL cholesterol as a “marginal risk factor” is that a large proportion of people who suffer heart attacks have relatively low LDL cholesterol.

Morgellons Gets a Little More Respect

Via plime: the AP reports that the CDC has commissioned a study of Morgellons, a mysterious, possibly parasitic, possibly psychosomatic ailment that has been known possibly for centuries but dismissed as delusional parasitosis.

The study will be done in northern California, the source of many of the reports of Morgellons (pronounced mor-GELL-uns). Researchers will begin screening for patients immediately, CDC officials said Wednesday. A Kaiser official expects about 150 to 500 study participants.
Morgellons sufferers describe symptoms that include erupting sores, fatigue, the sensation of bugs crawling over them and — perhaps worst of all — mysterious red, blue or black fibers that sprout from their skin. They've documented their suffering on Web sites.

The Morgellons Research Foundation has more information, including pictures of the alleged neon threads that grow out of victims.

Cholesterol Declared Good For You

Via Half Sigma: the New York Times reports that the link between "bad" cholesterol and bad outcomes has been torpedoed by two recent studies of non-statin cholesterol-reducing drugs:

In the last 13 months, however, the failures of two important clinical trials have thrown that hypothesis into question.
First, Pfizer stopped development of its experimental cholesterol drug torcetrapib in December 2006, when a trial involving 15,000 patients showed that the medicine caused heart attacks and strokes. That trial — somewhat unusual in that it was conducted before Pfizer sought F.D.A. approval — also showed that torcetrapib lowered LDL cholesterol while raising HDL, or good cholesterol.
Torcetrapib’s failure, Dr. Taylor said, shows that lowering cholesterol alone does not prove a drug will benefit patients.
Then, on Monday, Merck and Schering-Plough announced that Vytorin, which combines Zetia with Zocor, had failed to reduce the growth of fatty arterial plaque in a trial of 720 patients. In fact, patients taking Vytorin actually had more plaque growth than those who took Zocor alone.
Despite those drawbacks, that trial, called Enhance, also showed that patients on Vytorin had lower LDL levels than those on Zocor alone. For the second time in just over a year, a clinical trial found that LDL reduction did not translate into measurable medical benefits.

Statins do help people, but the mechanism may be something other than their cholesterol-lowering effects.

Popcorn Lung

Via plime: The Brisbane Times reports on a Denver man who's the only known consumer to fall prey to the dread disease of popcorn lung.

Popcorn lung, officially called bronchiolitis obliterans, generally has been associated with people who worked in microwave popcorn plants mixing large vats of flavours. Hundreds of workers have said they have severe lung disease or other respiratory illnesses from inhaling diacetyl vapours.
The chemical has been the subject of hundreds of lawsuits against the companies that produce or use the butter flavouring.
Watson is suing the store where he bought his popcorn instead.

The Gay Germ

The genetics of male homosexuality came up on a mailing list recently, so I had the opportunity to push the plague perspective, or as it is more commonly known, the gay gene theory or pathogenic hypothesis. Nor is the gay germ alone among infectious causes of personality:

Cochran claims that theories of the cause of narcolepsy - that it is an auto-immune disease triggered by a virus - make the mechanism of selective brain modification plausible. He also claims that only humans and sheep exhibit homosexual behavior at population levels near 1% or greater. He says that given their physical proximity, it would be plausible to expect a pathogen that affected both species.
Proponents cite increasing evidence that some cases of Schizophrenia may be linked to exposure with Toxoplasma gondii. Other studies suggest that a variety of mood disorders may be linked to Borna Virus.

Beware the Stealthy Headache

Via Universal Hub: TS the EMT reports that we almost lost a building full of people in Boston to carbon monoxide poisoning:

Shortly after nine o'clock, a little girl crawled out of bed, tiptoed into the living room, and told her mother she wasn't feeling well.
A few minutes later, the girl's sister complained of a headache, too. Then the mother began to feel ill herself. Assuming they were all coming down with a bug of some kind, she picked up the phone and called 911.
[...]
Fortunately, nobody was found unconscious in an apartment. Workers from the gas company came to investigate, and apparently they located the source of the problem. The windows were opened, the building aired out, and the residents were able to return to their homes.
This could have been a real catastrophe. A few hours later, everyone would have been alseep. The rising carbon monoxide levels would have gone unnoticed. Dozens of people would have lapsed into unconsciousness, and by the time anyone noticed a problem, everyone in the building might have been dead.
In fact, this might have been a criminal negligence case in the making. Leaving the scene we heard talk that work was being done on the building, and that workers had temporarily disconnected the smoke- and carbon-dioxide detectors.

Follica, the Kindest Cut

Via Universal Hub: Xconomy reports on Follica, a biotech startup dedicated to curing baldness.

Cotsarelis, an expert in epithelial stem cells such as those found in the skin, was studying how skin heals and noticed that new hair follicles seemed to be forming in the middle of some of some wounds. He learned that when the skin’s top layers were removed, some cells within the wound revert to a more primitive state (what he calls an “embryonic window”) from which they can develop into either hair or skin. With more research, says Zohar, Cotsarelis found that he “could actually push them to one direction or another.” In a widely read Nature paper published last May, Cotsarelis showed for the first time that it’s possible to create new hair follicles in adult mammals—and to shut down hair growth. He could even grow thicker, darker hair.
Zohar says Follica has further developed this work and filed additional patents to protect the technology. What’s so beautiful about the approach, she says, is that translating it into a treatment for humans involves only devices and drugs that are already on the market. A doctor would first use a microdermabrasion tool, say, or a laser to remove the top layers of the skin—as is already commonly done in a number of dermatologic and cosmetic procedures—knocking some cells back into a primitive state. The doctor can then use this newly created therapeutic window to inject drugs that push the cells to develop along one pathway or another and grow hair or skin. Zohar won’t reveal what drugs Follica is using, except to say that they are small molecule drugs normally taken orally for purposes with no relation to hair growth.

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Contagious Yawning

Via Gene Expression: Biology Letters reports "the disturbance of contagious yawning in individuals with autism spectrum disorder (ASD)."

Yawning video clips elicited more yawns in TD [typically developing] children than in children with ASD, but the frequency of yawns did not differ between groups when they observed control video clips. Moreover, TD children yawned more during or after the yawn video clips than the control video clips, but the type of video clips did not affect the amount of yawning in children with ASD. Current results suggest that contagious yawning is impaired in ASD, which may relate to their impairment in empathy. It supports the claim that contagious yawning is based on the capacity for empathy.

The news has already made it into the Wikipedia section on contagious yawning.

Christmas Clusters

PlagueBlog apologizes for falling behind in bird flu reporting. The clusters were coming fast and furious last week, but without sustained transmission. Armageddon is postponed once again. Here's a cluster roundup, mostly via ProMED-mail, as usual:

The WHO washes its hands of the cluster question in China:

The World Health Organization said Friday it was impossible to say whether a case of bird flu in China involving a 52- year-old man was due to human-to-human transmission - but, even if it was, it was down to very close contact between the victims.

The Indonesian cluster has dissolved, at least in the opinion of the Indonesian government, that bastion of bird-flu responsiveness:

Two sets of laboratory tests showed the six admitted to a hospital in Jakarta on Friday did not have the H5N1 virus, said Nyoman Kandun, director-general of communicable disease control at Indonesia's health ministry.

Pakistan is double-checking the WHO's negative results for their erstwhile bird flu cluster:

"In their preliminary tests the WHO team excluded suspected human-to-human transmission, but we have sent the samples to Geneva for further confirmation," health ministry spokesman Oriya Maqbool Jan told AFP.

The WHO team was sent after the ministry announced the death of a man who was one of six people infected with the deadly H5N1 strain of the avian influenza virus in North West Frontier Province along the Afghanistan border.

A brother of the victim also died before being tested for the virus. Both had worked on a cull of infected poultry.

PlagueBlog finds it suspicious that the "first" bird flu case in Pakistan was a cluster of six, and also that the first report out of China in six months was a cluster of two.

Epilepsy Drugs and Asians

Via the About.com Rare Diseases Blog: the FDA has recommended that persons of Asian ancestry have a genetic test for the HLA-B*1502 gene before taking epilepsy drugs containing carbamazepine, because of the risk of rare skin reactions. Gory pictures are available in this PDF about SJS.

Boy Meets Bat

Via Universal Hub: boy meets bat in basement and may yet live to tell about it.

Please remember that bats are not our friends. Bats are blood-sucking, disease-bearing flying rats out of a Cthulhu Christmas Special where the lucky ones die early and the handsome brave ones die pathetically later, foaming at the mouth and biting their friends in order to spread the madness. Just keep away. If you happen to come into contact with a slow-moving bat, save it for testing and see a doctor. Likewise for squirrels.

Up to a hundred people die of rabies every day in Asia because they don't know enough to seek treatment. Here in civilization, bats are the up-and-coming culprit:

Recently, bat rabies has emerged as an important epidemiologic reservoir in some parts of the world (i.e. the Americas and Australia). In North America, most documented human rabies deaths occurred as a result of infection from the silver haired bat rabies virus variant and in Australia at least two human deaths have occurred from exposure to a previously unrecognized rabies virus. In South America, wildlife rabies, especially bat rabies is increasing. For the first time in 2003, more people died from rabies following bites from wildlife than from dogs in South America.

New Strain of Ebola

The Atlanta Journal Constitution, your source for up-to-the-minute CDC news, reports that the current Ebola outbreak in Uganda (51 cases and 16 deaths as of Wednesday, according to the WHO) is due to a new, fifth strain of the virus:

Samples arrived at CDC's Biosafety Level 4 labs in Atlanta on Monday. By Tuesday, Ksiazek said, it was apparent this was not a typical Ebola virus.
Dr. Stuart Nichol, a CDC special pathogens team leader, said some molecular tests for Ebola were coming back negative, when another type of test came back positive. The CDC lab was then able to extract a small fragment of the virus' genome.
"It looks, based on this, like it's a new species of Ebola," Nichol said Friday evening.
Previously, there were only four known types of Ebola. The Sudan and Zaire species were discovered in 1976. A strain called Reston was identified in 1989 among monkeys imported to a lab in Virginia. And in 1994, the Ivory Coast strain was identified.
Depending on the strain, the death rate varies. Ebola-Zaire kills about 80 percent of its victims, while the Sudan strain kills about 50 percent, Ksiazek said.