November 15, 2012 · Posted in Meningitis
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Need a cheat sheet to help keep it all straight? The CDC thinks you should remember 10 easy bullet points about this surprisingly complex disease. Here they are:
1. There are five “types” of meningitis.
Meningitis may develop in response to a number of causes, usually bacteria or viruses, but meningitis can also be caused by physical injury, cancer or certain drugs.
The five “types” of meningitis are:
- Bacterial Meningitis
- Viral Meningitis
- Fungal Meningitis
- Parasitic Meningitis
- Non-infectious Meningitis
The severity of illness and the treatment for meningitis differ depending on the cause. Thus, it is important to know the specific cause of meningitis. For the ongoing outbreak of fungal meningitis and other infections linked to contaminated steroid medication, fungus was discovered as the cause. More on that below. But let’s first look at some of the other types of meningitis and facts you need to know.
2. There are vaccines that protect against three types of bacteria that can cause meningitis.
Bacterial meningitis is usually severe and can be life-threatening. While most people with meningitis recover, it can cause serious complications, such as brain damage, hearing loss or learning disabilities. In the United States, about 4,100 cases of bacterial meningitis, including 500 deaths, occurred each year between 2003-2007.
The germs that cause bacterial meningitis can be contagious. Some bacteria can spread through the exchange of respiratory and throat secretions (e.g., kissing). Fortunately, most of the bacteria that cause bacterial meningitis are not as contagious as diseases like the common cold or the flu. Also, the bacteria are not spread by casual contact or by simply breathing the air where a person with meningitis has been.
Other meningitis-causing bacteria are not spread person-to-person, but can cause disease because the person has certain risk factors (such as a weak immune system or head trauma). And finally, unlike other bacterial causes of meningitis, you can get Listeria monocytogenes by eating contaminated food.
The most effective way to protect you and your child against certain types of bacterial meningitis is to complete the recommended vaccine schedule. There are vaccines for three types of bacteria that can cause meningitis: Neisseria meningitidis (meningococcus), Streptococcus pneumoniae (pneumococcus), and Haemophilus influenzae type b (Hib).
3. There are things that can increase your risk of bacterial meningitis.
Factors that can increase your risk of bacterial meningitis include:
Age: Infants are at higher risk for bacterial meningitis than people in other age groups. However, people of any age are at risk.
Community setting: Infectious diseases tend to spread more quickly where larger groups of people gather together. College students living in dormitories and military personnel are at increased risk for meningococcal meningitis.
Certain medical conditions: There are certain diseases, medications, and surgical procedures that may weaken the immune system or increase risk of meningitis in other ways.
Working with meningitis-causing pathogens: Microbiologists who are routinely exposed to meningitis-causing pathogens are at increased risk.
Travel: Travelers to the meningitis belt in sub-Saharan Africa may be at risk for meningococcal meningitis, particularly during the dry season. Also at risk for meningococcal meningitis are travelers to Mecca during the annual Hajj and Umrah pilgrimage.
Bacterial meningitis infection may show up in a person by a sudden onset of fever, headache, and stiff neck. It will often have other symptoms, such as nausea, vomiting, increased sensitivity to light, and confusion. Infants may appear to be slow or inactive (lack of alertness), irritable, vomiting or feeding poorly. The symptoms of bacterial meningitis can appear quickly or over several days. Typically they develop within three to seven days after exposure. Later symptoms of bacterial meningitis can be very severe (e.g., seizures, coma). For this reason, anyone who thinks they may have meningitis should see a doctor as soon as possible.
Bacterial meningitis can be treated effectively with antibiotics. It is important that treatment be started as soon as possible. Appropriate antibiotic treatment of the most common types of bacterial meningitis should reduce the risk of dying from meningitis to below 15 percent, although the risk remains higher among young infants and the elderly.
4. Symptoms of viral meningitis in adults may differ from those in children.
Viral meningitis is generally less severe and resolves without specific treatment. However, the symptoms of viral meningitis are similar to those for bacterial meningitis, which can be fatal. Because of this, it is important to see a health care provider right away if you think you or your child might have meningitis.
Common symptoms in infants:
- Poor eating
- Hard to awaken
Common symptoms in adults:
- High fever
- Severe headache
- Stiff neck
- Sensitivity to bright light
- Sleepiness or trouble waking up
- Nausea, vomiting
- Lack of appetite
There is no specific treatment for viral meningitis. Antibiotics do not help viral infections, so they are not useful in the treatment of viral meningitis. Symptoms usually last from seven to 10 days, and people with normal immune systems usually recover completely. A hospital stay may be necessary in more severe cases or for people with weak immune systems.
5. There are no vaccines for the most common causes of viral meningitis, so the best way to prevent it is to prevent viral infections.
Most viral meningitis cases in the United States, especially during the summer months, are caused by enteroviruses (small viruses made of RNA and protein); however, only a small number of people with enterovirus infections actually develop meningitis.
There are steps you can take to help lower your chances of becoming infected with viruses or of passing one on to someone else:
- Wash your hands thoroughly and often, especially after changing diapers, using the toilet, or coughing or blowing your nose.
- Clean contaminated surfaces, such as doorknobs or the TV remote control, with soap and water and then disinfect them with a dilute solution of chlorine-containing bleach.
- Avoid kissing or sharing a drinking glass, eating utensil, lipstick, or other such items with sick people or with others when you are sick.
- Make sure you and your child are vaccinated. Vaccinations included in the childhood vaccination schedule can protect children against some diseases that can lead to viral meningitis. These include vaccines against measles and mumps (MMR vaccine) and chickenpox (varicella-zoster vaccine).
- Avoid bites from mosquitoes and other insects that carry diseases that can infect humans.
- Control mice and rats. If you have a rodent infestation in and/or around your home, follow the cleaning and control precautions listed on CDC’s website about LCMV (Lymphocytic choriomeningitis virus). In rare cases LCMV, which is spread by rodents, can cause viral meningitis.
6. Fungal meningitis is very rare in the United States, but is more common in places such as sub-Saharan Africa.
Although anyone can get fungal meningitis, people with weak immune systems, like those with AIDS or cancer, are at higher risk. The most common cause of fungal meningitis for people with weak immune systems is Cryptococcus. This disease is one of the most common causes of adult meningitis in Africa.
CDC is currently working with countries in Africa and Asia to begin screening for Cryptococcus. We have new rapid diagnostic tests that will allow clinicians to detect fungal meningitis early among HIV positive patients, which will help them receive treatment earlier and has the potential to save hundreds of thousands of lives. There are about a million cases of fungal meningitis in sub-Saharan Africa every year, and about 600,000 deaths — even more deaths than are caused by tuberculosis, so this screening has the potential to make a huge impact in these countries.
7. Fungal meningitis is not contagious.
Fungal meningitis is not transmitted from person to person. It can develop after a fungus spreads through the bloodstream from somewhere else in the body, as a result of the fungus being introduced directly into the central nervous system, or from an infected body site infection next to the central nervous system.
You may also get fungal meningitis after taking medications that weaken your immune system. Examples of these medications include steroids (such as prednisone), medications given after organ transplantation, or anti-TNF medications, which are sometimes given for treatment of rheumatoid arthritis or other autoimmune conditions.
Symptoms are similar to symptoms of other forms of meningitis; however, they often appear more gradually and can be very mild at first.
Fungal meningitis is treated with long courses of high-dose antifungal medications, usually given through an IV line in the hospital. The length of treatment depends on the status of the immune system and the type of fungus that caused the infection. For people with immune systems that do not function well because of other conditions, like AIDS, diabetes, or cancer, treatment is often longer.
8. The United States is currently experiencing an unprecedented multi-state outbreak of fungal meningitis and other infections.
The Centers for Disease Control and Prevention (CDC), in collaboration with state and local health departments and the Food and Drug Administration (FDA), is investigating a multistate outbreak of fungal meningitis and other infections among patients who received contaminated steroid injections. The infections identified as part of this investigation include fungal meningitis, a form of meningitis that is not contagious, and infections associated with injections in a peripheral joint space, such as a knee, shoulder, or ankle.
All of the infections were associated with one of three lots of preservative-free methylprednisolone acetate, an injectable steroid medication recalled on September 26, 2012, from the New England Compounding Center (NECC). See CDC’s website for more information about what patients need to know.
9. Primary amebic meningoencephalitis (PAM) is a very rare form of parasitic meningitis that causes a fatal brain infection.
Primary amebic meningoencephalitis (PAM) is a very rare form of parasitic meningitis that is caused by the microscopic ameba (a single-celled living organism) Naegleria fowleri.
Naegleria fowleri infects people by entering the body through the nose. This typically occurs when people go swimming or diving in warm freshwater places, like lakes and rivers. The Naegleria fowleri ameba travels up the nose to the brain where it destroys the brain tissue.
No data exist to accurately estimate the true risk of PAM. The hundreds of millions of visits to swimming venues that occur each year in the U.S. result in 0-8 infections per year.
Naegleria fowleri is found around the world. In the United States, the majority of infections have been caused by Naegleria fowleri from warm freshwater located in southern-tier states. The ameba can be found in:
- Bodies of warm freshwater, such as lakes and rivers
- Geothermal (naturally hot) water, such as hot springs
- Warm water discharge from industrial plants
- Geothermal (naturally hot) drinking water sources
- Swimming pools that are poorly maintained, minimally-chlorinated, and/or un-chlorinated
- Water heaters with temperatures less than 116.6 degrees Fahrenheit (47 degrees Celsius).
Naegleria fowleri is not found in salt water, like the ocean.
Several drugs are effective against Naegleria fowleri in the laboratory. However, their effectiveness is unclear since almost all infections have been fatal, even when people were treated. The fatality rate for an infected person who begins to show signs and symptoms is over 99 percent. Only 1 person out of 123 known infected individuals in the United States from 1962 to 2011 has survived.
10. There are several things that can cause non-infectious meningitis.
Non-infectious meningitis causes include:
- Systemic lupus erythematosus (lupus)
- Certain drugs
- Head injury
- Brain surgery
Treatment depends on the underlying cause (cancer, head injury, brain surgery, etc.).
This type of meningitis is not spread from person to person. Like other types of meningitis, symptoms of non-infectious meningitis include a sudden onset of fever, headache and stiff neck. It is often accompanied by other symptoms, such as nausea, vomiting, photophobia (sensitivity to light), and altered mental status.
Source: Centers for Disease Control and Prevention
If you still have questions about meningitis, join the NewsHour’s live chat with the CDC’s Dr. Amanda Cohn and Dr. Benjamin Park on Thursday, Nov. 15, at 1 p.m. ET. Submit your question in the comments section below or participate in the conversation live on Thursday.
Frederick A. Murphy / CDC handout via EPA file
By Maggie Fox, NBC News
A virus that killed two teenagers in Congo in 2009 is a completely new type, related to rabies but causing the bleeding and rapid death that makes Ebola infection so terrifying, scientists reported on Thursday. They’re searching for the source of the virus, which may be transmitted by insects or bats.
The new virus is being named Bas-Congo virus, for the area where it was found. Researchers are finding more and more of these new viruses, in part because new tests make it possible, but also in the hope of better understanding them so they can prevent pandemics of deadly disease.
The virus infected a 15-year-old boy and a 13-year-old girl in the same village in Congo in 2009. They didn’t stand a chance, says Joseph Fair of Metabiota, a company that investigates pathogens. Fair is in the Democratic Republic of Congo now, under contract to the U.S. Agency for International Development (USAID) to help battle an ongoing Ebola outbreak.
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“They expired within three days,” Fair said in a telephone interview. “It was a very rapid killer.”
A few days later a male nurse who cared for the two teenagers developed the same symptoms and survived. Samples from the lucky nurse have been tested and it turned out a completely new virus had infected him, Fair and other researchers report in the Public Library of Science journal PLoS pathogens.
The genetic sequences went to Dr. Charles Chiu, of the University of California, San Francisco.
“We were astounded that this patient had sequences in his blood from a completely unknown and unidentified virus,” Chiu said. They weren’t expecting that.
“Congo is very much known for having Ebola and Marburg outbreaks. Yet about 20 percent of the time we have hemorrhagic fever outbreaks that are completely negative, which means unknown causes and they are not Ebola.”
The sequencing puts this new virus on its own branch of the bad virus family tree — somewhat related to Ebola and the virus that causes Lassa fever, another horrific killer, and most closely related to the rhabdoviruses. This family usually only infects animals with one notable exception — rabies.
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But rabies is not known to cause hemorrhaging. It’s plenty horrible on its own, of course, killing virtually all patients if they aren’t vaccinated soon after infection.
A nurse who took care of the first infected nurse had antibodies to the new virus. It doesn’t look like the teenagers infected one another, says Fair, but they probably infected the first nurse, who probably infected the second. Tests of other villagers have found no more evidence of the virus, however, which is good news.
“Although the source of the virus remains unclear, study findings suggest that Bas-Congo virus may be spread by human-to-human contact and is an emerging pathogen associated with acute hemorrhagic fever in Africa,” the researchers wrote.
Africa is loaded with nasty viruses. Lassa fever virus comes from a family known as arenaviruses and causes 500,000 cases of hemorrhagic fever a year. Crimean-Congo hemorrhagic fever and Rift Valley Fever viruses are in another family called bunyaviruses; Ebola and Marburg viruses are filoviruses that kill anywhere between 30 percent and 90 percent of victims. They’re also helping wipe out great apes such as gorillas in Central Africa. This adds a new one to the list.
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It worries Chiu because its closest relative is spread by biting flies in Australia. “We think that is potentially a valuable clue. This virus may have come from an insect vector,” Chiu says. “What is scary about this virus is if it does happen to be spread by insects, it has the potential to be something like West Nile.”
West Nile showed up in the United States for the first time in 1999, having never been seen here before. It causes regular outbreaks in Africa and parts of Europe, however, and some experts think a mosquito or an infected person carried it on a flight to New York. It’s killed 147 people in an especially bad U.S. outbreak this year, although more than 90 percent of people infected with West Nile never even know it.
New viruses often cause disease — there was severe acute respiratory syndrome or SARS, which killed 800 people and infected 8,000 in 2003 before it was stopped. Scientists are now watching a similar virus that has emerged in the Middle east.
Chiu says there is not enough information to know how deadly the new Bas-Congo virus is.
“It has probably been lurking out there in remote areas and causing sporadic cases of hemorrhagic fever and no one had the resources to discover it,” Chiu said. “This is probably the tip of the iceberg. I believe there are many, many more of these emerging viruses that have yet to be discovered,” he added.
“This points to the importance of being vigilant, especially these remote areas of Africa and Asia. This is the area that I believe the next generation of emerging viruses will come from.”
Fair agrees, and says his team will be looking. They’ll also be checking to see if bats or insects can spread it. “It is a frightening prospect. That is why the next step in this process is to look for the vector,” Fair said.
That’s not so easy. Fair’s team and hundreds of other scientists have been looking for the reservoir — the animal or insect source –of Ebola. That would be a bat or other creature that can carry it without getting sick itself. So far they have had no luck, although fruit bats are a major suspect.
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And for the new Bas-Congo virus, the trail is now three years old. “Everything we do will be as a forensic investigation,” Fair said. “We really have to go look for a needle in a sack of needles.”
And in the meantime, there’s an outbreak of Ebola to cope with. Fair says a coordinated effort is going on, although this isn’t the worst outbreak he has seen. It’s killing about 30 percent to 40 percent of patients — not nearly as bad as some strains, which killed up to 90 percent of victims.
“If you had to get Ebola, this is the strain to get,” he said.
New virus in Africa looks like rabies, acts like Ebola
Tracking SARS back to its source January 2006
The previously unknown SARS virus generated widespread panic in 2002 and 2003 when the airborne germ caused 774 deaths and more than 8000 cases of illness. But where did this mystery virus come from? Scientists immediately suspected that it had jumped to humans from some other organism. In May of 2003, attention focused in on cat-like mammals called civets. Infected civets were discovered at a live animal market in southern China (where they are occasionally eaten). However, since further searches failed to turn up more tainted civets, scientists concluded that they were not the original source of SARS and continued their quest. Then in the fall of 2005, two teams of researchers independently discovered large reservoirs of a SARS-like virus in Chinese horseshoe bats. The bats now appear to be both culprit and victim in this mystery: they are the carriers of the SARS virus, but the virus is probably only passed to humans through intermediate hosts when bats are captured and brought to market.
Where’s the evolution? How exactly did biologists conclude that bats, and not civets, were the original source of the SARS virus? Figuring out the answer required reconstructing the evolutionary history of the virus.
Viruses evolve rapidly and constantly, changing within a lineage and splitting off to form new lineages. As they evolve, they accumulate small changes in the sequences of their genomes. Based on these genetic differences, biologists can reconstruct the evolutionary relationships of different viral strains, building an evolutionary tree that reveals which strains evolved from which strains and in what order they evolved.
In this case, biologists collected samples of the SARS virus’s genetic material, RNA, from different sources: infected humans, infected civets, and different species of infected horseshoe bat. The RNA was then copied, sequenced, and used to build a phylogeny, or evolutionary tree.
The tree showed that civet and human SARS viruses are very similar to each other and, most importantly, that both are nested within a cladeof bat viruses — so the ancestor of the civet and human strains seems to have been a bat virus! Based on this evidence, biologists have come up with a plausible path of transmission: infected bats and uninfected civets came into contact at a market, the virus was transmitted to civets and then multiplied and evolved in civets (or other animals) in the public market, until eventually the virus hopped to humans.
Interestingly, viruses seem to frequently make the jump from bats to human hosts. Bats appear to be the natural reservoirs for many human viruses, including the Ebola, Hendra, and Nipah viruses — and now we can add SARS to that list. But what is it about bats that makes them such a common source of viruses? Well, biologists aren’t sure, but it might have something to do with their tendency to roost tightly packed in caves with other bat species. This situation might encourage the transmission of viruses between individuals and species and provide opportunities for viruses to evolve and recombine with each other — much as biologists fear the avian flu will recombine with a human flu virus and evolve into a deadly, epidemic-causing strain.
Knowing that human SARS ultimately evolved from a bat virus can help us better understand emerging diseases and find ways to prevent future outbreaks. Certainly, we must limit contact between bats and humans and bats and other animals. However, such viruses have existed in wild animal populations for a long time — why are they suddenly evolving to infect human hosts? The answer probably has to do with changes in human behavior: expanding human populations encroach on the territory of wild animals; markets, farms, and ranches often bring different species together in conditions that facilitate pathogen spread; and increased travel and trade between tropical regions and other areas of the world carry pathogens to new environments. Understanding these paths of transmission may help us prevent future outbreaks of diseases such as HIV, SARS, and West Nile virus — all of which have made the leap from wild animals to human hosts.
Read more about it
- Lau, S.K., Woo, P.C., Li, K.S., Huang, Y., Tsoi, H.W., Wong, B.H., Wong, S.S., Leung, S.Y., Chan, K.H., and Yuen, K.Y. (2005). Severe acute respiratory syndrome coronavirus-like virus in Chinese horseshoe bats. Proceedings of the National Academy of Sciences USA102(39):14040-14045.
- Li, W., Shi, Z., Yu, M., Ren, W., Smith, C., Epstein, J.H., Wang, H., Crameri, G., Hu, Z., Zhang, H., Zhang, J., McEachern, J., Field, H., Daszak, P., Eaton, B.T., Zhang, S., and Wang, L.F. (2005). Bats are natural reservoirs of SARS-like coronaviruses. Science 310(5748):676-679.
Understanding Evolution resources:
Discussion and extension questions
- What do evolutionary trees represent?
- What did the phylogeny of SARS virus strains indicate to researchers?
- What evidence did researchers use to build the phylogeny of SARS virus strains? List two other types of evidence that could be used to build an evolutionary tree.
- Read the short article Evolution and the avian flu. Using the concepts of viral evolution introduced in that article, explain some possible ways that bat SARS could become adapted to human hosts.
- Research another case of an infectious disease that has evolved from a strain originally infecting a wild animal population (e.g., HIV). Explain how that disease made the jump to humans and how that “host switch” is similar to and different from the emergence of SARS.
Related lessons and teaching resources
- Teach the basics of phylogenetics. In this web-based module for grades 6-12, students are introduced to cladistics, which organizes living things by common ancestry and evolutionary relationships.
- Teach about how phylogenies are built. This classroom activity for grades 9-12 introduces how cladograms are built using anatomical characters and shows how shared derived characters can be used to reveal degrees of relationship.
- Teach about using molecular data to infer evolutionary relationships. In this classroom activity for grades 9-12, students formulate explanations and models that simulate structural and biochemical data as they investigate the misconception that humans evolved from apes.
- Lau, S.K., Woo, P.C., Li, K.S., Huang, Y., Tsoi, H.W., Wong, B.H., Wong, S.S., Leung, S.Y., Chan, K.H., and Yuen, K.Y. (2005). Severe acute respiratory syndrome coronavirus-like virus in Chinese horseshoe bats. Proceedings of the National Academy of Sciences USA102(39):14040-14045.
- Li, W., Shi, Z., Yu, M., Ren, W., Smith, C., Epstein, J.H., Wang, H., Crameri, G., Hu, Z., Zhang, H., Zhang, J., McEachern, J., Field, H., Daszak, P., Eaton, B.T., Zhang, S., and Wang, L.F. (2005). Bats are natural reservoirs of SARS-like coronaviruses. Science310(5748):676-679.
- Normile, Dennis. (2005). Researchers tie deadly SARS virus to bats. Science309:2154-2155.
- The usual suspects. (2005, November 17). The Economist. Retrieved December 19, 2005 from The Economist.
Civet photo provided by MCPA2; bat photo provided by Dr. Brock Fenton See Photos here
The history of brain surgery may date back as far as the late Stone Age, and some medical historians consider it the earliest operation ever performed. Recently, a specialist on Tibetan culture uncovered an intriguing account of ancient brain surgery in the 2,900-year-old Tibetan Tripi?aka, a collection of Buddhist texts passed down orally for thousands of years before being recorded in Sanskrit during the third century B.C. Perhaps most significantly, the description suggests that ancient Tibetan doctors conducted craniotomies and related procedures to ease patients’ symptoms and not as part of a religious ritual, as some scholars have suggested.
The Tibetan Tripi?aka.
Karma Trinley, an associate professor of Tibetan language and literature at Tibet University in Lhasa, found the passage on brain surgery after studying the Tripi?aka for four decades. In it, a veteran surgeon performs the operation on a man who suffers from such severe headaches that he would resort to banging his head on hard objects to relieve the pain. Tsogyel, a young Indian doctor who happens to be watching the procedure, counsels the surgeon to heat his tweezers, presumably in order to disinfect them.
“Tsogyel was a well-reputed doctor and was good at all medical practice except brain surgery,” Trinley told Xinhua News, China’s state-run news agency. “But the surgeon followed his advice and the surgery later proved successful.” Tsogyel’s sterilization technique went on to improve recovery rates for brain surgery during that time and helped him establish his own career as a surgeon, Trinley said.
Evidence of ancient brain surgery on the Tibetan Plateau first surfaced in 1998, when archaeologists unearthed human skulls bearing cracks that had healed before death. Researchers surmised that these early craniotomies, some performed more than 5,000 years ago, were intended to heal the spirit rather than the body. “Some believed it was a religious ritual to dispel evils or bring happiness, while others held that it was a therapy used by witches and wizards,” Trinley explained.
Because it includes details on the patient’s symptoms, the brain surgery scene in the Tripi?aka implies that doctors performed at least some of these operations for legitimate therapeutic reasons, Trinley said. Brain surgery is not the only medical treatment that appears in the Tripi?aka, which aggregates the teachings of Buddhism’s founder, Siddh?rtha Gautama (also known as ??kyamuni), and commentary by his disciples. “The Tibetan Tripi?aka contains ??kyamuni’s classifications of 440 ailments that were believed to be associated with wind, bile and phlegm, and were categorized accordingly,” Trinley said, adding that some of this knowledge is still used by Tibetan doctors today.
Many other ancient civilizations used brain surgery for both religious and medical purposes hundreds or even thousands of years before the advent of modern medicine, including the Egyptians, Romans, Greeks and some pre-Incan societies.
By KATIE MOISSE May 5, 2011
Karen Butler is from Oregon, not England. When asked where she got her accent, she says from her dental surgeon.
In 2009 Butler, a 56-year-old tax consultant in Toledo, Ore., awoke from denture implant surgery with an accent that’s a bit British with a Transylvanian twang, and it just sort of stuck.
“I had just had surgery, so at first we assumed it was because of all of the swelling,” said Butler. “But within a week the swelling went down and the accent stayed.”
Butler has foreign accent syndrome — a condition so rare that only about 60 cases have been documented worldwide. Often preceded by a small stroke, the new drawl is thought to stem from a minor injury to a tiny area of the brain responsible for language pattern and tone.
“This is a very small part of the brain that controls the articulation and the intonation of speech that’s affected, and that’s why it’s so rare,” said Dr. Ted Lowenkopf, a neurologist and medical director of Providence Stroke Center in Portland, Ore., in an interview with ABC News affiliate KATU. “The chances to hit such a small area are more than a million to one in a stroke.”
Because certain blood vessels in the brain are more prone to blockages, a stroke often damages parts of the brain responsible for language production and comprehension.
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“Stroke happens in very predictable ways,” said Dr. Julius Fridriksson, an associate professor of neuroscience at the University of South Carolina, who has seen many stroke patients but only a couple with foreign accent syndrome. “This type of damage is out of the ordinary.”
Butler said she was never tested for a stroke because she felt fine.
“I appear to be completely normal otherwise,” Butler said, adding that she never felt any pain or had neurological symptoms other than the change in her speech. “And I’m quite OK with [the accent].”
Nevertheless, Butler endures her fair share of teasing — mostly from her family. She struggles with the letter “W,” which she pronounces like a “V.” So her daughter once asked her to say, “I vant to suck you blood” and recorded it with her cell phone as a ring tone.
But Butler brushes it all off.
“With a sense of humor, you can face anything,” she said.
Not everyone with foreign accent syndrome is so lighthearted.
“It’s very much related to a person’s coping ability,” said Fridriksson. “Some people become isolated because they’re so self-conscious about it.”
Although Butler’s accent sounds vaguely British — Welsh, even — it’s purely coincidental.
“Although we think it sounds like a British accent, if you had a language expert listening to her, they would say that’s not an English accent,” Lowenkopf told KATU. “It’s sort of an amalgam of different-sounding speech that sounds like a foreign accent. But it’s not truly typical of any one foreign accent.”
Because her accent flipped between tax seasons, Butler was forced to start many phone conversations explaining to her clients that she was indeed still Karen Butler, their tax consultant from Oregon. Her husband Glen does his share of explaining too.
“[People] have wanted to know where I met her,” he told KATU with a smile.
The accidental accent is usually fleeting and goes away within weeks or months, Lowenkopf said. But the longer it lasts, the more likely it is to stick for good.
Butler kept her voicemail greeting from before the surgery to remind her and others of her once-Oregonian sound. And although speech therapy could help her get it back, she said she’s used to her new “foreign” accent.
“I used to be painfully shy, and now there’s always something to talk about,” she said. Copyright © 2011 ABC News Internet Ventures. By KATIE MOISSE May 5, 2011
September 14, 2012 · Posted in Ebola Virus
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Ebola outbreak kills one in Uganda, more cases seen
Sat May 14, 2011 2:01pm GMT
The girl from Luwero district, 75 km north of Kampala, died on May 6, Anthony Mbonye, Uganda government’s commissioner for community health told journalists.
“Laboratory investigations have confirmed Ebola to be the primary cause of the illness and death. So there is one case reported but we expect other cases,” said Mbonye.
The last outbreak in 2007 killed 37 people. (Reporting by Barry Malone; Writing by James Macharia)
Some protozoa infect the brain of their host, shaping its behavior in ways most suited to the pathogen, even if it leads to the suicide of the host
By Christof Koch | Tuesday, May 17, 2011 | 3
The ancient debate surrounding the existence of free will appears unresolvable, a metaphysical question that generates much heat yet little light. Common sense and volumes of psychological and neuroscientific research reveal, however, that we are less free than we think we are. Our genes, our upbringing and our environment influence our behaviors in ways that often escape conscious control. Understanding this influence, the advertisement industry spent approximately half a trillion dollars worldwide in 2010 to shape the buying decisions of consumers. And extreme dictatorships, such as that in North Korea, remain in power through the effective use of insidious and all-pervasive forms of propaganda. Yet nothing approaches the perfidy of the one-celled organism Toxoplasma gondii, one of the most widespread of all parasitic protozoa. It takes over the brain of its host and makes it do things, even actions that will cause it to die, in the service of this nasty hitchhiker. It sounds like a cheesy Hollywood horror flick, except that it is for real.
We know that illness in general can slow us down, incapacitate us and, in the worst case, kill us. Yet this organism is much more specific. Natural selection has given rise to pathogens that infiltrate the nervous system and change that system’s wiring to achieve its ultimate purpose, replication—like a computer virus that reprograms an infected machine.
Such is the case with T. gondii. It sexually reproduces only in the intestines of cats yet can maintain itself indefinitely in any warm-blooded animal. Infected cats shed millions of their oocysts in their feces. Taken up by all kinds of animals, including dogs, rodents and humans, they infect muscle and the brain to escape attacks by the host’s immune system. Hidden away, they remain dormant as cysts, surrounding themselves with a tough cell wall. Yet this quiet stage of infection, called toxoplasmosis, is deceptive. Violating all rules of good hospitality, these invaders make the host’s brain do things counterproductive to its own survival.
Toxoplasmosis has been most thoroughly studied in rats and mice. Both species have a deep-seated, innate fear of cats for obvious reasons. Spray a bit of cat urine into a corner, and the rodent will avoid this location, well, like the plague. In contrast, an infected animal loses its innate fear of cats. By some measures, it even appears to be mildly attracted to the smell of felines. This is an unfortunate turn of events for the rodent, because it is now more likely to be successfully hunted by a cat. On the other hand, this is a great deal for T. gondii. When the cat devours the sick critter and its contaminated brain, T. gondii moves into its final host, where it reproduces, completing its life cycle. Not quite what the romantics have in mind when they write about “the circle of life”!
The behavioral manipulation induced by T. gondii is quite specific. The infected rodent doesn’t look sick; its weight is normal; it moves about normally, possibly a bit more frantically than other mice; it grooms itself; and it interacts routinely with its conspecifics. Think how different this case is from what happens in rabies, another nasty infection. The animal loses its instinctual shyness, aggressively attacking others (the proverbial mad dog), thereby spreading the rabies virus through its bite. But because T. gondii can reproduce only in felines, it wants its host to be eaten by cats, not by just any carnivore. And because cats hunt live prey and do not eat carrion, T. gondii must not immediately kill its temporary host.
Rodents Aren’t Superheroes How does T. gondii effect its insidious changes in the host? Experiments by Joanne P. Webster of Imperial College London, Robert Sapolsky of Stanford University and others have shown that infected rats or mice do not turn into the murine equivalent of Siegfried, the hero of Wagner’s Ring who knew no fear. No, they still avoid open spaces, remain nocturnal creatures, retain their aversion to the urine of other predators and learn to fear a tone associated with a foot shock. Might the protozoa have stunted their smell? After all, if they cannot smell anything anymore, they would not know how to avoid places smelling of cat urine. But infected mice still avoid food if it smells different—an aversion that arose partly because for centuries humans have been trying to control rodents by poison. The infected mice also respond appropriately to the smell of their littermates.
Clues about how the parasites affect the animal come from several observations. First, the density of cysts in the amygdala is almost double that in other brain structures involved in odor perception. Parts of the amygdala have been linked to anxiety and the sensation of fear. Second, the genome of T. gondii contains two genes related to mammalian genes involved in the regulation of dopamine, the molecule associated with reward and pleasure signals in the brain, including in ours. So perhaps the creepy protozoa makes suicidal activities, such as hanging around places frequented by cats, feel more pleasurable for the infected rodent?
What elevates this vignette about evolution and life in the wild to epic proportions for humanity is that about a tenth of the U.S. population is infected by T. gondii (in some countries, such as France, the infection rate is seven to eight times higher, possibly because of the widespread consumption of uncooked and undercooked meat). Human toxoplasmosis is usually considered to be symptom-free (what doctors refer to as asymptomatic). Exceptions are patients with a weakened immune system and the unborn (hence the need for pregnant women to avoid cleaning cat-litter boxes).
Science has known for a long time that schizophrenic patients are two to three times more likely to carry antibodies to T. gondii than are controls who are not schizophrenic. Furthermore, antipsychotic drugs that block the action of dopamine, such as haloperidol, commonly used in the treatment of schizophrenia, are also effective in combating toxoplasmosis in both rats and people. And some infected adults go on to develop psychotic symptoms similar to schizophrenia. Little is known about the mode or site of action of this pathogen in the human brain. The exact link between T. gondii and psychiatric diseases is tantalizing but remains murky.
Recent claims go so far as to argue for a role of T. gondii in shaping distinct cultural habits, depending on the rate of infection in the population. A prospective study tracking the road safety in Czech recruits during their 18 months of compulsory military draft found a rate of accidents six times higher in affected drivers. Are the young men with toxoplasmosis infection simply slowed down? Or do they drive more aggressively?
In my November 2009 column, I described the discovery by cognitive neuroscientists that the feeling of freely willing an action (called authorship or agency) is a subjective, conscious sensation no different, in principle, from the conscious awareness of seeing the azure blue sky or feeling the sharp pain of a toothache. When I engage in a dangerous pursuit, such as taking the end of the rope on a steep section of a granite wall in Yosemite Valley while climbing, I feel as if “I freely decided” to do so, whatever this might mean in a metaphysical sense. Yet my action is most likely caused by an inexhaustible multiplicity of factors not accessible to my conscious introspection, including, yes, possibly some tiny single-celled parasites lodging in my brain and making me act out their silent commands. The wonder of it all.
By OLIVIA KATRANDJIAN June 4, 2011
The rapidly developing European E. coli outbreak that has killed 18 people and sickened thousands, including four suspected cases in the United States, has become the deadliest outbreak of E. coli in modern history. Where exactly people are being infected with the disease is still unknown, although 17 people fell ill after eating in the northern German city of Luebeck in May, according to the local media. Researchers from Germany’s national disease control center are inspecting the restaurant in question.
Other health experts suspect the disease first spread last month at a festival in the northern German city of Hamburg that was visited by 1.5 million people. But as of yet, there is no concrete proof that either site is the cause of the outbreak.
In a briefing Friday, the U.S. Centers for Disease Control and Prevention said the four suspected cases in the United States are all people who likely contracted the infection while in northern Germany in May and brought it back to the United States. Three of the victims are hospitalized with hemolytic-uremic syndrome and the fourth reported bloody diarrhea consistent with the outbreak strain of E. coli.
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Two American military service members stationed in Germany are also suspected cases. The CDC said both of them have a similar diarrheal illness.
Government officials stressed that the outbreak has not affected the United States directly.
The Food and Drug Administration is monitoring lettuce, tomatoes and cucumbers from Spain and Germany based on information it has received from European investigators. Produce from those countries accounts for less than 0.2 percent of produce imported into the United States every year.
The FDA says it is also stepping up its food safety regulations.
Hygiene Key to Avoiding Spread
While the outbreak hasn’t hit U.S. soil yet and the infection isn’t easily spread, there are ways to be sure that any illness that may be caused by the outbreak isn’t spread.
In addition to avoiding contaminated food, good hygiene is the most important way to minimize transmission, according to Dr. Maria Alcaide, an assistant professor of infectious diseases at the University of Miami’s Miller School of Medicine.
“It’s also spread through contaminated feces,” Alcaide said. “Anyone who is sick should wash their hands, and their caregivers should as well.”
Anyone who starts noticing any symptoms should get to a doctor.
“If anybody gets very bad, bloody diarrhea, they should get medical care immediately, and providers should also be aware of what’s going on with the situation,” Alcaide said.
ABC News’ Kim Carollo contributed to this report.
Plague is an infectious disease that affects animals and humans. It is caused by the bacterium Yersinia pestis. This bacterium is found in rodents and their fleas and occurs in many areas of the world, including the United States.
Y. pestis is easily destroyed by sunlight and drying. Even so, when released into air, the bacterium will survive for up to one hour, although this could vary depending on conditions.
Pneumonic plague is one of several forms of plague. Depending on circumstances, these forms may occur separately or in combination:
•Pneumonic plague occurs when Y. pestis infects the lungs. This type of plague can spread from person to person through the air. Transmission can take place if someone breathes in aerosolized bacteria, which could happen in a bioterrorist attack. Pneumonic plague is also spread by breathing in Y. pestis suspended in respiratory droplets from a person (or animal) with pneumonic plague. Becoming infected in this way usually requires direct and close contact with the ill person or animal. Pneumonic plague may also occur if a person with bubonic or septicemic plague is untreated and the bacteria spread to the lungs.
•Bubonic plague is the most common form of plague. This occurs when an infected flea bites a person or when materials contaminated with Y. pestis enter through a break in a person’s skin. Patients develop swollen, tender lymph glands (called buboes) and fever, headache, chills, and weakness. Bubonic plague does not spread from person to person.
• Septicemic plague occurs when plague bacteria multiply in the blood. It can be a complication of pneumonic or bubonic plague or it can occur by itself. When it occurs alone, it is caused in the same ways as bubonic plague; however, buboes do not develop. Patients have fever, chills, prostration, abdominal pain, shock, and bleeding into skin and other organs. Septicemic plague does not spread from person to person.
Symptoms and Treatment
With pneumonic plague, the first signs of illness are fever, headache, weakness, and rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery sputum. The pneumonia progresses for 2 to 4 days and may cause respiratory failure and shock. Without early treatment, patients may die.
Early treatment of pneumonic plague is essential. To reduce the chance of death, antibiotics must be given within 24 hours of first symptoms. Streptomycin, gentamicin, the tetracyclines, and chloramphenicol are all effective against pneumonic plague.
Antibiotic treatment for 7 days will protect people who have had direct, close contact with infected patients. Wearing a close-fitting surgical mask also protects against infection.
A plague vaccine is not currently available for use in the United States.
Facts about Pneumonic Plague
Escherichia coli Infection
( E. coli Infection, Escherichia coli O157:H7)
by Krisha McCoy, MS
En Español (Spanish Version)
- Risk Factors
Escherichia coli ( E. coli ) infection is caused by a bacteria. It is the leading cause of bloody diarrhea. This type of infection may need medical attention. Contact your doctor if you think you may have it.
This infection is caused by some types of the E. coli bacterium. Most E. coli infections are caused by:
- Eating undercooked beef, especially ground beef
- Drinking contaminated water
- Drinking unpasteurized milk
- Working with cattle
Digestive Pathway Through Stomach and Intestines
© 2011 Nucleus Medical Media, Inc.
The following factors increase your chance of developing E. coli infection:
- Age: children and older people
- People with another illness
- Working with cattle
- Living in northern states
- Abdominal cramps
- Watery diarrhea
- Bright red, bloody stools
- Mild fever
- Nausea or vomiting
Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include:
- Stool culture—to find out if you have E. coli O157:H7 in your intestines
Talk with your doctor about the best plan for you. Treatment options include:
Fluid Replacement and Monitoring
Most people will get better in 5-10 days. They rarely need a specific treatment. Avoid medicine that stops diarrhea. Drink plenty of water and fluids. Fluids through an IV line may be needed in cases of severe dehydration .
Treatment for Hemolytic Uremic Syndrome (HUS)
HUS is a life-threatening condition. It occurs in some people with E. coli infection. HUS may need to be treated withblood transfusions and kidney dialysis . Symptoms may include:
- Pallor, tiredness, and irritability
- Small, unexplained bruises, or bleeding from the nose or mouth—caused by problems in the body’s clotting mechanism
© 2011 Nucleus Medical Media, Inc.
If you are diagnosed with an E. coli infection, follow your doctor’s instructions .
To help prevent E. coli infection:
- Cook all ground beef and hamburger thoroughly.
- Avoid eating undercooked hamburger or other ground beef.
- Keep raw meats separate from ready-to-eat foods.
- Wash hands, counters, and utensils with hot soapy water after they are exposed to raw meat.
- Drink only pasteurized milk, juice, and cider.
- Wash fruits and vegetables under running water.
- Drink municipal water that has been treated with a disinfectant (eg, chlorine).
- Wash hands after bowel movements and after changing soiled diapers.
Last reviewed September 2010 by David L. Horn, MD, FACP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2011 EBSCO Publishing. All rights reserved.
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