Monday, December 3, 2012
Revenge of the parasites
Malaria is a life-threatening illness marked by high recurrent fever, shaking chills, and severe headache. Though malaria is now treatable, even with treatment it sometimes progresses to coma and death. Survivors frequently suffer recurrent symptoms and can be debilitated. The World Health Organization estimated that in 2010 there were 216 million people infected with malaria. Hundreds of thousands of them died, though precise estimates are lacking.
Malaria has plagued people for tens of thousands of years. It may have contributed to the decline of the Roman Empire. Very little was known about malaria until the late 1800s when the parasite that infects the red blood cells of malaria patients was first observed under a microscope. Later work discovered that mosquitoes were responsible for transmitting the parasite from person to person.
Since that time malaria control has involved a combination of mosquito control, avoidance of mosquito bites, medication to prevent infection, and medication to treat infected patients. Despite advances in all these fronts, malaria remains a tough adversary. It was the most dangerous health hazard faced by U.S. troops in the South Pacific in World War II. As many as half a million troops were infected.
In the second half of the 20th century as developed nations became more affluent, malaria elimination was a marker of their progress in public health. Mosquitoes were sprayed. Standing water was drained. The U.S. eliminated endemic malaria transmission in 1949. Greece did the same in 1974. That doesn’t mean that there were no cases in the U.S. (or Greece) since then, but that all the cases were imported. People who were infected abroad would travel to the U.S. and become ill here, but no one has been infected in the U.S. since 1949.
Well, 46 years later malaria is regaining lost ground. This week the Wall Street Journal reported that endemic malaria transmission has returned to Greece. That means that infected mosquitoes are infecting people in Greece for the first time since the 70s. In the past two years there have been over 50 endemic cases of malaria in Greece and over 100 imported cases. So far there have been no deaths.
Since its economic collapse three years ago, Greece’s public health system and its mosquito eradication efforts have been hard hit. The nation’s ability to care for patients and to prevent infection has been hobbled by worsening scarcity of resources and financial uncertainty. In response, the U.S. Centers for Disease Control and Prevention (CDC) has released an outbreak notice advising travelers to take precautions to prevent mosquito bites when traveling in Greece. Travelers to the agricultural regions of Evrotas should also take prescription medications to prevent malaria.
My friends who were born in the U.S. sometimes think that human progress is inevitable and irreversible, that the human condition can only improve over time as if propelled upward by some natural law, like water flowing downward. I was born in Romania, so I know that this isn’t so. I know that a modern affluent country can be utterly ruined. If you have friends from Iran or Cuba, they’ll tell you the same thing. (If you don’t have friends from Iran or Cuba, make some. Then beg to be invited to their homes for a meal. In both cases, the food is delicious.)
Perhaps the return of malaria in lands from which it was eliminated is a sign of the local cracking of the thin veneer of civilization. Perhaps it is a very late marker of societal collapse or of fiscal profligacy. If that is the case, it may be wise in the next few years to bring insecticide and mosquito nets to Italy, Spain, Portugal, and eventually, to California.
Health Scourge Hits Greece (Wall Street Journal)
Malaria in Greece (CDC Outbreak Notice)
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000. Holding privileges at Cedars-Sinai Medical Center, he is also an assistant clinical professor at UCLA's Department of Medicine. This post originally appeared at his blog.
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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
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Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
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David Katz, MD
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Other blogs of note:
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.
The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.