November 13th, 2007 by Dr. Val Jones in Expert Interviews, News
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Sadly, four transplant patients in the Chicago area recently discovered that their new organs were infected with HIV and hepatitis C. This is the first case of infected organ donation in the past 20 years, with over 400,000 successful, healthy transplants completed in that time period.
I’m actually a little surprised that this is the only known case of infected organ transplants in the past two decades, since the tests to rule out HIV and hepatitis C rely on antibodies. It takes the body at least three weeks to produce antibodies to these viruses, and so people who are infected with HIV and hepatitis C have false negative tests for the first few weeks. So there is always the risk that an organ donor could have contracted these viruses within 3 weeks prior to his or her death.
I asked Dr. David Goldberg, an infectious disease specialist in Scarsdale, NY, to weigh in:
Are there any tests available now that can detect the viruses themselves, or only antibodies? How early after infection could we detect them?
Traditional serologies measure antibodies against the viruses which take weeks or months to develop, whereas there is a more rapid test, called “PCR,” that is a direct measure of the number of viruses in the blood.
HIV reproduces rapidly, so the virus can usually be detected in the bloodstream within 8 days of infection. By contrast, hepatitis C virus replicates more slowly, so the virus may not be detectable until as long as 8 weeks after exposure. So the use of the HIV PCR test in addition to antibody tests would pick up almost all cases of HIV, but the hepatitis C PCR might still miss a number of early infections.
How can we protect future organ recipients from such a tragic event?
PCR is not generally performed because the test is time-consuming and many organ donors are trauma victims, which leaves little time for testing. However, PCR testing could theoretically reduce the number of HIV infected organs that are transplanted (from recently infected individuals), but would not improve the odds in hepatitis C because of the slow growing nature of the virus. In the end there’s no perfect test or 100% guarantee that organ donors don’t have HIV or hepatitis C.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 16th, 2007 by Dr. Val Jones in News
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Several frozen hamburger meat recalls have been issued in the past month. First it was the Cargill. Inc. plant in Butler, Wisconsin (supplying Sam’s Club) recall and now it’s the J&B Meats, Coal Valley, Illinois (supplying Tops and Sam’s Choice Brands).
So how does this meat get contaminated? As I mentioned in an earlier blog post about cows, they are kind of dirty creatures. They tend to stand around in manure and flick it all over themselves. In addition, there are certain intestinal bacteria that colonize them (including a certain type of E. coli, called 0157:H7) that are harmless to them, but are very harmful to humans. If their manure is used to fertilize veggies (or gets into the veggie’s water irrigation supply) – spinach poisoning can result. If the bacteria get into hamburger meat (as can happen during the butchering process and meat grinding) beef recalls may be in order.
E. coli 0157:H7 poisoning is scary because it can cause life-threatening illness (bloody diarrhea and kidney damage), especially in the young and immunocompromised. There are no antibiotics to treat it, and so the best “treatment” is prevention.
Keep in mind that the vast majority of meat is not contaminated with this bacteria, and that the small risk is usually associated with hamburger meat in particular. Ground beef (as you can imagine, though it’s a little disgusting to think about it) is more likely to have been in contact with the bacteria-laden intestines of the cow, since many different parts of the animal are used and ground into hamburger. It is much less likely for a whole steak, for example, to be contaminated with E. coli.
According to the USDA, one cannot rely on meat color to be sure that a sufficiently high temperature has been achieved in the cooking process. The best way to be sure that your hamburgers have been hot enough to kill any potential bacteria lurking therein is to use a thermometer and to make sure that the center of the meat reaches 160 degrees Fahrenheit.
So the take home message is this:
- Ground beef may be contaminated with E. coli bacteria, especially if it’s purchased at Sam’s Club or Tops.
- Regular beef is less likely to be contaminated.
- Don’t rely on meat color to ensure that it’s safe to eat.
- Cook all red meat to 160 degrees Fahrenheit to be sure that any bacterial contaminants are killed.
- See your doctor immediately if you have bloody diarrhea, fever, or other symptoms of E. coli poisoning.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 15th, 2007 by Dr. Val Jones in News
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I was always taught that chlamydia (a bacterial sexually transmitted infection) could cause infertility in women but didn’t affect men at all. Now it seems that male fertility may also be affected by chlamydial infections.
New research from Spain suggests that chlamydia can damage sperm DNA as well as their swimming ability. In fact, DNA damage in sperm from men infected with chlamydia is 3 times higher than in uninfected sperm. Also, fertility rates my be reduced by as much as 73% in couples infected with chlamydia.
Fortunately for men, their new sperm (produced after antibiotic treatment for chlamydia) appears to be normal/unaffected. For women, the damage is permanent. The crafty chlamydia bacteria crawl up into the fallopian tubes and create such an inflammatory reaction that the tubes are often scarred for life. Eggs released by the ovaries may be blocked from entering the uterus from narrowed and scarred fallopian tubes. This is why one chlamydial infection can put a woman at increased risk for ectopic pregnancy, miscarriage, infertility, and chronic pelvic pain.
It is estimated that as many as 1 in 10 people ages 18-25 are actively infected with chlamydia (in the US and Britain). The treatment can be as simple as one dose of oral antibiotics (1g of Azithromycin). Since chlamydia can be asymptomatic in men and women, and hard to diagnose in men in particular – I personally would recommend having both partners take a dose of Azithromycin before having unprotected sex in a monogamous relationship. Obviously, it’s always far better to have protected sex – but since 1 in 10 people have this infection, it seems pretty clear that people are not using condoms all the time. If you want to preserve your fertility – be vigilant about this infection. The good news here is that it’s easy to treat and can be prevented.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 17th, 2007 by Dr. Val Jones in News
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Physicians have known for at least 40 years that infectious bacteria (like staphylococcus aureus) can be transmitted on clothing. And now, as part of a comprehensive plan to reduce hospital infection rates, Britain’s National Health Service has recommended against physicians wearing white coats.
An interesting research study showed (back in 1991) that the dirtiest part of physicians’ coats are the sleeve tips and pockets. But surprisingly, coats that were washed at 1 week intervals and coats that were washed at 1 month intervals were equally capable of transmitting bacteria. Now that multi-drug resistant bacteria have become so common, they too can hitch a ride on coat sleeves and make their way from patient to patient.
During my residency, I clearly remember being horrified by the grunge I saw on my colleagues’ coats, all hanging up together on hooks outside the O.R.s. and in various parts of the hospital. I used to wonder if they were spreading diseases – but comforted myself that many bacteria need a moist environment to survive – so while the coats were certainly filthy, by and large they were not moist. Unfortunately my self-comfort was somewhat ill conceived – gram negative bacteria (like E. coli) do indeed need moisture for survival, but many viruses and gram positive bacteria (they usually live on the skin) do just fine in a dry environment. Other studies have confirmed that stethoscopes also carry a high bacterial load if not cleaned between patients. In fact, in reviewing some research studies for this blog post, I found that researchers have analyzed everything from hospital computer keyboards, to waiting room toys and patient charts. Infectious bacteria have been cultured from each of these sites.
Which leaves me to wonder: can we ever create a sterile hospital environment? Not so much. Although I agree that infections can be spread by white coats, and that a short sleeved clothing approach might help to reduce disease spread, I’d like to see some clear evidence of infection rates being reduced by not wearing coats before I’d prescribe this practice uniformly (pun intended). Bacteria can be spread on any type of clothing, by blood pressure cuffs, by stethoscopes, by dirty hands, by hospital charts… and we certainly can’t dispose of all of these. What would be left?
White Coat Rants (a wonderful new ER blog) describes the “ER of the future” – adhering to all the possible safety concerns of oversight bodies. Take a look at this whimsical perspective on what it would take to make the Emergency Department truly “safe” and imagine what it would take to make the hospital totally sterile.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 4th, 2007 by Dr. Val Jones in News
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I subscribe to Eureka Alert Breaking News – and although a lot of their press releases are on small studies of questionable relevance, I do think that some of the basic science research is provocative. Let’s see if I can pique your interest with the best of this week’s Petri dish news:
1. Tylenol may inhibit bone growth? A small study conducted at the University of Granada suggested that bone forming cells (called osteoblasts) were inhibited by a Tylenol bath. As far as pain killers are concerned, we’ve known for a while that non steroidal anti-inflammatory medications (NSAIDs) may indeed inhibit bone growth. But since Tylenol is not an NSAID, we were hoping that it would not adversely affect bone healing. Could this mean that Tylenol is not so great for bone surgery pain after all? That’s a stretch… but an interesting question.
2. Can you clean blood with a laser? Boy it sure would be nice to be able to kill all the potential viruses in blood used for transfusions. Apparently there’s a new pulsed laser technique that shows some promise in fracturing viruses with laser vibrations. So far, the laser was successful in reducing bacterial viruses by 1000x. Next up? Let’s see what the technique can do to Hepatitis C and HIV viruses.
3. Skinny people might have a “skinny gene.” Scientists have been studying a gene called Adipose (Adp) for over 50 years now. It was first discovered in fat fruit flies (I kid you not). Apparently if the Adp gene doesn’t work well, the flies become fat and “have difficulty getting around.” Worms, mice, and humans seem to have the same gene. Further analysis might unlock the secret to the genetics of thinness. Or maybe we should just eat less and exercise more?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
