Top five

Clay (and Laurel) coming to you mostly live after completing our second week of the Diploma Course at the London School of Hygiene and Tropical Medicine.  Very much like being back in medical school, existing on coffee, tea, peanut butter and jelly sandwiches, and spending the evenings in the library studying. 

We can now definitively identify the sculptures on the window balconies at the school. 

You will note the mosquito is obviously a Culicine, and therefore not a worry when it comes malaria, but, on the other hand, could give you Yellow fever, which is pretty high on the list of things not to get. Speaking of which, it turns out that tetanus is also on the list, very near the top. One professor ranked it a close second to rabies, and it is certainly worthy of top five consideration in nearly everyone’s book (it’s a competitive list in the tropics, what with plague, typhus, meningococcal meningitis, Ebola, anthrax, mellioidosis (watch House reruns if you want to be misinformed about this bad bug), and we haven’t even gotten to worms and leishmaniasis yet!). Even the vectors are unappealing: mosquitos, ticks, louses (lice, I guess), flies, and creepy fresh water crustaceans.  It would be easy to get the impression that the tropics are inundated with deadly diseases spread by vermin, but of course that is a gross misunderstanding and completely ignores all the things you can catch that don’t even need a vector.  All seriousness aside, we are learning a ton and the people and material are very inspirational. Some of the professors have been knighted for their contributions to science and humanity and all love what they do.

One of the most fascinating subjects for me has been an intense update on the global HIV/AIDS epidemic. It has evolved over the course of our careers from a relentless, demoralizing and devastating illness culminating in certain death to a very manageable illness. For example, according to a recent study cited in the course, a 25 year old Dane with a new diagnosis of HIV can expect to live to at least age 65 and contend as much with hypertension, diabetes, and cholesterol problems as they will with any infectious complications if the HIV. Even in Africa, millions are now on effective anti-retroviral therapy and the epidemic is changing shape there too.

Another interesting topic has been polio, once a top five scourge, now unheard of except for outbreaks in Pakistan, Afghanistan, Nigeria, and Northern India.  It turns out, when the western world was a less hygienic place, almost everyone was exposed to polio by the age of five and almost no one that age has paralytic complications. It was only when we had some control of the waste that exposure to polio was delayed to older kids and adolescents, much more susceptible to trouble. The WHO was so close to worldwide eradication of this disease about ten years ago they could taste it. However, suspicion of the vaccine program (Nigeria), and lack of security (Afghanistan, etc.) and remoteness of some locations have allowed the virus to persist and even make a comeback. Even if global eradication were achieved, it is not clear that vaccination programs should be halted, as the vaccine (attenuated) virus, has the potential to back-mutate to wild polio and wreak havoc.

Other topics covered this week: biostatistics, epidemiology, ebola fever outbreak, relapsing fever (watch out for this one, two cases in California recently), and various typhus and spotted fevers. In the lab, we made our own malaria smears and learned to diagnose the various types.

Finally, a tip for anyone traveling to a malaria infested area: try not to catch it because if you do, and return to the US, like about a thousand people a year do, you are very likely to be misdiagnosed and this can end very badly. If you do get malaria, try to get p. malariae. It’s the least common and therefore the coolest; it tends to be milder and is the only quartan malaria (very desirable feature). The only drawback is that it can, occasionally, go on for years, but hey, you can get every third day off with a fever.