Field of Science

It's Silent. But is it Deadly ?

Last February, an international controversy descended over the landlocked country of Malawi. The cause of this was a new bill about to be put forward that centred on the maintenance of clear air in public places.
Any person who vitiates the atmosphere in any place so as to make it noxious to the public to the health of persons in general dwelling or carrying on business in the neighbourhood or passing along a public way shall be guilty of a misdemeanour
This would prohibit smoking in  public, the use of stinkbombs and outdoor barbecues. And more importantly, it could be interpreted as prohibiting public flatulence. That's right ! Citizens would be advised to clench hard or be prosecuted.
Surely this was a mistake ! No government would try to ban an involuntary physiological process.  When pressed on this piece of legislation, the justice minister George Chaponda responded 
"Government has a responsibility to ensure decency, Would you be happy to see people farting anyhow?"
He confirmed that the intent of this law was ban outbreaks of public flatulence. When news of this spread, Malawi became a worldwide laughing stock, and the bill was silently killed off. The then Justice Minister clearly disliked flatulence enough to support a draconian law against it. To be fair, is there anyone out there who actually likes the smell of flatulence?

Farts are unpleasant as a rule. I have yet to meet someone who, upon smelling a fart, inhales deeply and declares "mmm....Spicy ! "
But no matter how oleaginous, no matter how putrid, a fart has never killed anyone. Right?

The year is 1968. An outbreak of wound infections at Vanderbilt University Hospital was causing concern. The culprit, a bacterium known as Streptococcus pyogenes. This bacterium causes sore throats, skin problems and in the worst case scenario necrotizing fasciitis. A surgical wound infected with Streptococcus pyogenes can become life threatening.

So when nine patients contracted Streptococcus pyogenes infections during the month of august, there was a serious cause for concern. These patients had very little in common. They were operated on in different theatres. they were housed in different wards. In fact the only thing linking these patients was the anaesthetist attending them. He hadn't been ill with any of the disease associated with Streptococcus pyogenes. But it is possible for people to be asymptomatically colonised on their throats. So naturally they took throat swabs from him. They found nothing. There was no trace of Streptococcus pyogenes. So he couldn't possibly be the source of the infection.
The week after, another patient attended to by him developed a wound infection. This time they swabbed him again, in the throat and the nose. And again, all of these tests turned up negative. But taking no chances, he was prescribed a five day course of oral antibiotics anyway.
Despite this, during October, three more patients attended by this individual contracted the outbreak bacterium. The air in two operating theatres where this anaesthetist had attended tested positive for Streptococcus pyogenes.
An infection was found to have "took place in a room just vacated by the carrier". Yet this individual still tested negative for the outbreak bacterium. The staff at Vanderbilt were stymied. Where could the outbreak be coming from?

A similar case that had occurred at Washington University hospital two years previously held the answer. A similar outbreak had occurred, affecting eleven people. In this case, they had identified a carrier, who also mysteriously tested negative for Streptococcus pyogenes. In a desperate attempt to find out where he was harbouring this bacterium, they swabbed the following areas: Nose, Throat, Armpit, Groin, Teeth, ears, scalp, left foot, eyes, hands, anus and the right foot. They really did look everywhere, and they found the Streptococcus in an unexpected place. His rectum was teeming with Streptococcus pyogenes.

Upon finding about this case, the doctors at Vanderbilt decided to take a rectal swab from their suspected carrier. And they too found that the rectum contained the outbreak bacteria.

 With this evidence in mind, it doesn't take a genius to figure out how the infection was spreading.

Whenever the anaesthetist expelled gas, Streptococus pyogenes was expelled along with it. The usually clean and sterile operating theatres became peppered with this dangerous bacterium. The course of oral antibiotics they gave the anaesthetist initially to clear the infection didn't work because they were targeted to his throat. Now they knew the exact source, they could give a more appropriate antibiotic treatment to completely clear the individual of this bacterium. He was relieved of his duties, and put on this course, after which he was completely clear of bacteria.

Luckily, thanks to the miracle of antibiotics, none of his patients actually died from these flatulence acquired infections. However we now live in times where more and more species of bacteria are becoming resistant to antibiotics, and perhaps we should reconsider reigning in our collective flatulence. If bacterial infections become untreatable, we may all need to "bung up" to prevent the spread of infectious diseases.

On a side note, Streptococcus pyogenes is also known as Group A streptococcus. Or GAS for short. Try reading through this article again with all instances of Streptococcus pyogenes replaced with GAS. It's confusing.

Schaffner W, Lefkowitz LB Jr, Goodman JS, & Koenig MG (1969). Hospital outbreak of infections with group a streptococci traced to an asymptomatic anal carrier. The New England journal of medicine, 280 (22), 1224-5 PMID: 4889553

McKee WM, Di Caprio JM, Roberts CE Jr, & Sherris JC (1966). Anal carriage as the probable source of a streptococcal epidemic. Lancet, 2 (7471), 1007-9 PMID: 4162660

Edit- At the time of writing this post, I was unaware of the anti-government protests and brutal crackdowns happening in Malawi. I have altered the tone of this article to be less supportive of the current oppressive regime.

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