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.

Hello Field of Scientists !

Old readers of this blog may have noticed a couple of changes to the design, domain name, and the little widget in the corner. This is because this blog has been accepted into the Field of Science network.
Double You, Zero Zero Tee !

To new readers, I should offer an introduction of some sort. This blog focuses on a number of different subjects, usually related to infection, with the occasional drawing or cartoon. I hope you enjoy reading this as much as I enjoy writing.

Links 04/06/11

Hello, Gutentag and other such phrases.

You may notice in the next couple of weeks that there will be a complete lack of new posts. This is mostly because I have a few massive experiments set up for the next few weeks, that will absorb all of my energy.

But never mind that, there is plenty of other stuff on the internet that is worth reading.

Writing

Puffthemutantdragon.wordpress.com - Although it is very new, the first few posts are certainly worth a read. The style is long form, and the posts are notable not only because of their science coverage, but the coverage of the scientists themselves. It is because of this weaving together of fact and story that I recommend it as a cracking read. My favourite post so far is on the bubonic plague


Podcasts

http://www.psycho-babble.net/  I would like to say that I wasted an afternoon listening to the entire back catalogue of this podcast. But that would be a lie. I don't think that it was a waste of my time at all. It is funny, interesting and informative.

Webcomics

 Gunnerkrigg Court - Probably one of the best webcomics out there, with tight plotting, great art and characterisation. Admittedly, it does happen to be a story about a person going to a mysterious school.
 But apart from that, it does occasionally deal with scientific themes as well as magical ones. If you want to know the one reason why I respect this comic are these three pages. I don't know many comics that are brave enough to give a balanced view of animal research, but apparently this is one of them.

Bugs, Drugs and Disease, and a Tale of Possible Terror Error?

Last year, the UK was in the midst of an outbreak of anthrax, in which resulted in 47 infections, and 13 deaths. Bigger than the 2001 letter bomb attacks. Hospitals up and down the country were put on alert. The news media were notified, and the public were told of the dangers. But there was no panic amongst the general public. A case of the famous British stiff upper lip?
Not so much. This was not a terrorist attack. This was just another occupational hazard for heroin addicts.
These people were the victims of this outbreak. The drugs that they were injecting in their veins were contaminated with spores of anthrax.
To get to the source of this problem, we need to look at where the heroin itself is coming from. The main supplier of heroin to Europe for the past ten years is Afghanistan. Yes, that Afghanistan.

(I was inspired by Mitchell and Webb. see here )

It would be easy to jump to the conclusion that this was in some way related to terrorism. However, I personally don't believe this to be the case.
Nobody stepped up and admitted to causing this attack. And why would they? To out and out admit a connection to the sale of drugs would ultimately damage their support. If they were indeed targeting addicts, then they were vastly overestimating the compassion that the public has for these individuals. The panic and terror caused by this event was conspicuous by its absence.

So if this was not a terrorist attack, then what is the more likely way in which the anthrax got into the heroin supply?
The answer lies in the bug that causes Anthrax. We know anthrax as a terrifying biological weapon, but it is also a living micro-organism. It's been around longer than war itself. it has it's own life cycle, its own intentions that are separate from those who would use it as a weapon.

Bacillus anthracis is the bacterium that causes anthrax. It is a pernicious little bug, which can survive in soil for long periods of time. It can get stuck to grass, where it is eaten by a cow, sheep or other such creatures. It then multiplies, secreting virulence factors which ultimately lead to the death of the host, which can take weeks. over this time, the host can spread the bacteria over a wide area through faeces.

Ultimately, the bacteria kill the host, and as it decomposes, they re-enter the soil, ready to re-start their lethal life cycle. 

These bacteria can then form highly tenacious spores that lie in wait for their next victim to accidentally graze them. Humans who come into contact with these animals or their leavings can become infected by this bacterium. 

It has been found worldwide in various places. There is an area that researchers refer to as the "Anthrax Belt" which stretches from the Middle east into Central Asia. And bang in the middle of it are the poppy fields of Afghanistan. These poppy field, which may be fertilized with the manure from infected livestock. Or carried from these fields in leather sacks made from the skins of animals with anthrax.

The spores can tough it out through the various processes that turn the poppy plants into heroin.

And the desperate user injects this bacteria into their blood stream.

This is a terrible problem, but it is just one of the many terrifying bacterial infections which a heroin user will expose themselves to. Contaminated needles are known to spread MRSA,  Streptococcus pyogenes, Pseudomonas, and this doesn't even count various terrifying viral infections like HIV. It's yet another hazard to which I.V. heroin users expose themselves.

Knox D, Murray G, Millar M, Hamilton D, Connor M, Ferdinand RD, & Jones GA (2011). Subcutaneous anthrax in three intravenous drug users: a new clinical diagnosis. The Journal of bone and joint surgery. British volume, 93 (3), 414-7 PMID: 21357967

Schmid, G., & Kaufmann, A. (2002). Anthrax in Europe: its epidemiology, clinical characteristics, and role in bioterrorism Clinical Microbiology and Infection, 8 (8), 479-488 DOI: 10.1046/j.1469-0691.2002.00500.x

Comic Journal Club: Was Hahnemann a Nostrum Vendor ?

Whilst combing the old literature, I found this gem of a paper from 1859. Aa normal blog post would not do the job for this paper, so I made a mad decision.  I decided to tell the story through the use of comic.

What the EHEC is that diagram of ?

 The history of science is peppered with great moments where people have gone above and beyond the call of duty in order to present their work in an accessible way. Think Florence Nightingale, and how she drew attention to the abominable conditions in hospitals through the use of a simple chart.  Or perhaps Vesalius, and his intricate and detailed diagrams of the human anatomy. 

The following paper deserves it's place among the greats, as it too has taken the graphical representation of science to a whole new level.

So what is this paper about?

#21 Old Faithful