Well, hello again! I thought it was time to get to work on this Ebola problem. These are data about Ebola virus infections over the last 40 years. The current outbreak is a big epidemic and the Ebola strain is a very virulent one. cdc.gov/vhf/ebola/resources/outbreak-table.html#thirtytwo Niemann-Pick disease is a rare and fatal metabolic storage disease of infancy,childhood and occasionally adolescence.A fat called sphingomyelin accumulates in cells and the liver and spleen go bad. NP occurs when there is a hereditary lack of a membrane bound transporter which they called NPC1. In the Type C version of the disease, a protein that belongs in the transporter is missing, so the sphingomyelin cannot get out of the cells. But people with Niemann Pick disease are more or less completely immune to Ebola and Marburg virus disease because the Ebola has a glycoprotein that needs to bind to NPC1 in order to penetrate the host cell. All the filolviruses work this step the same way. I believe that an attack on the viral glycoprotein that attaches to the host cell wall to trigger endocytosis of the virus into the cell is where the research should be concentrated. Another possible point of attack would be to stop the virus in the host cell by disrupting its production of negative sense ssRNA, which it uses to produce the messenger RNA (mRNA) that will carry the information to translate the viral proteins. In other words, a virus gets in but it cannot multiply because each new virion requires its viral proteins. The third point of attack might be to stop the intracellular formation of the glycoprotein that the next generation of assembled viruses will need in order to get out of the host cell, just like the parent virus got in. At each step, the number of infectious particles increases exponentially, so all other things being equal (which they probably are not, but no harm in theorizing) one might expect the attack on the earliest step to be the most effective. CAUTION: The clinical features of Ebola and Marburg, the filovirus diseases are primarily a hemorrhagic fever; They both involve the enormous overproduction of a cytokine storm by the host, which is what ends up killing the host. We are going into a paranoid phase. Ebola is to some of the other diseases below what AIDS was to Hepatitis C: Hep C was a far greater risk, but AIDS had the fear factor.Ebola and Marburg are very much like many other CURABLE diseases. Yellow fever, falciparum malaria, typhoid fever, shigellosis, rickettsial diseases such as tick typhus, cholera, gram-negative septicemia, borreliosis (relapsing fever), scrub typhus, plague, Q fever, even acute candidiasis. The parasitic conditions like leptospirosis, histoplasmosis, trypanosomiasis, visceral leishmaniasis can all come in from Africa. What if hemorrhagic smallpox got out of the lab, or suicidal terrorists decided to use it? Then there is the biggest viral killer in Africa - measles: fulminating measles can be a hemorrhagic crisis. Fulminant viral hepatitis occurs in the wealthy nations of the world. Then there are non-infectious diseases that, when acute and serious enough, can be confused with MVD and Ebola. The acute leukemias could do it: promyelocytic leukemia is a bad one; these leukemias are now curable with early intervention. Hemolytic uremic syndrome, usually in children who have caught a bacterial infection from food or water, looks just like the accelerating phase of Ebola. Hemorrhagic snake venom could certainly mimic Ebola, and it needs early intervention. The Boomslang snake of Subsaharan Africa has a nasty hemorrhagic venom that takes some hours to work. Sometimes the snake bites ineffectively but may innoculate just enough venom to set off a fatal hemorrhagic chain of events hours later when the victim has long since written it off as being significant. These tree snakes rarely come in contact with humans, but if someone labeled the victim ?Ebola and put her in isolation instead of giving her antivenom....oops! Any clotting crisis involving acute massive factor deficiency/platelet consumption, such as in thrombotic thrombocytopenic purpura, hereditary hemorrhagic telangiectasia, Kawasaki disease, and even forget plain old warfarin intoxication, could be labeled Ebola. The bottom line is: Ebola and Marburg are hemorrhagic diseases and if we are to recognize them while, at the same time, avoiding any confusion with other communicable or non-infectious diseases, we must be very good, old-fashioned bedside forensically-minded people. Modern medical training and cookbook practice has pretty much rendered the old-fashioned medical clinician an extinct species. A watchful and educated public is now a better defense against dangerous epidemics than todays medical profession. So you can either yawn at this article and whine about it being too long for facebook, or you can read it and do your homework before you go on your next trip to Timbuktu, or what little the terrorists have left of that ancient and beautiful place. David S. Footerman, MD
Posted on: Sat, 02 Aug 2014 23:04:36 +0000
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