Epidemics do not simply appear out of nowhere. They can simmer for months, isolated within a small segment of a population, escaping the notice of the public health community before boiling over into the larger community, triggering the identification of a spreading contagion. Too often, those individuals who recognize a nascent threat of outbreak and sound the alarm do not receive the public recognition they deserve.
This past spring, a street dog and her puppy were captured in Cairo, Egypt. Her vaccination certificates were forged, and she was shipped to the United States by an animal rescue organization in a shipment that included seven other dogs and 27 cats. Days later, following her placement in a Virginian foster home housing several other dogs, this rescue developed the frank signs and symptoms of rabies, and she was quickly euthanized.
Just thirty-odd years ago, a HIV diagnosis was a death sentence. Advances in pharmaceuticals and in our understanding of the mechanisms of HIV infection mean that today it is a manageable, chronic disease on par with diabetes, hypertension, and cardiovascular disease. People with HIV are living longer, and a graph recently published by the Centers for Disease Control and Prevention (CDC) shows that in the United States the average age at death from HIV infection has dramatically increased since 1987. (1)
Three scientists that developed treatments for debilitating parasitic infections were awarded the Nobel Prize in physiology or medicine today for their ground-breaking advancements in tropical medicine.
Advancements in the medical sciences follow a well-trod path: observation of a problem, reasoned hypothesis and experimentation, and implementation of a solution. This course is governed by logic and, occasionally, reinforced by unorthodox thinking with the ultimate goal of improving the viability of man. An exception to this rule is the invention of the rubber glove. One of the most important breakthroughs in the practice of medicine was born not of careful problem-solving and the scientific process, but of a romantic gesture, a clinical schoolboy’s crush, an event which one observer described as “Venus [coming] to the aid of Aesculapius.”
Forensic biology has made tremendous strides in the past few decades thanks largely to advances in DNA techniques and analysis. Genomic sequencing has generated new methods of human identification reaching far beyond fingerprints and dental records, providing crucial information in the course of investigations, valuable evidence in historical fieldwork, and personal closure in the wake of tragedy.
Abracadabra! Many of us are familiar with this mystical incantation. Its arcane staccato and euphonious intonation has become deeply ingrained in our language through the word’s use as a magical catchphrase. The hex was, in my childhood experience, rather useless when it came to opening locked cabinets and provoking instantaneous transformations; nothing was conjured and very little materialized except for my own disappointment. But millennia past, this word was held in reverence, and it was used for a whole other purpose altogether. Abracadabra was not a silly-sounding piece of magician’s gibberish, but the “most famous of the ancient charms or talismans employed in medicine” and a powerful invocation against a very specific and very dangerous curse: malaria.
In March of 1942, a young woman was dying of sepsis in a New Haven hospital. In just one day, she would be miraculously revived by a newly discovered experimental drug, seemingly by “black magic” as one consulting physician would mutter. The woman’s full recovery with the new antibiotic known as penicillin was the very first occasion of its usage in the United States and would jump-start the pharmaceutical industry’s interest in and manufacture of the drug (1).
Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, continues to make inroads in the United States and physicians are both unprepared to diagnose and under equipped to treat cases of the disease in their patients.
Chagas is a rare disease in the United States and has typically been associated with immigration from Central and South America, where the disease is endemic. The dynamics of the disease are changing, however, and strong evidence continues to emerge indicating that local infection is occurring among the American population, particularly in the southern states.
In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died. All 5 patients had laboratory-confirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection. Case reports of these patients follow.