One of the hardest questions to answer in an infectious disease outbreak investigation is “Why?”
Why then? Why there? These questions can be almost impossible to answer – not only because of their heady metaphysical nature but also because of the difficulty of assessing the minute interactions between microbe, environment and human host. Public health officials are often left shrugging their shoulders, half-heartedly admitting to an unsatisfied public that they just don’t know and indeed may never know, later drowning their sorrows in dark and smoky bars with cup after cup of the metabolic waste products of unicellular fungi.
Much of the United States is mesmerized by the belligerent squawks from North Korea’s Kim Jong-un and the volatile tension straddling the Korean peninsula, but I’m more concerned about what is happening in China right now and the troubling trickle of news on a new bird flu strain H7N9.
The Wall Street Journal has a superb write-up of a Nepalese man infected with extremely drug resistant tuberculosis (XDR-TB) who is currently detained at the US border in South Texas. XDR-TB is resistant to four of the major types of antibiotics that are used to treat and control TB infections and this man is the first person with this particularly dangerous strain of TB to cross the border and be quarantined in this country (1).
My father-in-law David is a dentist and he recently emailed me an astonishing, must-watch video, “The Dentist of Jaipur.” A short documentary by Falk Peplinski that made the rounds of film festivals in 2006 and 2007, the four-minute film shows two men in this famed city in Rajasthan, India practicing dentistry on the streets.
That insistent buzzing drone you hear? It’s the sound of our burgeoning mosquito problem and the nasty diseases that they carry wreaking havoc throughout the world. 2012 was a prodigious year for mosquito-borne arboviral diseases, with West Nile virus, Japanese encephalitis, malaria, dengue and yellow fever outbreaks and epidemics raging in the United States, the Sudan, Puerto Rico, Malaysia, Indonesia, India, Peru, Brazil and many other nations besides.
The Pump Handle, an online “water cooler for the public health crowd”, have been publishing a series of articles on Public Health Classics, “exploring some of the classic studies and reports that have shaped the field of public health.” From lead poisoning to the Surgeon General’s 1964 report on the implications of cigarette smoking, the series makes for engrossing material about how our health and standards of living have radically changed due to pivotal research and medical findings.
This is the story of a sailor and a pirate, and the two different types of oceans that they traversed. There are seven on Earth but only one courses through man. This ocean contains no mysterious and pale sea creatures, bottomless depths or brightly-flashing predators, but it does brim with industrious cells, with dissolved carbon dioxide and occasionally with unwanted parasites.
In August of 1961, a Norwegian teenager sailed from a fjord in Oslo through the North Sea and the Atlantic Ocean to Douala, Cameroon, a port tucked under the outward slab that makes up West Africa. He was a freshly turned fifteen year old and was working as a kitchen hand on a Norwegian merchant vessel. From Cameroon, he and his crew on the Hoegh Aronde sailed northwesterly from port to port, docking at Nigeria, Ghana, Cote D’Ivoire, Liberia, Guinea and Senegal over a period of 10 months before returning to his homeland (1).
It was an exotic start to what would be a short but wide-ranging career as a sailor – over a period of four years, he would call at ports in Asia, Europe, Canada and throughout the Caribbean. Though he would never find himself in West Africa again, he would always carry a souvenir of his visit to this incredibly diverse and ecologically rich niche of the world.
His journeys were lonesome, solitary. In Cameroon the sailor unburdened himself of his loneliness and slept with at least one woman, catching gonorrhea – this much is known. Perhaps it was the same woman or another that infected him with an unfamiliar virus simmering away in West Africa just waiting to travel foreign oceans and lands. A viral hitchhiker with a proclivity for the horizon, a pirate if you will. This virus, a certain strain of HIV included in the rare outlier group O that is genetically and immunologically distinct from the main group M that is plaguing the world today, a HIV group that native to West Africa and to Cameroon in particular but found itself in a Norwegian man who would travel the world.
When he returned to his homeland in 1965, he married and became a father to two children in a short two-year span. In spite of his exciting new role as husband and father, he often felt unwell and his family was plagued with strange illnesses. His muscles ached, a red rash covered his body and he found himself often besieged by respiratory ailments (2). In 1967, his wife became ill with fevers, an omnipresent yeast infection as well as the same respiratory infections that lurked in her husband. The next year, the sailor would see his youngest daughter developing unusual diseases not often seen in toddlers – arthritis, blood and bone infections, along with the same yeast and respiratory infections afflicting her family.
Despite his poor health, the sailor found himself crossing the sea again to Europe. From 1969 to 1973, he worked as a long-distance truck driver delivering cargo as he traversed Belgium, the Netherlands, France, Germany, Austria, Switzerland and Italy (1).
With his ailing family far away across the North Sea, the sailor would seek refuge again in Europe. His coworkers would later say that he slept with many women and prostitutes along his long and lonely lorry routes. Often beginning his route in Wesseling, Germany, he would deliver to Liége and Lyons in France, occasionally stopping in Reims between the two cities (1). Investigators in this part of France would later find cases of HIV group O in individuals that had died in the late 1970s and early 1980s but had never visited verdant Cameroon.
In 1974, the sailor fell deeply ill. He died two years later, at the age of 29, his body riddled by bizarre diseases and was followed quickly in death by his wife and his youngest daughter. Autopsies would find puzzling results – overwhelming systemic infections not often seen except in the severely immunocompromised. The pathologist conducting the autopsy would save the sailor’s lymph node, liver, kidney and lung, the mother’s leg muscle and the daughter’s lymph node, spleen and liver and, years later, the family’s serum samples would test positive for HIV antibodies. This unfortunate family, to this day unidentified, represent the first recorded cluster of confirmed HIV/AIDS infections in the pre-AIDS era, before the AIDS pandemic sparked in the late 1970s and early 1980s. The sailor’s daughter is the earliest known case of pediatric AIDS (3).
“The sea has neither sense nor pity,” wrote Anton Chekov in his short story “Gusev”. Blood churns, dark liquids pumped through the valves by the stalwart heart, all the while feeding our bodies oxygen. A corrosive virus pirates the sea, hijacking cells and visiting the ports of our body, our brain, muscles, spleen and liver. Why infect that one person, at that moment in time? There is no meaning or sense to it. The tides rise, the tides fall. The earth spins, blood spills. A ship makes its port on schedule, becomes lost or is brought to the bottom of the sea. A man dies from an infection caught 15 years earlier in a distant port, a salty partner that he introduced to his family. There is no meaning, little salvation and only grief.
This article was awarded the Best Life-In-Science post at the inaugural ScienceSeeker awards for 2012-2013.
If you’d like to read the “Gusev” story by Chekhov, you can do so here.
Shortly after the researchers’ work into the Norwegian AIDS cluster, researchers from Tulane discovered evidence that a St. Louis teenager, Robert Rayford, was infected and died of AIDS in 1969. His case is troubling – a 15 year old succumbing to an infection that typically takes year before progression to AIDS and death. Some sources claim he was a gay prostitute while others say that he was sexually abused as a child. Whichever tragic alternative it may be, the fact remains that this boy had never traveled outside of St. Louis, someone infected him and that AIDS was most certainly circulating in a limited fashion in the United States before the 1970s. Read more about him in this 1988 New York Times article.
A few months back, I created a playlist of hip hop and R&B artists singing about the HIV/AIDS crisis and admonishing safe sex to their listeners. Check out the playlist and accompanying article “Let’s Talk About Sex: Hip Hop on HIV” here.
1) Hooper E. (1997) Sailors and star-bursts, and the arrival of HIV. BMJ. 315(7123): 1689-91
2) Lindboe CF et al. (1986) Autopsy findings in three family members with a presumably acquired immunodeficiency syndrome of unknown etiology. Acta Pathol Microbiol Immunol Scand A. 94(2):117-23
3) Frøland, SS et al. (1988) HIV-1 infection in Norwegian Family before 1970. Lancet. 1(8598): 1344-5
Frøland SS, Jenum P, Lindboe CF, Wefring KW, Linnestad PJ, & Böhmer T (1988). HIV-1 infection in Norwegian family before 1970. Lancet, 1 (8598), 1344-5 PMID: 2897596
A few months back, Carl Zimmer published a short article on the startling widespread prevalence of neurocysticercosis; the larval infective form of the pig tapeworm Taenia solium that just so happens to infect the human brain. Check it out, but beware!, you will be learning about a parasite that gives unwelcome deep tissue massages in your gray matter and you will see photographic evidence of it.
I know that the study of infectious diseases seems grim. Bacteria are increasingly becoming antibiotic resistant, baby parasites nest in your brain and tuberculosis spreads to your toes. I get it – all this devotion to the study of what gruesome-thing-du-jour is in your blood and saliva isn’t sunshine, puppies and rainbows. So in the interests of maintaining public optimism, I offer you GBV-C, a virus that has been found to offer a protective, antiviral effect against HIV infection. Yes, that HIV.
This article was published as a guest post on the blog of the Parents of Kids with Infectious Diseases (PKIDs) nonprofit on April 2, 2012. It can be visited here in an edited, shorter form. You can find out more about this great organization and their public health mission here.
The re-wilding or “greening” of urban and suburban spaces has been an indefatigable, faddy trend in urban planning for the past two decades. Urbanites like accessible parks and community gardens and food forests and stately trees and along with our car-filled cities. Hell, we name our streets after trees – spruce, elm, oak, pine and so on. These are the things we do to justify our shoddy recycling habits and not giving due care to our carbon footprint. Sustainability is the new mantra, screen-printed on our reusable grocery totes. So it can be troubling when we see the repercussions when we bring nature into the neighborhood and blur the line between urban comforts and rural charms. One of those manifestations can be rodents, coyotes, foxes, opossums, and raccoons joining the ‘hood.