Category: Immunology (page 1 of 2)

Homeopathy: Is It Really Effective In Upper Respiratory Tract Infections With Fever In Children? Not Quite

ResearchBlogging.org

A recently published paper, with the outcomes of a collaborative European Randomized Controlled Trial (RCT) undertaken in Germany and Ukraine, is making waves amongst jubilant homeopaths as yet another evidence supporting their long-held belief in the clinical effectiveness of homeopathy. Naturally, this 2016 paper in the Journal Global Pediatric Health by van Haselen et al. piqued my curiosity and I dove in to see what the hullabaloo was all about.

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Keep Calm and Know Your Fever (Before You Reach for That Medicine)

Growing up in the Eastern part of India, I was subject to a most peculiar cultural phenomenon known as “ThanDa lege jaabe” (ঠাণ্ডা লেগে যাবে in the vernacular, translated as: You’ll catch a cold). This odd concept, most beloved of the mothers in that region and handed down generations after generations, would teach them that any vagary of the sub-tropical weather — sun, rain, autumnal zephyrs, wet and foggy riparian winters, and everything in between — was liable to cause acute upper respiratory tract infections (uRTIs), characterized by runny nose, cough and sneeze, perhaps even progressing to pharyngitis, laryngitis or tracheobronchitis. And the most feared symptom was elevated body temperature, or fever.

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Of Serious Concern: Drug-resistant Acinetobacter baumannii in Treated Wastewater

Currently one of the most common disease-causing bacterium in the world, Acinetobacter baumannii, for sure, is a nasty bug — an emerging nosocomial (hospital-associated) pathogen, being increasingly observed in serious conditions requiring intensive care (including ventilator-associated pneumonia, sepsis, meningitis, wound infection and urinary tract infection). Unfortunately for patients, particularly immune-suppressed ones, this bug is now known to be extensively drug resistant (XDR; resistant to most antibiotics including carbapenems, with the exception of two drugs of last resort, colistin and tigecycline), with a smaller proportion resistant to even these two (known as pan-drug resistant, PDR, which are therefore virtually untreatable with the current crop of FDA-approved medications).

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Vox Media Report On Pandemrix And Narcolepsy Misses A Key Highlight, Progress By Trial

I read with a great deal of interest a report on Vox by their science and health reporter Julia Belluz (@juliaoftoronto on Twitter) on the recently publicized story of Pandemrix, an H1N1 pandemic influenza (a.k.a. “Swine Flu”) vaccine manufactured by GlaxoSmithKline (GSK), and the condition of narcolepsy (a debilitating sleep disorder) that affected a small fraction of individuals who received this vaccine.

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Inflammation, Acupuncture, and HPA axis: Faulty Science Clouds Understanding

In the wake of my recent critique of acupuncture being touted as a remedy for allergic rhinitis, I was pointed (via a Twitter comment) towards a 2013 review in Evidence Based Complementary and Alternative Medicine, which purported to propose a mechanism for the much-claimed anti-inflammatory effects of acupuncture. There are several putative mechanisms, discussing all of which will make this post gargantuan. Therefore, I shall focus on the explanation involving the hypothalamus-pituitary-adrenal (HPA) axis.

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No, Drinking Your Own Urine Will Not Cure Ebola (Or Anything Else)

Fear does strange things to people. The fear du jour currently permeating the US is, of course, the Ebola virus disease. Despite the august efforts to reassure and educate from CDC and the WHO, there has spread a modicum of panic (often with tragic results); we have seen Ebola response become a political issue, and as pointed out recently by that redoubtable scienceblogger, Orac, a ghastly profusion of conspiracy theories and quackery has crawled out of nooks and crannies, feeding into the overall noise that is smothering rational discourse on the topic. But even before Orac wrote on it, my attention was drawn on Twitter to the latest volley of insane quackery to emerge, a supposedly “Ayurvedic approach” to curing Ebola – the Ayurveda nowadays being a catch-all term to refer to everything pre-scientific mumbo-jumbo allegedly written in the ancient Hindu holy texts, the Vedas. Because culture.

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Lies, misrepresentation, cherry picking quotes: PeTA’s tactics to garner support against animal research

I work with immunology of infectious disease and study host-pathogen response. My work has naturally involved a good amount of animal experimentation, especially mouse models of various infections. These mouse models are incredibly useful, because they offer a valuable window into the process of infection, pathogenesis (‘disease production’), and the kind of immune response a vertebrate mammal generates to the infection. The same broad reasoning applies to rodent models of various metabolic and endocrine diseases, as well as cancer. These models are attractive because most often these research animals are genetically homogeneous, and therefore, provide a less complex (and more manageable) environment to study the genesis, as well as treatments, of a disease – while mimicking much of the same physiological responses seen in larger and more complex animals.

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“Faith Healing”, medical neglect by another name

In Scientio Veritas is my blog for talking about professional matters, related to science in health and disease, and so forth; and long-time readers (if any!) may know that I don’t like to bring in discussions on the controversial (and – I think – personal to many) issue of religion or religious faith, unless the specific issue impinges upon scientific and/or public health matters. Today, two of my scientist-blogger friends highlighted via social media a particular case of the latter kind, which screams to be commented upon because of its serious public health implications. So I shall endeavor to do so as best as I can.

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Exciting Science: Oncolytic Viruses (Review published in PLOS Pathogens)

ResearchBlogging.org

Science is awesome. But I expect you already knew that, dear readers o’mine. In science laboratories across the world, every day dedicated researchers are testing ideas, generating and evaluating hypotheses, critically analyzing observations, and thereby, making significant contribution to the humanity’s attempts to understand in greater depth and detail the wonderful natural world that surrounds us, of which we, along with other living beings and non-living objects, form a part.

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Occupational Health and the Law: UK vs. US; I ask a question

ResearchBlogging.org

A UK case report on Occupational Health and Safety, published in August, came to my attention today. Two NHS Occupational Health investigators from UK, Charles Poole of the Northern General Hospital, Sheffield, and M Wong of the Dudley & Walsall NHS Trust Health Center, presented two clinical cases associated with a relatively new occupational industry in that nation: “The separation of garden waste from domestic waste, its collection and processing in industrial composting sites, so as to reduce biodegradable waste going to landfill“.

It is well known that any kind of disturbance created in a given environment, for any reason, can often potentially release harmful substances in air in form of aerosols, or minute particles capable of floating in air. We have seen that with the yeast-like fungal pathogen, Cryptococcus gattii, which was found, via environmental studies, to be present in high concentrations in the soil of Vancouver Island (British Columbia, Canada), and to spread during dry summer weather likely as airborne particles (a.k.a. “propagules”). Release and dispersal of spores of various molds during large-scale air-disturbing activities such as construction, renovation and/or demolition of buildings is a well-studied phenomenon in the fields of Infection Control and Epidemiology; for example, see Krasinski et al., 1985; Streifel et al., 1983. The waste separation, collection and processing appear to be no different. The investigators write:

The process of composting organic matter encourages the production of bacteria, fungi, spores and endotoxins, which may be released to air in bioaerosols. Levels of bacteria and fungi up to 106 colony forming units/m3 in ambient air have been reported in relation to composting…

The problem has not been studied well at all in the population of waste-composting workers, because – as the investigators indicate – reports of illness in these workers are relatively rare. As a result, no safe levels of exposure to such potentially hazardous aerosols have been defined in this context, nor have been the exact conditions conducive to exposure; we don’t know if, and/or how much of, the exposure depends on variables such as composition of the compost, weather conditions, steps and systemic controls engaged during the separation and collection process.

In the existing clinical literature, one of the major culprits implicated in these environment-related diseases is the ubiquitous, spore-producing mold, Aspergillus, in form of its various species, mostly commonly Aspergillus fumigatus which is the etiological agent behind various diseases involving the upper (nose and upper part of the air-tube) and lower (lower part of the air-tube and the lungs) respiratory tract. Untreated or incompletely treated, these diseases can be severe and chronic. One particularly important manifestation is the Allergic Broncho-Pulmonary Aspergillosis (ABPA, in short), which is a complex or multi-component, immunologic, inflammatory response similar to allergies or hypersensitivities – which if not detected and treated early (with antifungals and steroid immune-suppressants) can lead to serious lung damage. ABPA is generally observed in people with certain debilitating conditions, such as cystic fibrosis, or immunosuppression, but rarely in otherwise healthy individuals. In ABPA, apart from classical respiratory symptoms, reduction in lung functions, and lung abnormalities observed under X-ray, certain allergy-related responses are noted in blood (more precisely, serum) – such as:

  • Type I hypersensitivity to bits and pieces of Aspergillus (all recognized as antigens by the immune system), leading to the excessive generation of allergy-associated antibody, called Immunoglobulin E (IgE). By its action, IgE causes release of highly inflammatory mediators, such as histamine, leukotriene, and prostaglandin, from immune cells, which have both immediate and long term deleterious effects.
  • Type III hypersensitivity to Aspergillus antigens, in which small complexes of these antigens with antibody run amok through the body, depositing in blood vessels, kidneys and joints – eventually leading to immune-mediated destruction of tissues at those sites.
  • Eosinophilia, in which eosinophils, a type of white blood cells, markedly increase in number in blood and/or tissues, a common occurrence in allergy and asthma, and in parasitic (worm) infections. Activated eosinophils, a member of immune defence, are capable of causing tissue damage by various mechanisms.

The UK case report describes two late-thirties, early-forties patients, both garden waste collectors by profession, and both diagnosed with ABPA at occupational health clinics; both responded to treatment and were released with the advice not to work with waste and compost. Another member of their team, who though not ill had symptoms of asthma and tested positive for high serum IgE to Aspergillus antigens (indicating exposure) was given the same advice.

The investigators go on to make some recommendations at the end of the report. They write:

Until the results of large epidemiological studies of garden waste collectors and industrial compost workers are known, the few case reports of ABPA […] would indicate that workers with asthma who are sensitized to A. fumigatus or who have cystic fibrosis, bronchiectasis or are immunosuppressed should not work with garden waste or compost, unless their exposure to airborne fungi can be controlled. Whether asthmatics who are SPT positive or specific IgE positive to A. fumigatus will go on to develop ABPA is unknown, but they should be made aware of the theoretical risk.

Annual health surveillance by way of a respiratory questionnaire and skin prick testing is also recommended for these workers. Other cases of ABPA or EAA in garden waste and compost workers should be sought and reported, until such time that the results of a national study of UK compost workers are known.

The recommendations gave rise to some germane questions in my mind. These are, of course, valid from a clinical standpoint, and made keeping the health and welfare of the patients in mind. But given that these are related to occupational health, how do these situations play out from the perspective of the employer? How are these situations different in the UK as opposed to in the United States? For example:

  • Can/should the employers (say, a waste management firm) mandate pre-employment testing for Aspergillus-specific IgE and skin prick hypersensitivity testing?
  • Can/should the employers refuse employment to a person who tests positive for IgE and hypersensitivity because of a theoretical risk? Relatedly, can/should such an employee be made aware of this theoretical risk?
  • Should such an employee choose to ignore this theoretical risk and accept the job (or continue on the job after a diagnosis) and become inflicted with ABPA, can/should the employee be able to claim occupational exposure and Worker’s Compensation?
  • Specifically in the US context, can a Health Insurance company demand the results of these surveillance tests for a person engaged in the waste management profession, and if positive, treat this as a pre-existing condition and refuse payment in the event the employee becomes ill and needs treatment?

I don’t have the answers to any of these questions. Perhaps someone conversant with labor and/or occupational health-related laws would care to illuminate me in the comments?


Poole CJ, & Wong M (2013). Allergic bronchopulmonary aspergillosis in garden waste (compost) collectors–occupational implications. Occupational medicine (Oxford, England) PMID: 23975883
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