Necrotizing fasciitis. For many people this is one of the most terrifying, invasive infections imaginable, and for one unlucky woman in Georgia this is her current reality. Reports of this disease date back to Hippocrates in 500 BC, whose early description was that “diffused erysipelas caused by trivial accidents, [where] flesh, sinews, and bones fell away in large quantities, [leading to] death in many cases1.” Many people regard the disease as a medical monster, an invasive and lethal infection that progresses at a rate straight out of science fiction.
For those of you not familiar with the story, a young Masters student named Aimee Copeland was injured while on a home-made zipline. When the line broke she fell and cut her leg on rocks in the river beneath her. What started as a small cut on her leg quickly grew into a life threatening infection that resulted in the amputation of her entire left leg and possibly her hands in order to limit the spread of the disease. How is it possible that a small injury so quickly became life threatening? To understand this we have to understand more about necrotizing fasciitis itself and the bacteria that cause it.
After writing for a month I’ve gotten my first reader question and I’m excited to share the answer with the rest of you. Here’s the question I got a week ago from a reader working in a tissue bank regarding their samples:
I work in a tissue bank and have some concerns in the practice we use for handling our tissue. When the tissue is ready for processing we receive it in a partially frozen state. To thaw, we have the tissue soak in sterile water for a period of 15 min. We process in rooms with air exchanges that are similar to a hospitals OR. We do have preventative measures after the process we take to protect the tissue. However, we recently have been trying to accommodate clients by processing aseptically. My question is, can the use of water create a harbor for bacterial growth considering the length of time the tissue will remain in the room throughout the duration of the process. (8 to 16 hours) and would there be any alternative means of a safer way in which to thaw the tissue? -G
This is a great question but a little bit outside of lab work that I’m personally familiar with. Thankfully though, aseptic technique works the same way everywhere, so here are some suggestions I came up with based on my experience. Continue reading →
With the presence of non-curable viral sexually transmitted disease (herpesvirus and HIV) at the forefront of public fear and awareness it is very easy to think of the bacterially induced STD’s as curable and less dangerous. However, one of the key challenges faced by the medical community today is the rapidly rising rates of antibiotic resistance in bacteria as diverse as M. tuberculosis to E. coli. This rising tide of antibiotic resistance is not restricted to certain species and has been more recently documented in Neisseria gonorrhoeae, the causative agent of gonorrhea, also colloquially known as “the clap.” Continue reading →
In order to eradicate polio there must be a vaccine in use that is affordable, stable for delivery to undeveloped regions, safe for infants, and not result in the circulation of virus that can revert to a disease causing phenotype (see The Problem with Polio). One method creating this vaccine that could theoretically work is the introduction of recombinant polio capsid proteins being expressed in food items such as bananas instead of in a traditional vaccine1. For example, it may be possible to engineer bananas that express recombinant polio capsid proteins in such a way that antigenic epitopes of the three serotypes of polio are expressed and illicit an immune response at the gut mucosal level when ingested. These recombinant proteins could be engineered so that they are expressed at conserved levels in the banana and are heat-stable. This would facilitate the transport of the bananas, or even food products made with the antigenic bananas, to rural areas in hot climates where the virus is still endemic. Immunity could be built up in the individual by repeated ingestion of the engineered bananas, and subtyped bananas (serotype 1 antigen expressing, bivalent 1 and 2, etc) could be made for specific regions with only certain strains of the virus circulating. Another benefit would be that infants can ingest bananas and would be a much easier and safer route of inoculation than injection. This food-based vaccine may also be more well-accepted by communities distrustful of injections being given by unknown aid workers. This is very important because sensitivity and reassurance are very important in not alienating the very people that we are trying to help with vaccine campaigns. This approach using modified bananas would also result in a cheap and effective means to generate many doses of the vaccine that could potentially lower the price per dose of polio vaccination.
If this banana-based vaccine were developed it would be a great step forward in the fight against polio. Large amounts of bananas could be grown and given to children in areas with circulating polio that would result in significant herd immunity without concomitant circulation of vaccine virus. This would limit persistent shedding of virus and destruction of the only known reservoir for polio. Using this method it would be possible to follow the current WHO protocols for vaccination and National Immunization Days, certification of polio-free regions, and the eventual discontinuation of vaccination three years after WHO certification. However, much work must still be done before these modified foods are a reality and much will have to be done in order to convince the general public of the safety and efficacy of these genetically modified organisms.
1. Goldstein, D.A. & Thomas, J.A. Biopharmaceuticals derived from genetically modified plants. QJM : monthly journal of the Association of Physicians97, 705-16 (2004).