Grateful, mothers, parasites

Here I am thinking again about how grateful I am.
1. Grateful to God and all who help me get through a day
2. Grateful about thoughts of mothers and Mother's Day
3. Grateful that Barbara and Sacha have a good education (see comment on parasites)
4. Grateful about visit to Botanical Gardens and Carnegie Hall
5. Grateful about www.bellavocesingers.com
6. Grateful that Plasmodium falciparum and Naegleria fowleri have been of interest
7. Solar energy stuff at
http://www.motherjones.com/news/feature/2008/05/sol-man-mr-matchdotcom-pimps-solar.html

Carnegie Hall

7:00 PM in Stern Auditorium/Perelman Stage with Ara Guzelimian, Provost and Dean, The Juilliard School. Chicago Symphony Orchestra
Bernard Haitink, Principal Conductor
HAYDN - Symphony No. 101 in D Major, "The Clock"
SHOSTAKOVICH - Symphony No. 4 in C Minor, Op. 43

Bella Voce Singers

Saturday, May 17, 7:30 pm Friends of Historic New Utrecht Concert Series
1831 84th Street in Bensonhurst, Brooklyn
BVS have a diverse repetoire including Gustav Holst and Bela Bartok. BVS is an independent, not-for-profit women's choir based in Brooklyn, NY. BVS originally began in 2000 as an all-female teen group, when the founding director was teaching at a high school in Manhattan. When the founding director left the school in 2001, the group followed her to Brooklyn, where they eventually were named one of the top high-school age choirs in NYC and performing at Carnegie Hall. As the Bella Voce members began to graduate and move on to college, many decided that they still wanted to sing together, so the group expanded to include all women ages 16 and up. Bella Voce is now a group with about 30 members.

Naegleria fowleri

Naegleria is an absolutely fascinating parasite because it is found everywhere in great abundance but infections are very rare. If infections were more common or the presence of the parasite was less common it would be nowhere near as interesting. The current rate of infection means that there must be some other unknown factor that contributes to infection. Besides being very interesting, Naegleria can also be devastating. The main reasons for this are that the symptoms are very vague and once inside the body the parasite kills the host very quickly. This, in combination with the low infection rate, makes Naegleria an unlikely diagnosis made by a medical professional. This means that a diagnosis of Naegleria is often made after the patient dies.

Significance of Naegleria

Due to the low rate of infection, Naegleria does not get much attention, but it is still a very important parasite. The rapid progression of the disease and the low rates of diagnosis makes it very important that the general public be made aware of the risk factors and symptoms so that if infected, one can aid in their diagnosis. This is one of the few ways that we can increase success in treating this infections.

Where is the parasite found

Naegleria is found worldwide, but the free-swimming infective stages must be in the soil or a body of fresh water to survive. This can include geothermal pools, lakes, rivers, and even poorly maintained swimming pools. Trophozoites have even been found in bottled drinking water!(Roberts and Janvoy, 2008). Infection rates are more common in warmer months and in warmer climates. In the U.S. infections have occurred in the following states: Arkansas, Arizona, California, Florida, Georgia, Louisiana, Missouri, Mississippi, North Carolina, New Mexico, Nevada, Oklahoma, South Carolina, Texas, and Virgini (Free Living Amebic Infection, CDC.gov)

Mode of Infection

Naegleria invades a host only very rarely. When this does occur it is from a free-swimming trophozoite penetrating the nasal passage. This is thought to occur if contaminated water enters the nose. Forceful entry of the water into the nose (from jumping or diving into the water) is thought the increase the chance of infection. Once in the nasal passage the parasite travels up the olfactory nerve to the brain. It is in the brain that the parasite causes the most damage.

Who gets infected

Anyone that is exposed to the parasite can be infected. But it is more likely that children will be infected. This is because they engage in activities that are thought to aid transmission of the parasite such as jumping or diving into bodies of possibly infected water, playing in water which leads to the disruption of the sediment, getting water in their nose, and swimming in a poorly maintained pool.

How many get infected

Infections are very rare. In the U.S. only 33 infections have been reported in the past ten years!(Free Living Amebic Infection, CDC.gov) Throughout the 1990’s 179 cases were reported worldwide (Roberts and Janvoy, 2008)

Diagnosis

Diagnosis of Naegleria in a living patient is rare due to the rapid progression of the disease. Infections can be diagnosed by microscopic examinations of the cerebrospinal fluid, in which a Giemsa stain will show trophozoites (Free Living Amebic Infection, CDC.gov).

Pathogenesis

Once in the brain, Naegleria causes a condition known as Primary Amebic Meningoencephalitis (PAM). It usually causes death in its victims within a week. PAM affects all of its victims the same, whether male or female; adult or child. However, infections are more common in children due to their behavior in possible infected areas. When in the brain the parasite causes a condition called encephalitis, which is swelling of the brain tissue. This can cause headaches, fever, sensitivity to light, weakness, and seizures. The parasites can also invade the olfactory bulb, resulting in an altered or absent sense of smell.

Treatment

Treatment is rarely effective. This is because cases are rarely diagnosed in time for treatment to be effective. In properly diagnosed cases, treatment with Amphotericin B has proven to be effective in elimination the parasite in two reported cases (Roberts and Janvoy, 2008). Ongoing Lab work has also shown the parasite to be sensitive to quinghaosu (Roberts and Janvoy, 2008).

Control

Because Naegleria is everywhere it is difficult to avoid contact with it. It is only after an infection occurs in a particular body of water that a warning is issued, and access to the particular body of water is often restricted to the public. It has been suggested that the use of nose plugs while swimming may reduce the chance of infection. Swimmers should also exercise caution during peak infection times, when the weather is warmer. Educating the public on symptoms and risk factors may also increase the chance of making a correct diagnosis before it is too late.

Education Efforts

The CDC, along other online medical resources, has extensive sections on the dangers of Naegleria and safe swimming practices. But these are resources that one must be looking for; so therefore do not reach the general public. There is little general information available to an individual that is unaware of the danger (TV commercials, fliers in doctors offices, newspaper articles).

Current Research

There are three main aspects of Naegleria that are of great interest in current research. The first is comparing characteristics of different species of non-infective Naegleria to the infective species Naegleria fowleri to find possible modes of infection(Gonzalez-Robles, 2007) (Serrano-Luna 2007). The second is isolating Naegleria fowleri from infected individuals and comparing them to free-living forms of the same species with the hopes of finding characteristic differences that may have lead to infections (Cervantes-Sandoval 2007). The third current area of research is to compare differences in strains found in different climates to determine if temperature changes the expression of certain genes, resulting in higher infection rates (Mar 2008).

To make a case for more research

The statistics of Naegleria infections speak for themselves. Publicizing the stats would most likely result in public demand for more research. The low infection rate suggests that we do not know the whole story behind the mode of infection. Further research regarding the mode of infection could completely eliminate infections. The success rate of diagnosis and treatment enhances the argument that there needs to be more information gathered about this parasite. Of all of the reported infections, only 8 individuals have been cured. This is only an 3% success rate (Roberts and Janvoy, 2008). This makes it even more crucial that Naegleria be better understood.

The most important aspects for the public to know

It cannot be stressed enough that in order to increase successful diagnosis and treatment, the public must be made aware of the risk factors and symptoms. This will lead medical professionals in the right direction to make a diagnosis in time so that treatment may be effective. So the simple thing that the public should know is that one should be aware when participating in certain activities. The flagellated form (which I think is absolutely adorable) can be used as a mascot to keep the public- especially children- interested.

Plasmodium falciparum

P. falciparum is the other parasite that I found a particular interest in, but for completely different reasons than for Naegleria. The reason that I am interested in Plasmodium is because it has such an impact on humans, and is so preventable. All that it takes is a little bit of knowledge about prevention to save countless lives. It is because of this that I feel that any effort to raise awareness, even as modest as a student taking interest and telling friends to donate bed nets, can have an impact.

Significance

Plasmodium falciparum is currently the leading cause of death due to parasitic infection. Every year there are more than 1 million malaria related deaths. Tragically, many of these deaths are young children (Malaria, CDC.gov). It is because of this, malaria is so significant. Many aspects of the disease, including control, genetics, prevention, vaccination, and drug resistance have been the main focus of many research labs. The fact that malaria has been eradicated in many areas (the U.S. included), but remains such a problem in others means that it is not significant enough (Roberts and Janvoy, 2008).

Where is the parasite found

The geographic location of the disease is limited to suitable environment of the vector, the female anopheles mosquito. This includes tropical regions of Africa, Asia, and South and Central America. Malaria is most prevalent in Sub-Saharan Africa.

Mode of Infection

Malaria is transmitted by the female Anopheles mosquito. When the mosquito feeds, it injects the infective stage of P. falciparum, the sporozoite, into the victim.

Who gets infected

Anyone who is at risk of being bitten by the vector is at risk for contracting malaria. Children are at higher risk for infection because they have not been exposed to the parasite, so therefore, have not developed partial immunity. Individuals that are heterozygous for the sickle cell trait are immune to infection.

How many get infected

Every year there are between 350-500 million reported cases of malaria. At least one million of these cases result in death (Malaria, CDC.gov).

Diagnosis

Malaria is most often diagnosed using microscopic examination of the patient blood using a giemsa stain. An infected individual will show the parasite (in either the trophozoite stage or the ring stage) within the red blood cells. If reliable microscopy in unavailable, an antibody test can also be used to make a diagnosis.

Pathogenesis

This parasite infects the red blood cells and the liver. Once in the blood cells, the parasite undergoes an asexual reproduction stage, which produces many merozoites that cause the cell to burst. Upon bursting the merozoites are released into the blood, causing an immune response resulting in a fever spike. Intervals between fever spikes correspond with the length of time needed to complete division (about 48 hours). The patient will experience chills between fever spikes. The infection of the blood cells can also cause blackwater fever, which is the severe destruction of red blood cells. It causes renal failure and is characterized by very dark urine. The patient will also exhibit anemia due to the destruction of the red blood cells. A condition known as cerebral malaria also occurs with infection. This is when red blood cells get stuck in the capillaries as a result of the infection. A patient will also show hepatosplenomegaly

Treatment

Due to different strain showing resistance to medication, treatment is based on geographic regions. Chloroquin, quinine, sulonamides, and artemisin are commonly used to treat malaria infections.

Control

Control is a very significant aspect in the battle against malaria. The use of insecticide treated bed nets is a very effective tool in preventing infection. Also important is to eliminate conditions that are favorable to the vector, such as the presence of certain brush and standing water. Also the behavior of the vectors (when and where does it feed, what part of the body does it bite…..) are important aspects of control.

Education Efforts

Because there are so many ways to reduce the transmission of malaria, there are currently massive efforts to educate people in endemic areas of risk factors of contracting malaria. This includes teaching about modes of transmission, proper ways to take medication, prevention, and conditions that contribute to the vector.

Current Research

Due to the impact that malaria has on the people living in endemic areas, research has been ongoing. Effectiveness of combination therapy in treating resistant strains has been a major point of focus recently (Falade 2008). Also many aspects of vector control, such as insecticide resistance, have been major points of focus (Chouaibou 2008)

To make a case for more research

Again, the statistics on malaria infections speak for themselves. The more that these stats are made public; the more the public will want research efforts to continue. There is already a lot of ongoing malaria research, but with the impact that the disease is having, there can never be enough.

The most important thing for the public to know

The importance of prevention cannot be stressed enough. In non-endemic areas, the public needs to know how much of an impact this disease has in parts of the world, and how much of a difference something as simple as donating bed nets or resources for education can make. In endemic areas, the public needs to be aware of the ways that they are able to protect themselves.