To Your Health
by Barry J. McCasland, M.D.
We spray ourselves with Deep Woods Off! We wear long sleeves, socks and long pants after dusk. We fog our environs with Yard Guard. We fire up propane powered attracting killer contraptions and plug in electric powered zappers. And still, when we feel the distinctive bite, we swat the little creatures, smearing their blood and ours, and perhaps someone else’s. Yes, folks, mosquitoes are among the earth’s
most annoying creatures. But can they cause more than an itchy, swollen lump? Can they cause real disease? Yes, they can.
West Nile virus was first identified in 1937 in Uganda and made its New York debut in 1999. The reservoir of the virus is actually birds. But when a mosquito bites an infected bird, it acquires the virus and can transmit it by biting a human. This probably happens far more often than we actually realize. Most infections with West Nile virus cause West Nile fever, a three to six day illness consisting of fever, abdominal discomfort, diarrhea, muscle aches, loss of appetite and swollen lymph nodes. Most of us would chalk this up to a “summer cold.” The symptoms remit without treatment and recovery is virtually guaranteed. That’s how it happens, most of the time…
Some people, when infected with West Nile virus, develop a far more serious disease affecting the nervous system. The virus is most likely to gain access to the nervous system in individuals whose immune defenses are weak. This includes pregnant women, small children and babies, the elderly, and anyone with HIV or an organ transplant, or diseases such as cancer and diabetes. When the virus infects the brain we call it West Nile encephalitis. Symptoms include headache, seizures, progressive decline in sensorium from confusion to agitation and eventually coma. Life support is often necessary. West Nile encephalitis is fatal 10 percent of the time and causes permanent brain damage in half of the cases. Rarely, West Nile virus can affect the spinal cord producing a paralytic illness similar to polio. But before we move our rose gardens into our screened-in porches, remember, folks, only a small number of people develop nervous system disease – for most it’s just a nondescript viral illness.
You may ask yourself what fancy virus killing concoctions has medical science developed to cure West Nile encephalitis. Nothing. Zippo. There are no treatments other than basic life support. As of the writing of this article, there were no clinical trials testing any antiviral compound against West Nile Virus.
All cases of West Nile infection are subject to mandatory reporting to the CDC. In 2011 there were 14 cases of West Nile virus invading the nervous system in our home state of Georgia. More than half of the cases occurred in the coastal counties, and all between July and October, when mosquito density is its highest. I have personally treated three cases. Two of them were husband and wife, both developing
the disease simultaneously and undoubtedly bitten by the same mosquito! They recovered and did well. A third was a middle aged man who, in the weeks following his recovery, developed full-blown Parkinson’s disease. This is a known complication of encephalitis and happened in great numbers after the influenza encephalitis epidemic of 1917.
Our best strategy for preventing West Nile virus infection is to avoid being bitten by mosquitoes. So wear long sleeves and long pants and socks after dusk, a time when some of us “after work” rose gardeners are deadheading and disbudding. And apply a mosquito repellent that contains DEET (careful – not all DEET products are approved for use by children). More importantly, try to get rid of standing water since this is where mosquitoes breed. And it goes without saying that if you or a loved one develops a fever that leads to confusion or diminished responsiveness, get to an emergency room as soon as possible. With thrips already chomping, and Japanese beetles on the way, let us not allow mosquitoes to ruin our rose gardening pleasure.
What is your worst gardening fear? Is it finding a snake at the base of ‘Hot Cocoa’? Is it a swarm of bees rushing toward you as you deadhead ‘Graham Thomas’. Maybe it is a chance meeting with a coyote as you enjoy the glow of ‘Iceberg’ on a balmy spring night. Folks, there’s something far more fierce out there, yet smaller than the eye can see. We’ve come to know it as flesh eating bacteria.
We were all saddened by the terrible loss of several limbs and near loss of life of Aimee Copeland, the young Georgia woman who fell off a homemade zip line apparatus and gashed her left calf. Although she received medical care the day of the accident – stitches – a virulent strain of Aeromonas bacteria multiplied exponentially in her wound and within three days caused the dreaded necrotizing fasciitis. Aimee underwent her first of several surgeries that day, removal of parts of her abdomen and her left leg and though young, and healthy, she suffered a transient cardiac arrest coming off the operating table. Though we are encouraged by her remarkable rehabilitation strides, her life will never be the same.
What makes a bacteria a flesh-eating bacteria? How do these infections begin and how do they spread? What can we do to treat them and, more importantly, prevent them?
To begin with, bacteria do not eat flesh. They can, however, destroy it. Certain bacteria produce virulent molecules called toxins that wreak
their havoc in a number of ways. For instance, Group A Streptococcus, the bacteria most commonly found in cases of necrotizing fasciitis, can produce a toxin that activates a huge part of the immune system, the T-cells, which normally fight viral illnesses and cancers. Activation of the T-cells causes them to secrete chemicals into the circulation in huge quantities causing fever and dilation of blood vessels leading to a drop in blood pressure, shock and death. Other bacteria produce toxins that destroy blood vessels, leading to the death (necrosis) of tissues that are deprived of circulation. Dead tissue harbors the bacteria and allows them to reproduce. As the small blood vessels near the site of infection are damaged, bacteria enter the vessels and spread to other parts of the body, including the internal organs, and set up other areas of tissue destruction. Death ensues when critical organs stop functioning or when bacteria circulate widely through the body causing low blood pressure and cardiac arrest.
Besides Streptococcus, other bacteria can produce toxins strong enough to produce necrotizing fasciitis including Staphlococcus, Vibrio, Aeromonas (as in Aimee’s case), Bacteroides, and Clostridium. This last bacterium, Clostridium (specifically Clostridium perfringens), is a soil-borne organism found everywhere in our gardens, including on the tips of rose prickles, in mulch, and in the sharp implements we use for pruning. C. (for clostridium) perfringens is related to C. botulinium, which causes botulism, and C. tetani, which causes tetanus, both deadly infections caused by toxins that the bacteria secrete. Flesh-eating infections, or necrotizing fasciitis, commonly occur in individuals with weak immune systems, like diabetics, the elderly, infants and those with chronic illnesses. As in Aimee’s case, they can affect the very healthy as well.
Necrotizing fasciitis bacteria require a portal of entry, usually a cut, which may be deep or superficial. Deep infections cause severe pain and fever, but may produce few visible abnormalities on the skin early on. Superficial infections, just as dangerous, produce an area of redness that enlarges from hour to hour. Treatment includes the rapid removal of dead tissue, amputation of affected limbs, intravenous antibiotics and life support. Skin grafts are often required. High-pressure (hyperbaric) oxygen and gamma globulin may be helpful if available. Serious infections are commonly fatal.
So what are we rose gardeners to do? Wash all cuts thoroughly with water and mild soap. When? NOW. Not when we’re finished gardening. See a doctor for any cut that is too deep to wash out completely. If there is redness at the site of a puncture, draw a circle around it, and if it doubles in size, get to a doctor FAST. And remember, any breach of the skin that is followed by a fever and ill feeling needs rapid attention, as it could be an impending catastrophe. Let’s agree to treat any gardening related cuts and puncture wounds rapidly so we never have to
worry about flesh-destroying bacteria.
You’ve just finished some autumn maintenance on your roses. You’ve staked the eight-foot canes of ‘Elina’, removed the brown and crispy petals from the blooms of ‘Memorial Day’, and cleared some brushy vines away from the base of ‘Graham Thomas’. Rose season is winding down and soon our roses will enter a slumber. But what’s that nagging itch on your hands and forearms? Probably nothing, until the next day when it’s a blistering, red rash. Oh no! You’ve got Toxicodendron radicans allergic dermatitis!
Yes folks, it’s poison ivy, and it can be serious. The rash of poison ivy is a type of dermatitis, an inflammation of the skin. There are two types of dermatitis. The first is irritant dermatitis, and it is caused by substances that directly damage skin such as acid, nickel and
Banner Maxx. The second type of dermatitis, which includes poison ivy, is allergic dermatitis. A substance called an antigen binds to components of the skin, is recognized by the immune system and begins the cycle of inflammation. This is carried out by a host of cell
types including T-cells, a type of blood cell that constitutes a major component of the immune system. The antigen supplied by poison ivy is called uroshiol (you may also see it spelled urushiol), and it is contained in the sap of the poison ivy, poison oak and poison sumac plants.
Uroshiol is extremely potent. A tiny amount is all it takes to cause a rash. It is estimated that a quarter ounce of pure uroshiol could cause a rash on every living human on earth! Once it touches your skin, it is absorbed and bound to skin cells within ten minutes. It can then be inadvertently spread from one area of skin to another, or one person to another, until it is washed off. If it gets on tools or gloves it can be transferred by contact to other areas of skin. Uroshiol persists on objects for years or even decades unless washed off. If poison ivy plants are burned, uroshiol enters the smoke and, if inhaled, can cause a serious reaction in the throat and airways.
The rash of poison ivy appears within 24-48 hours, but in very sensitive individuals, it can appear in about four hours. By the way, about 85 percent of all people are sensitive to uroshiol, and repeated exposures make us increasingly sensitive. The rash consists of yellow fluid-filled vesicles (blisters) on a red base. It is very itchy, and may last up to two weeks. New vesicles may form during that time. It is important to know that once the uroshiol has been washed off, the rash is not contagious. Even the material in the blisters cannot spread the rash.
We all need to have a clear mental image of poison ivy, poison oak and poison sumac. I suggest you look up some images online – just type “poison ivy images” into your search engine. Remember that poison ivy leaves generally grow in threes, and the side leaves are asymmetric, that is, the central vein of the leaf does not course down the center of the leaf. Make note of this when you look up images!
If you are exposed to poison ivy, drop everything and get inside. Put rubbing alcohol on any area of skin potentially exposed. Alcohol instantly denatures (destroys) the uroshiol, the component of the sap that causes the inflammation. Then, wash the exposed areas with warm water. And then, take a shower and throw your clothes in the laundry. You’re through gardening for the day. The next day, using gloves, collect all of the tools you used and wash them off with a garden hose. Apply alcohol to the handles.
If you get a rash and blisters, try to avoid scratching – it can encourage bacterial infection of the inflamed skin. Apply over-the-counter remedies like Aveeno or calamine lotion. Do not use bleach and do not use alcohol on broken skin. If a large area is involved, or if it involves the hands or face, see a doctor. A few days of oral steroids will bring the reaction to an end faster. If it involves the eyes, throat, or airways, get to the emergency room fast!
I will end with some poison ivy trivia. The term “poison ivy” was coined in 1609 by Captain John Smith, explorer and founder of Jamestown, Virginia, the first permanent English settlement in the New World. The term “uroshiol” derives from the Japanese word urushi, meaning lacquer. Valuable gold objects were painted with uroshiol lacquer to discourage thieves from stealing them.
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