Buruli Ulcer - Infection that Consumes Skins

Buruli Ulcer is a disease caused by infection by the Mycobacterium ulcerans. It is one of the most neglected disease in the world, specifically in the developing countries. Mycobacterium (other bacteria of the same family) is also the bacteria that causes tuberculosis and leprosis; however, Buruli ulcer has received the least attention.

Infection of this disease occurs mainly in tropical areas such as Australia, West Africa, Southeast Asia and New Guinea. Among which, this disease has the largest impact in developing countries, mainly due to the lack of knowledge in the disease.

It has been reported that the mycobacteria strives within aquatic environments (such as small aquatic animals, biofilms). Transmission mode to humans is still under investigation. Thus, Buruli ulcers usually occurs near water sources, infecting children under 15 years mainly. There is no evidence that this disease can be transmitted from person to person.

A young boy with Buruli ulcers
Picture Source: click here

Symptoms in General

Buruli ulcer begins with a painless mobile swelling in the skin (any part of the body). The more severe infection can be painful. Buruli ulcer is a long term, necrotizing disease that slowly destroys the skin and soft tissue by the toxin secreted by the mycobacteria.Without treatment, massive ulcerations take place and if the bone is affected, gross deformities will be the consequence.  If the ulcers develop on the limbs, the movement of the patients will be greatly restricted; even after the lesions have healed, the massive scarring will affect the mobility of the patients. In more severe cases, lifetime disabilities are norm in the patients. Can you imagine the pain the patients are enduring?

Treatment And Prevention

The most efficient treatment of Buruli ulcer is the surgical removal of the ulcers. For disease in more advanced stage, prolonged treatment with skin grafting will be necessary. However, surgical practice is scarcely available in developing countries. A combination of antibiotics can be used to reduce the requirement for surgery.

Bacille Calmette–Guérin (BCG) vaccination has been observed to provide short-term protection against the disease. Although only limited protection is available, it will still be useful by ensuring a complete coverage of this vaccine in the heavily affected regions. Once again, people in developing countries have very minor chances to receive such vaccination due to extreme poverty as well as lack of knowledge in diseases.

Noma - The Disease that Destroys Smiley Faces

There are many unfortunate people around the world, especially people in the developing countries. They do not even have the basic food and necessities to allow them to live healthily. Horrifying diseases roam, leaving the people in great agony. 

Gangrenous stomatitis, commonly known as Noma, is a condition whereby the mucous membrane of the mouth and other tissues of the patients are destroyed. This disorder usually occurs in developing countires where there is malnutrition and poor cleanliness. This is also more often seen in young, severely malnourished children of young age (2- to 5-year-old).  

Once infected, Noma causes rapid tissue destruction, the gums and cheeks become inflammed and ulcers develop. The ulcers and destroyed tissues lead to severe breath odor. Infection of the tissues then spread to the skin, lips and cheeks, eventually destroying the soft tissue and bone around the infected regions. The infection will lead to deformities and loss of teeth. The patients' facial features will be severely disfigured and the normal functions of the jaws will be greatly impaired. 

The actual cause of the disorder is still not known. However, it might be due to a type of bacteria. Antibiotics and improved nutrition can aid in controlling the disorder. The condition can be fatal in some cases if left untreated; on the other hand, the condition might heal eventually even without treatment. To treat the disorder, surgery might be required to remove the destroyed tissues, and plastic surgery will be required to reconstruct the facial bones. Patients recovered from the disorder will have horrifying scars on their faces. 

This might look horrifying to you, do bear in mind that this kid
do not have a choice, if he does, a life free of disease is all he desires.

To reduce the risk of Noma, it is important to improve hygiene level and nutrition. However, sad to say, these two basic preventions are often the hardest to fulfill in most of the developing countries. 

Living with Elephant's Body Parts

The "Elephant-syndrome", elephantiasis, by the name of it, patients develop thickening of skin and and underlying tissues (resembling the elephant's trunks) in the body parts. The areas of thickening of skin and tissues can occur in face, legs and even male genitals. The disease results in the affected body parts to swell up to the size of a fist or head. The abnormalities triggered by the disease not only lead to great inconvenience in the patients' daily lives, and also agony in the patients.

Extreme case of lower limb swelling.

The disease is initiated by thread-like parasitic worms with Wuchereria bancrofti being the most common cause, and is transmitted by mosquitoes. As the mosquito sucks blood from a human, it introduces the larvae of the parasitic worms which will travel to the human lymphatic system and develop into adult worms to a length ranging 1 to 4 inches. The worms will be living within the infected person for years (usually about 7 years), the longest ever recorded is 40 years.

A woman with enlarged arms.

The sexually matured worms will mate and release millions of microscopic larvae into the blood stream. As the adult worms live within the lymphatic, obstruction of the vessels will lead to swelling, especially in the lower body especially the legs and the genital areas. Therefore, the parasites, as well as the body immune system, contribute to the development of elephantiasis which takes years to show. On the other hand, the disease may develop without being infected by the parasites.

Picture source: click here

The picture shows an enlarged scrotum, affected about 4% of the infected males.

It has been evident that if a pregnant woman got infected by W. bancrofti, her child will have the chance to be infected as well. This can be explained by the parasite's antigens being passed to the fetus' blood circulation. Another scenario will be the fetus becomes tolerant to the parasites' antigens. In future, parasite infection (of the same antigens as the one presented in fetus stage) will be able to evade the host immune system of that child and leading to the development of elephantiasis more easily.

Currently, the medication available is only able to kill the adult worms within the lymphatic system, while the larvae not responsive to treatment.

The Sleeping Beauty Syndrome

Human African trypanosomiasis, also known as the sleeping sickness, is a vector-borne parasitic disease. Sleeping sickness is caused by protozoa of 2 organisms from the Trypanosoma Genus - namely the Trypanosoma brucei rhodesiense and Trypanosomoa brucei gambiense.

T.b.rhodesiense - infection emerges in a few weeks and is more virulent and faster developing as compared to T.b.gambiense. (10% of the reported cases of sleeping sickness)

T.b.gambiense - results in a chronic condition which can extend in a passive phase for months or years before symptoms emerge. When the symptoms show up, the patient is already in an advanced disease stage where the central nervous system is affected. (90% of the reported cases)

Causes

Tsetse flies act as a vector of the Trypanosoma. Tsetse flies are infected when they consume blood from infected people, the parasites enter the midgut of the fly and multiply in the salivary glands.

Infected Tsetse flies go around biting people, leaving behind red, painful swollen wound when they inject the parasites into the skin tissue. The parasites will then enter the lymphatic system and pass into the bloodstream.

Symptoms of the disease

General

• Anxiety
• Drowsiness
• Fever
• Headache
• Increased sleepiness
• Swollen lymph nodes

Patients often feel very sleepy in the day but have difficulty sleeping at night and this gives the

disease it's name.

Infection

• Mother-to-child infection occurs when the trypanosome cross the placenta barrier and infect the fetus.
• Accidental infections have occurred in laboratories due to pricks from contaminated needles.

If no treatment provided, Sleeping sickness is 100%

fatal!

Screening

Diagnosis must be made as early as possible before the neurological system is affected

to reduce complications.

Microscopic observation of:

• Blood smear
• Lymph node aspirates
• bone marrow
• Cerebrospinal fluid tests (in the later stage of the disease)

Treatment

• Melarsoprol - used for both forms of infection. It is derived from arsenic and can be fatal to as much as 10% of the patients taking the drug.
• Eflornithine - effective against T.b.gambiense. Less toxic, alternative for Melarsoprol.
• Pentamidine - used for the treatment of 1st stage of T.b.gambiense infection. However, it can cause toxic or allergic side-effects.
• Suramine - treatment for the 1st stage of T.b.rhodesiense infection. Side effects in urinary tract and allergic reaction.

Ebola Virus

Ebola virus is one of the deadliest viruses in the world, and a cure for which has not yet been discovered. Ebola virus infection is called Ebola hemorrhagic fever (Ebola HF). The virus is named after the Ebola River where the first case of the disease had occurred.

Eboli virus

After the virus infection, there is an incubation period of about 2 to 20 days before the symptoms start to show. At the beginning, an infected person will have fever, muscle aches, headache, weakness, which then followed by diarrhea, vomiting. As the Ebola virus targets the endothelium inside the body, blood vessel walls, organs linings, digestive tract linings will all be damaged from the infection eventually. As a result, patients start to bleed internally and externally.

If a person is detected to have Ebola virus infection, the individual has to be isolated, as Ebola is a highly contagious virus. Among humans, Ebola virus can be transmitted from infected patients to people simply by contacts of body part. (body fluids, skin, mucous membrane) Although this disease is highly transmissible, contacting patients in early stage may not be infected.

To date, there is still no cure for Ebola HF. Medications are given to patients to ease their symptoms. The patients have to depend on their immune systems to fight against the deadly virus. The mortality rate for the disease can be up to 89%, whereby most of the patients die from organs failure.

Gross Human Parasitic Worms III - Roundworms

In the previous post, I have mentioned one of the parasites in human's digestive tract, the Tapeworm. In this post, another kind of human parasite, Roundworm, will be discussed.

Ascaris is a type of parasitic worm known as the Giant intestinal roundworm. This type of parasite infects human living in areas with poor sanitation. Roundworm is the most common type of human parasites worldwide, and its infection is named Ascariasis.

Roundworms live in the small intestines. The females can grow up to 40cm in length, weighing 9g and produce over 200,000 eggs everyday!

When Roundworm eggs are ingested, they will hatch in the intestines and burrow through the intestine walls. After that, they make their way to the heart, the lungs and finally break out into the alveoli as shown in the diagram below.

If large amounts of roundworms accumulate in the body, it will result in the blockage of intestinal tracts. At this stage, patients will feel intense abdominal pain. To examine if a person is infected with roundworm, stool sample can be send to examine and suspected cases can undergo an abdominal X-ray. In some cases where the blockage of intestine is too severe, surgery is required to get rid of the worms.

For more information of roundworms in your pets, check out: Roundworms in Pets

Gross Human Parasitic Worms II - Tapeworms

For as long as human exists on the Earth, there are many organisms that feed off, reside in, seek shelter from the human body.

In this post, the most common type of parasitic worm that reside in the digestive tract of a human. The tapeworm.

Tapeworms larva can be ingested by eating uncooked or undercooked meat. After the larvae arrive at the intestines, they will start to grow into adult tapeworms that can be as long as 30m (fish tapeworm), 40m (beef tapeworm)and 120m (some other species of tapeworm)!

And what's the most horrible part? When a person has tapeworm infection, there will be definitely more than one of those in the digestive tract. These intestine intruders, when at adult stage, lay millions of eggs each day! Just imagine that, the whole intestines of yours filled with those slippery wrigglers, it will sure send chills down your spine.

How does the tapeworm attach to the intestines?

Tapeworms have sharp hooks on one side of theirs heads. Those hooks drill into the lining of the intestines and simply provide anchor for the tapeworms.

Tapeworms are usually found on meat products, thus high protein diets are not good for a healthy life. Diet high in fiber is a good prevention against these disgusting worms, as dietary fiber promotes regular bowel and clears off these parasites from the intestine.

Gross Human Parasites I - The Guinea Worms

Guinea worm is the common name for Dracunculiasis, which thrives in some of the third world countries where clean water supply is not available.

If this worm is new to you, you may start to wonder what does the worm look like?

The answer is: Guinea worm looks exactly like a spaghetti noodle at mature stage (sorry to spaghetti lovers ) It can grow up to more than 90cm in length.

How do people get infected?

Well, at places where clean water is not accessible, people can get infected while drinking stagnant water that hosts tiny water flea that carry the larvae of Guinea worm. Once inside the stomach, the larvae take 1 year to mature and pierce through the walls of intestines to mate. The males will die after mating where the female worms burrow into the deeper connective tissues and attempt to leave the human host (usually through the lower limbs).

At this stage, as the Guinea worms try to burrow their ways out of the human hosts, painful blisters are formed on the human skin. The pain is excruciating with a burning sensation, human hosts often soak their limbs in cold water to ease the pain.

Once the blister or open-sore submerge into water, the female Guinea worms will take their chance and release thousands of larvae. The water flea will consume the larvae, and another cycle will begin.

Currently, there is no cure for Guinea worm disease. To remove the Guinea worm from a human host, one must wrap the worm in a stick once the worm emerges from the skin. Then, slowly, bits by bits, wound the worm around the stick by pulling the worm out of the skin. The whole process is long and painful, sometimes it might take more than 1 month just to extract the worm out of the body. (the worm is very long and is buried deep in the connective tissue)

I dare you to read this post while eating spaghetti. *EviL grin*