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Subj: PRO> Chronic diseases of infectious etiology revisited

Date: 1/28/99 9:59:07 PM Eastern Standard Time

From: promed@... (ProMED-mail)

CHRONIC DISEASES OF INFECTIOUS ETIOLOGY REVISITED

*************************************************

A ProMED-mail post

http://www.healthnet.org/programs/promed.html>

[see also:

Chronic disease & Chlamydia 990112132243

Chronic disease & GI tract micro-organisms 990114155235

Chronic disease: Borna virus & mental illness 990113090849

Chronic disease: diabetes & viruses 990113085337

Chronic disease: Koch's postulates & conclusion 990121114545

Chronic disease: microbes & PKD, obesity 990119205430

Chronic disease of infectious etiology 990112135759]

Date sent: Thu, 28 Jan 1999 12:34:58 -0700

Chronic Disease of Infectious Etiology Revisited

-------------------------------------------------

Judging by the responses I received to a series of postings about chronic

diseases with suspected infectious causes, an argument could be made for an

idea whose time has come. Nearly simultaneously, The Atlantic Monthly,

February 1999, in an article by Judith Hooper, entitled " A New Germ

Theory, " appeared. Also, in Natural History, February 1999, a series of

short articles appears on the ubiquity of microbes in the world and their

deep involvement in it. Implicit in the articles is the call to understand

the relationships more fully between humans and microbes.

Many ProMED-mail readers suggested additional chronic diseases or

conditions be worthy of mention. One reader suggested that immunizations

given to individuals with mild or low-grade infections might serve to

trigger additional activity on the part of the organism producing the

low-grade infection.

Crohn's disease and infection

-----------------------------

In regards to Crohn's disease, a writer informed me of a group of

researchers in England at the Royal Free Hospital in London that has

described measles virus in granulomas involving small mesenteric veins.

Additional research shows some ambiguities, but ambiguity is something of

the signature of a chronic disease with a suspected infectious etiology.

Another reader asked me about treatments for Crohn's disease, especially in

light of the strongly suspected bacterial etiology. I referred the reader

to a pair of internet sites which I had gleaned from previous postings on

ProMED-mail. [it is interesting that people sometimes assume that writers

are the repository of all information on the topic. I attempted to absolve

myself of that burden early in my composition of this series.]

Asthma, other chronic diseases and infection

---------------------------------------------

I was asked by another reader to consider asthma as a chronic disease with

a possible infectious cause. For the most part, asthma has been linked to

exogenous environmental agents, but usually of an allergenic nature rather

than infectious. I am unaware of any research into the infectious nature,

if any, of asthma.

Additional chronic diseases suggested as candidates with infectious

etiologies were, Kaposi's Sarcoma & its associated herpesvirus [EBV,

Epstein-Barr virus], Multiple Sclerosis and Varicella-Zoster virus, Sudden

Infant Death Syndrome (SIDS) [not exactly chronic], Chronic Fatigue

Syndrome (twice, one with a toxic etiology and another with an infectious

etiology), bovine spongiform encephalopathy (BSE) and Creutzfeldt-Jakob

Disease (CJD).

Cancer and SV40

------------------

Dorothy Preslar, Director of ProMED-AHEAD, in response to the post on

viruses and cancer, sent me a report from Newsday, December 29, 1998,

entitled " A New Cancer Risk? Monkey Virus Found in Polio Vaccination

Implicated in Study. " Briefly, monkey kidney cells were used to culture

polio virus for use in vaccines from 1955-1963. [Though the article does

not say so, the vaccine referred to here is the live attenuated Sabin

vaccine - Mod.JW] Use of these rhesus monkeys was halted when simian virus

number 40 (hence the name SV40) was found in the monkeys providing the

kidneys. By that time 98 million Americans had received the vaccine

prepared from them. Government officials have persisted in saying that

little or no risk is involved from having received the vaccine. But a type

of lung cancer, called mesothelioma, previously attributed to asbestos

exposure, is now being attributed to SV40 acquired in the polio vaccine.

This has the classic signs of an emerging disease: the unnatural

introduction of a virus into a host via iatrogenic means (an injection).

Hepatitis and Chlamydia

------------------------

Regarding Chlamydia, a reader informed me that _Chlamydia psittaci_ has

been linked in some cases of psittacosis to hepatitis. This reader stated

that 95% of psittacines (parrot-like and parakeet-like birds) are positive

for _C. psittaci_, which then raises the question, is there more hepatitis

in humans attributable to _C. psittaci_ than is being diagnosed?

Obesity and adenovirus

------------------------

Dr. Nikhil Dhurandhar, one of the primary investigators into the link

between obesity and an adenovirus, wrote back with some additional comments:

" Chickens and mice experimentally infected with the human adenovirus Ad-36

develop obesity and paradoxically, reduce serum cholesterol and

triglycerides. Approximately 70% of the animals inoculated with the virus

develop this syndrome.

" About 30% of the obese humans but only 4% of the non-obese subjects carry

neutralizing antibodies to Ad-36. Among the obese, antibody positive

subjects have significantly lower serum cholesterol and triglycerides

compared to the antibody negative obese subjects.

" Ad-36 causes obesity in animals and is strongly associated with human

obesity. We are currently working in several directions based on these

basic findings. "

Koch's postulates and chronic disease

--------------------------------------

Koch's postulates and the conclusion of the series elicited several

comments by readers. Some shared extensive comments and even publications

on the subject of Koch's postulates and the nature of disease. Another

article by Relman addresses directly the issue of Koch's postulates:

Fredericks, D. N., and D. A. Relman. 1996. Sequence-based identification of

microbial pathogens: A reconsideration of Koch's postulates. Clin Microbiol

Rev. 9:18-33.

Some particularly cogent remarks follow:

" In essence using Koch's postulates from the 1880s ... to [approach]

problems in the 1990s is precisely analogous to using Freudian techniques

to treat people for psychological problems today. Koch's postulates can't

take into consideration problems like carriage, obligate cell growth,

hit-and-run pathogenesis, and so forth. "

" Overall, I find an enormous resistance among the scientific community to

the infectious etiology of some types of chronic diseases. I wonder how

many good ideas get " nipped in the bud " due to these unreasonably

super-high standards expected of projects in this area. "

" Re your comments on Koch's postulates (and other scientific practices that

celebrate simplicity): I recently goaded a colleague (an HIV

epidemiologist) by suggesting that the net effects of Occam's razor on

clinical medicine may turn out to be negative. I have in mind the possible

impediments and delays imposed by insisting on giving priority of testing

(and funding) to oversimplified hypotheses, before more complex hypotheses

can be evaluated. I am now slowly ( " off duty " ) doing my homework (reviewing

research literature) to find out whether I can really defend such a

willfully provocative assertion. "

Comment

----------

In reading the comments and articles graciously shared with me, [one can

see] there are alternative ways in which to approach disease mechanisms.

Koch's postulates are but one way. It would be naive for the

microbiological research community to assume that there will or should be

one way to approach chronic infectious diseases. The nature of acute

disease allowed for the development of " rules " or " postulates. " The nature

of chronic disease is likely that there are no rules. What this means is

that there are likely to be many models, paradigms for chronic diseases,

each of which enhances our understanding of particular diseases, but none

of which is applicable to each and every chronic disease.

As for the chronic diseases not covered in this series, consider them

omissions of ignorance. [in line with] the mission of ProMED-mail, chronic

diseases with suspected infectious etiologies may fall under the definition

of emerging diseases and therefore be worthy to report. They share certain

elements with the " classical " emerging diseases.

Finally, all respondents to my series were most gracious and applauding.

For that, I am most thankful to you. However, the real champions of this

work are the primary investigators and their teams. It was a relatively

easy task for me to compile the information. The researchers are the ones

hammering out the stories of low-level microbial activity in the middle of

all the other cellular activity going on. My hope is that this series has

called attention to their work.

--

Hal B. Nash

Asst. Professor of Biology

Western Wyoming College

Rock Springs, WY 82902

e-mail: hnash@...

.............................jw/es

--

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