Guest guest Posted January 28, 1999 Report Share Posted January 28, 1999 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 -- Send all items for posting to: promed@... (NOT to an individual moderator). 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