Simpson Presentation - 9.24 · Microsoft PowerPoint - Simpson Presentation - 9.24.19 Author:...

9/24/2019

UCSF Fresno Mini Med School 2019 1

Historical Dermatology&

Vaccines

GREG SIMPSON MD

Disclosures

I do not have any relevant financial endorsements to disclose.

I will be talking about the off label use of many medications

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Outline

History of select Infectious disease

Infectious Disease and Vaccines

Why the caduceus?

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Case 1- 42 y.o. African male

Dracunculiasis Guinea Worm

Cyclops water flea in drinking water (carry the larvae)

1980’s- 3.5 million cases, 2018- 28 As of February 2019, only 7 countries remaining to be

certified Guinea worm free: Angola, Chad, Democratic Republic of the Congo, Ethiopia, Mali, South Sudan, and Sudan

Metronidazole or thiabendazole and stick

Clean water sources, Larvicide (ABATE) or filters

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CDC eradication program ERADICATED

1. Small Pox

2. Rinderpest

GLOBAL ERADICATION UNDERWAY 1. Polio

2. Dracunculiasis

3. Yaws

4. Malaria

REGIONAL ELIMINATION ESTABLISHED OR UNDERWAY 1. Hookworm

2. Lymphatic filariasis

3. Measles

4. Rubella

5. Onchocerciasis

6. Bovine spongiform encephalopathy (CJD)

7. Syphilis

8. Rabies

Medical Significance?

Asklepios- Greek God of medicine (1200 BC)

Hippocrates 20th generation “follower”

Today’s medical significance?

Caduceus- Hermes (Greek) staff

1902- US Army and pharmacies used it as a “stamp” on medical supplies

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The Black Death is estimated to have killed 30% to 60% of Europe’s population. In total, the plague may have reduced the world population from an estimated 450 million to 350–375 million in the 14th century. It took 200 years for the world population to recover to its previous level.

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Plague Yersinia Pestis

Black Death-14th Century

1900-1904- Chinatown in SF

Typically the disease moves back and forth between fleas and their rodent hosts

Yosemite-2015 two cases

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37 yo AAF

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Syphilis(Treponema Pallidum)

Transmission by contact with lesion of primary or secondary stage, or transplacental (secondary is most contagious)

Primary Syphilis Chancre: painless ulcer, raised indurated borders

Secondary Syphilis Flu-like syndrome, generalized LAD, HSM

Cutaneous lesions in 80%, bilateral, symmetric macules, papules, pustules

palms/soles, condyloma lata, “moth-eaten” alopecia

Syphilis

Latent: positive serology, o/w asymptomatic

Tertiary Syphilis

Generally 3-5 yrs. after infection (early as 6 mos)

Nodular, Ulcerative mucocutaneous lesions

Bone involvement

Cardiovascular: AI, CVA, aortic mycotic aneurysm

Neurologic: meningitis, CN d/o, ICP, Charcot’s dz(arthropathy secondary to tabes dorsalis)

Famous People who may have died from syphilis?

Hitler, Al Capone, Vladimir Lenin, Oscar Wilde

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Figure 2a (LEFT) Early Syphilis*Incidence Rates for Females by Age Group (in years) Fresno County, 2006–2015

Figure 2b (RIGHT) Early Syphilis*Incidence Rates for Males by Age Group (in years) Fresno County, 2006–2015

Epidemiological Trends in Syphilis, Fresno County

19

Ironically, the most productive strain came from a moldy cantaloupe from a Peoria fruit market. A more productive mutant of the so-called cantaloupe strain was produced with the use of X-rays at the Carnegie Institution.

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Tuskegee Experiment

Tuskegee Alabama 1932-1972

400 AA men, “Bad Blood”

Tx- Bismuth, mercurials, Salvarsan (didn’t work)

1940’s penicillin- withheld from these men

1972

130 died of syphilis or complications

40 wives contracted it

19 children with congenital syphilis

Tuskegee

“ Longest non-therapeutic experiment on human beings in medical history”

1974- National Research Act

Founded the Institutional Review Boards

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Small Pox

Small Pox

Variola major, Variola minor

Inoculation in China-10th century

widely practiced by the 16th century, Ming dynasty

In 1796, Edward Jenner- cowpox

Vaccine- Latin for cow (vacca)

Killed up to 300 million people in the 20th century

1967, 15 million cases occurred a year

1977- Last naturally occurring case (Somalia)

1980- WHO declared eradication

By 1986, routine vaccination stopped

1802

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Aral small pox incident

Vozrozhdeniya Island

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Measles-First Disease(aka Rubeola)

Paramyxovirus- ss rna

Spread via respiratory droplets

cough, coryza, conjunctivitis

Complications: superinfection, pneumonia, SSPE

Tx: supportive, Vit A?

pre-1963-US-500,000 cases

2001-world-30 million illnesses and 770,000 deaths

2018- 477,000 cases, 2019(through July)- 487,000

2019 (in US)- 1,234 reported this year- most in 25 years

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Forschheimer’s spots

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Third disease rubella

Togaviridae- ssRNA virus

50% asymptomatic, “rose-pink” macules and papules

1964- US- 12.5 million cases

11,000 miscarriages 20,000 cases of CRS

Congenital Rubella syndrome- cardiac, cerebral, ophthalmic and auditory defects. Premie, LBW

2,100 died, 12,000- deaf, 3,600-blind, 1,800-MR.

1969 live vaccine, early 1970s,(MMR)

First Trimester!!!

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Dewdrop on a Rose PetalVesicle becomes cloudy &

umbilicated with irregular borders.

Crust forms in center & eventually replaces the remaining portion of

the vesicle at the periphery.

“Chicken Pox”Varicella Zoster Virus

Human Herpes Virus 3

Transmission via respiratory droplets (very contagious, from 5 days before onset of symptoms until ALL lesions are dry/crusted)

Successive crops of macules, papules vesicles, pustules, crusting (“dewdrop on a rose petal”)

Facescalptrunk, resolves in 1-3 weeks

1995- vaccine approved (developed 80’s)

Complications (adults): pneumonitis, meningitis, encephalitis, Reye’s syndrome…

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“Shingles”Varicella Zoster Virus

Human Herpes Virus 3

VZV infection of the ganglion, partial immunity?

Groups of vesicles along sensory nerve in dermatomes

Complications: post herpetic neuralgia, facial paralysis, auditory symptoms

Tx: high dose IV acyclovir in immunocompromised hosts

2006- >60 y.o.- Zostavax

2017- >50 y.o.- Shingrix

Herpevac-2002-2010 (Herpes simplex virus 2- didn’t work),

Herpes Vaccine-2019- promising

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Anthrax

Bacillus anthracis (GP spore-forming rod)

Derivation of name Anthrax? Greek word- Anthracite (coal)- black skin lesions

Inhalational, GI, Cutaneous

Louis Pasteur in 1881 ( went on to develop vaccines for small pox, cholera and swine erysipelas)

September 18, 2001, Letters containing anthrax spores were mailed to several news media offices and two Democratic US senators killing five people and infecting 17 others.

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Conclusions

Caduceus- Dracunculiasis Plague Syphilis Small pox Measles Rubella Chicken pox/ Shingles Anthrax

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THANK YOU FOR COMING!

Cell- (901)485-4170Office (559)266-4100

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