Pinkeye Was Only Symptom in Child Killed by Enterovirus - Bloomberg
This is so sad. What's sadder still is how many parents are going to be bringing in their kids for me to evaluate with "pink eye" who are going to say "do you think he has that virus, that entero thing?"
What do I tell them? That this kind of fluke immune system overreaction to viruses and other infections exists is well known. During the "Great Influenza" circa 1918-1919 there were well-documented cases of people whose first symptoms of "the flu" were to say "I don't feel well" and collapse, dead. That's not the virus, that's the vagaries of their own immune systems, their own genetic inheritance, at work. Some white cell somewhere says "oh no, it's that virus," and hits the panic button, starting a relentless cascade of unstoppable, lethal, chemistry. It's a cascade as old as the species, probably precambrian in origin.
Do I go into that much detail with the worried mom or dad? No. Do I try and reassure them as much as I can that "it's probably just a mild bacterial infection, as about 50% of all "pink eye" turns out to be, or do I join them in a "folie a deux" and call the emergency room for an admission for overnight observation for "pink eye?" Sure. That's not going to happen. Reassurance, eye drops, maybe an overnight vigil, two hours on, two hours off, Mom, Dad alternating "the watch," so they can see if anything bad happens they might want to call 911 for, but what else is there? Eye drops, a pat on the emotional back and out the door. That's going to happen.
One of the things I tell my patients when I have the time is everyone's immune system responds somewhat differently to the same virus. Where one family member may get a full-blown upper respiratory syndrome from, say, an enterovirus like Rhinovirus or Coxsackie, others may get only a mild fever, feel achey, out of sorts for a day or two and have nothing more than what we call a "subclinical illness." Did their immune system get exposed to that virus before and they had some residual "memory cells" floating around to respond rapidly to a viral invader or did they have a more effective "innate immune response" that recognized the virus? Had they simply won the genetic lottery through Darwinian evolutionary principles and had the DNA and subsequent proteins necessary to combat and survive the infection?
What is really fascinating - to me, academically - about viruses is where they come from. Sure, we like to think "bats" and other wild animals as reservoirs, but how long do humans carry viral infections within their bodies, spreading the dna or rna packets that are viruses as they go about their daily business? I like to think about how Spanish explorers brought common viruses - common to Europeans - to native Americans 600 years ago and how devastating those viruses were to the native populations. What viruses were those? Smallpox or head colds (rhinovirus, enterovirus)? Can you imagine a ship full of otherwise healthy seamen passing head colds around for the months' long voyage? Did every ship have a few guys who were sick on any given day or did the virus burn itself out but lie dormant, subclinical? I've got a sneaking suspicion that humans ARE intermediate vectors in MANY viral infections, not just the double-stranded DNA viruses we know for a fact that we can harbor for life (poxviridae like chickenpox and epstein-barr and cytomegalovirus - the latter two which cause "mononucelosis" and never leave the host once infected) but rna viruses as well. And if not in our own cellular DNA in our mitochondria or in the genome of one of the multitude of species of bacteria that live co-mensally in or on our body's surfaces. Why not?
If it's any consolation, one thing we've learned about viruses is - being careful not to apply any unnecessary teleology here - they gain no advantage by killing off all their hosts. They "adapt," and become less lethal. Ask the Australians why they still have rabbits after the myxoma virus was introduced to wipe them out in 1950. How did syphilis become less of a problem from the ravages of the rampaging, disfiguring organism it was in Europe when it was brought back from the new world by said same Spanish explorers and "conquistadores" and their - sniffling, sneezing, coughing - crew? Who - or what - conquered whom?
IF it's any consolation, thinking long-term is reassuring for me at least. I know Ebola HF, Marburg, Enterovirus D68, HIV will be with us for a long time to come but they won't kill all of us. If we're smart, we'll lock down borders, there will be survivors. We'll find vaccines, treatments, ways to not just cope but to survive. Just for historic value, look up Rudyard Kipling's 1905 story "As Easy as ABC" sometime.
This is so sad. What's sadder still is how many parents are going to be bringing in their kids for me to evaluate with "pink eye" who are going to say "do you think he has that virus, that entero thing?"
What do I tell them? That this kind of fluke immune system overreaction to viruses and other infections exists is well known. During the "Great Influenza" circa 1918-1919 there were well-documented cases of people whose first symptoms of "the flu" were to say "I don't feel well" and collapse, dead. That's not the virus, that's the vagaries of their own immune systems, their own genetic inheritance, at work. Some white cell somewhere says "oh no, it's that virus," and hits the panic button, starting a relentless cascade of unstoppable, lethal, chemistry. It's a cascade as old as the species, probably precambrian in origin.
Do I go into that much detail with the worried mom or dad? No. Do I try and reassure them as much as I can that "it's probably just a mild bacterial infection, as about 50% of all "pink eye" turns out to be, or do I join them in a "folie a deux" and call the emergency room for an admission for overnight observation for "pink eye?" Sure. That's not going to happen. Reassurance, eye drops, maybe an overnight vigil, two hours on, two hours off, Mom, Dad alternating "the watch," so they can see if anything bad happens they might want to call 911 for, but what else is there? Eye drops, a pat on the emotional back and out the door. That's going to happen.
One of the things I tell my patients when I have the time is everyone's immune system responds somewhat differently to the same virus. Where one family member may get a full-blown upper respiratory syndrome from, say, an enterovirus like Rhinovirus or Coxsackie, others may get only a mild fever, feel achey, out of sorts for a day or two and have nothing more than what we call a "subclinical illness." Did their immune system get exposed to that virus before and they had some residual "memory cells" floating around to respond rapidly to a viral invader or did they have a more effective "innate immune response" that recognized the virus? Had they simply won the genetic lottery through Darwinian evolutionary principles and had the DNA and subsequent proteins necessary to combat and survive the infection?
What is really fascinating - to me, academically - about viruses is where they come from. Sure, we like to think "bats" and other wild animals as reservoirs, but how long do humans carry viral infections within their bodies, spreading the dna or rna packets that are viruses as they go about their daily business? I like to think about how Spanish explorers brought common viruses - common to Europeans - to native Americans 600 years ago and how devastating those viruses were to the native populations. What viruses were those? Smallpox or head colds (rhinovirus, enterovirus)? Can you imagine a ship full of otherwise healthy seamen passing head colds around for the months' long voyage? Did every ship have a few guys who were sick on any given day or did the virus burn itself out but lie dormant, subclinical? I've got a sneaking suspicion that humans ARE intermediate vectors in MANY viral infections, not just the double-stranded DNA viruses we know for a fact that we can harbor for life (poxviridae like chickenpox and epstein-barr and cytomegalovirus - the latter two which cause "mononucelosis" and never leave the host once infected) but rna viruses as well. And if not in our own cellular DNA in our mitochondria or in the genome of one of the multitude of species of bacteria that live co-mensally in or on our body's surfaces. Why not?
If it's any consolation, one thing we've learned about viruses is - being careful not to apply any unnecessary teleology here - they gain no advantage by killing off all their hosts. They "adapt," and become less lethal. Ask the Australians why they still have rabbits after the myxoma virus was introduced to wipe them out in 1950. How did syphilis become less of a problem from the ravages of the rampaging, disfiguring organism it was in Europe when it was brought back from the new world by said same Spanish explorers and "conquistadores" and their - sniffling, sneezing, coughing - crew? Who - or what - conquered whom?
IF it's any consolation, thinking long-term is reassuring for me at least. I know Ebola HF, Marburg, Enterovirus D68, HIV will be with us for a long time to come but they won't kill all of us. If we're smart, we'll lock down borders, there will be survivors. We'll find vaccines, treatments, ways to not just cope but to survive. Just for historic value, look up Rudyard Kipling's 1905 story "As Easy as ABC" sometime.
