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Industrial farming practices in the U.S. are one of my pet peeves, from an environmental and health standpoint, as well as my “foodie” sensibilities.
Freshly laid, unfertilized farm eggs actually keep best unwashed until they are cracked, & will keep at room temperature for weeks. An egg, even unfertilized, is alive, exchanging air through the shell & living off yolk nutrients. Think about it, they are designed to be living incubators for a chick. They will slowly dehydrate & lose quality, but they will live and remain edible for a long time. (How do they tell if an egg is unfertilized?)
Americans – Why do you keep refrigerating your eggs? nicely summarizes the interesting & little-advertised facts about how American industrial farming practice requires us to scrub, chlorine wash, & refrigerate eggs at 40F, so as to reduce the risk of Salmonellosis and other infections. In Europe, less industrialized farming practices & vaccination of poultry against Salmonella has dramatically reduced this problem. Washing eggs is illegal, & they are kept at 70F to reduce condensation that might promote bacteria. Kept dry at this temperature, the coating on the egg from laying protects them from dehydration & bacterial entry for a long time on store shelves.
Unfortunately, in the U.S. even backyard flocks have been contaminated with Salmonella & are usually unvaccinated, so the risk is not so low. I keep my farm eggs unwashed but refrigerated to retard bacteria (wash before use, of course). I love eggs from pasture-raised chickens & ducks; they’re richly flavored & higher in omega-3 fatty acids & antioxidants from their naturally “buggy” diets. Discard any egg if it’s slimy, discolored, has an odor (it shouldn’t at all), or has new powdery spots on it.
My esteemed colleague, clinician, researcher and FL native Dr. Anthony Cannella speaks tomorrow morning at the University of Florida Emerging Pathogens Institute Seminar Series in Gainseville, discussing the links between individual immune response and development of disease, which may either protect, or promote an uncontrolled and lethal manifestation of disease. Dr. Cannella has been studying human T-cell (Th1) and humeral responses in pathogens like Brucella and Coccidioides for the past several years, and I believe he’s onto something critical.
Antimicrobials are not the answer. There are only so many metabolic pathways to chemically block in living organisms, and far more ways for them to evolve resistance. Sometimes even as simple as waking a sleeping gene archived from an ancestor that armed itself against a similar defense raised by plants of eons past. The antibiotic pipeline has gone dry, with little more than a few “me-too” drugs in development at best.
For a long time, I’ve believed that the next step in the evolution of medicine and the battle against infection, lies in unlocking the secrets of immunity. How does that one person at work who never gets a flu shot and never gets sick get away with it? While a woman in her 20’s dies of influenza within a week? How does one person arrive at the ER dying of sepsis from a Staphyloccal cellulitis, while a nursing home resident tolerates repeated bacteremias without so much as a leukocytosis? Why do so many children get away with swimming with Naegleria every year, but a few succumb? Is it just the particular strain of pathogen? The volume of invader? The person? Or all of it?
What causes an immune system to respond so aggressively that it kills its owner? How do we harness it? Can we? Should we? Dr. Cannella is doggedly on the hunt, and I am grateful. Follow him on Twitter @apc_md, and go see him speak if ever you can. He’s one of those scientists you can actually understand, and he loves Medicine and people. A really cool person, you’ll like him.
Fight the good fight, Doc.
Research has shown that prescription and over the counter drugs are present in our nation’s water supplies. Antibiotics in the waste stream and sewage systems are a significant source of resistant bacteria in our environment and can kill beneficial microbes. Many other drugs have more than one effect, including hormonal and toxic effects in animals and plants.
Water is one of the few vital elements without which we cannot survive. H2O does not break down. All of the water on the planet today is the same that has existed since the beginning of Earth. Please do your part to keep our water supplies pure and healthy.
DO NOT flush expired or unwanted prescription and over-the-counter drugs down the toilet or drain, unless the label or accompanying patient information specifically instructs you to do so. To dispose of prescription and over-the-counter drugs, call your city or county government’s household trash and recycling service and ask if a drug take-back program is available in your community. Some counties hold household hazardous waste collection days, where prescription and over-the-counter drugs are accepted at a central location for proper disposal.
If you don’t have a take-back program near you, here is the next best way to dispose of medications in household trash:
1. Take your prescription drugs out of their original containers.
3. Put the mixture into a disposable container with a lid, such as an empty margarine tub, or into a sealable bag.
2. Mix drugs with an undesirable substance, such as cat litter or used coffee grounds (You don’t want animals or even children swallowing them!).
4. Conceal or remove any personal information, including Rx number, on the empty containers by covering it with permanent marker or duct tape, or by scratching it off (Labels contain a lot of personal information that you may prefer to keep private).
For more information on how to dispose of medications, including which can or should be flushed, visit FDA’s Disposal of Unused Medicines: What You Should Know.
Or for more information on protecting water supplies, go to www.epa.gov/ppcp/ or call the Safe Drinking Water Hotline at 800-426-4791.
Stay thirsty, my friends,
People forget we’re just a fraction of this planet’s ecosystem. Vibrio is *natural* throughout warm Gulf salt waters, yet it mostly only threatens people with immune impairment, liver disease & iron overload conditions. Diseases and disease vectors are adapting to warming climates & expanding their habitats all over the globe. Expect more Northern cases as the range of warm climate microbes shifts (Ecologist Richard Ostki discusses the arguments fir & against this statement here).
Get straight facts on Vibrio at CDC’s page on Vibrio vulnificus.
Get more on the role of climate change in communicable diseases at Climate change influences infectious diseases both in the Arctic and the tropics: joining the dots at Global Health Action.
Expect the unexpected,
Chagas disease is an insidious parasitosis caused by Trypanosoma cruzi.
T. cruzi is transmitted while a Triatomid bug bites and sucks the blood of a host. It defecates as it feeds; irritation and inflammation prompts the rubbing of feces carrying live parasites into the wound. It will also infect any mucosal tissue, such as a nearby eye or mouth, as when the bite occurs near an eye, Romaña’s sign. Or when swallowed in juices made from tropical fruit that may be contaminated with insect droppings. It may also be transmitted from mother to baby during pregnancy.
Long endemic to Central and South America, it has slowly crept north with human development and spread of its insect vector’s preferred habitat, mud and thatch homes, rodents and dogs. T.cruzi has been found in Triatomid bugs in California, Arizona, and New Mexico in recent years. And interestingly, it has recently caused foodborne outbreaks related to guava juice, sugar cane juice, and especially acai fruit, which is popular in Brazil and the U.S. for its anti-oxidant properties. Acai palm is a common host plant for Triatomid bugs in the Amazon, and T. cruzi has been shown to survive storage and freezing for some time. That may give some pause to those consuming it for health benefits, but any imported juices must demonstrate compliance with FDA Hazard Analysis and Critical Control Point (HACCP) regulations before being admitted to the U.S., and failure to comply with any aspect means automatic detention. (And if you’re wondering now whether the growth in acai consumption in recent years has expanded the habitat range for T. cruzi’s vector, you will be happy to know that the Brazilian government has prioritized sustainable and environmentally responsible development over capitalism, by carefully controlling acai agriculture. Only 1 million hectares of land is authorized to grow acai commercially.)
Temperate regions have historically been a barrier to this parasite in North America. Climate change, however, may cause further northern encroachments of Triatomid bugs and its habitat. Increasing travel and trade may bring new hosts.
Most people who are infected develop no or mild flu-like symptoms. Only decades later do 20-30% of these develop heart, gastrointestinal, and neurologic dysfunction that must be treated symptomatically. Anti-trypanosomal drugs do not help beyond the early stages, and then only to reduce severe symptoms, not to kill the parasites. Those who develop suppressed immunity, such as HIV/AIDS or after organ or bone marrow transplantation, may reactivate dormant parasites and develop life-threatening meningoencephalitis, myocarditis (inflamed heart muscle), and other organs. Chagas is difficult to accurately test for with blood work, and unlikely to show up in blood smears in chronic phases (except in reactivation disease), so making the diagnosis is often only detected in the U.S. when a donor’s blood is permanently rejected for donation because of a positive EIA antibody screen for Trypanosoma cruzi. Polymerase chain reaction (PCR) assays are very unreliable.
Pest management and housing improvement is key to stopping human transmission in areas where Triatomid bugs and T. cruzi may co-exist. Screening of pregnant women occurs in endemic countries, but it may be reasonable to start doing so in the U.S. in selected areas or cases of travel exposure, and experts are in fact weighing the options.
“Perseverance” was my son Philip’s most defining trait, and he was always proud of a certificate he was given for it by his second grade teacher. I keep that certificate in prominent view, because, in life and in death, he taught me to survive.
Now and then I like to recognize and share stories about survivors. It reminds us all of how fragile life and our expectations are, and yet how it’s possible to overcome terrible events and to live purposefully, meaningfully, and even joyously despite, or even because of, a “new normal”.
My good friend, colleague, and co-editor of Gompf’s ID Pearls 2.0, John Toney MD, nearly lost his daughter, Sarah, to a horrific highway accident in May. It’s been long months of surgeries, anguish, frustration, and labor to arrive at this point, but Sarah is now back at Marshall University studying Pharmacy with what she now calls her “pharm-ily”, the friends and mentors who supported her through what must have seemed an unspeakably endless summer.
Please trace her journey at MU Pharmacy Student Returns.
Then stop for a moment and reflect on the everyday blessings in your life. They add up. I promise.