Monthly Archives: April 2013

Possible Cause Of Chronic Fatigue Found

Norwegian researchers recently reported discovering the immune mechanism that may underlie chronic fatigue syndrome. This often obscure condition is hard to detect and hard to diagnose. Until relatively recently it was widely believed to be purely psychosomatic, with no physical cause or easily observable symptoms. Something such as an immune response that can be seen and tested for is an important breakthrough. The idea was initially suggested in 1984 when a cluster of cases in Nevada brought the illness to the attention of the medical community, but this is the first study providing tangible evidence for the hypothesis.

The scientists had noticed that a medication used to treat autoimmune diseases such as rheumatoid arthritis successfully treated CFS, which is notoriously difficult to treat even when it is recognized. Normally the illness is managed with cognitive-behavioral therapy and antidepressants, with other medication playing only a minor role. The Norwegians decided to take a closer look at what the medication was actually doing, and found that it reduced the amount and activity of a type of immune cell called B-cells.

B-cells are one of the immune systems two major components. Produced in bone marrow in humans, B-cells’ role is to learn what disease-causing agents look like and go out to neutralize them. The understanding of how B-cells work in the immune system has expanded in recent years; the T-cells that detect invaders were previously believed to run the immune system and be largely responsible for autoimmune disease, but B-cells seem in more recent studies to play a larger role in both healthy and malfunctioning immune response. In particular, the degree to which B-cell response is involved in rheumatoid arthritis was found to have been underestimated.

Now B-cells are believed to also be responsible for chronic fatigue syndrome. Also known as myalgic encephalomyelitis, CFS is characterized not only by the tiredness resting doesn’t alleviate that gives the condition its name, but also by inflammation in parts of the brain. If it is an autoimmune disease, the inflammation is likely a result of the immune response.

Mark Your Calendar For Annual Checkups

Spring means spring cleaning to a lot of people, the time for the sort of general maintenance work that helps keep your life orderly and organized. It’s also a good time to do maintenance on you. Early detection can be a lifesaver for many conditions, so now is an excellent opportunity to get to your healthcare provider for important health screenings and tests to help you catch serious diseases before you see symptoms.

Here are some things you should be sure to be checked for:

  • Heart disease. Heart disease is the biggest single cause of death for men and women alike. Chronic high blood pressure is an early warning sign of, and common precursor to, heart disease, but often has no symptoms itself. It’s important to get your blood pressure checked regularly. Cholesterol screenings are also important for adults, even people in their 20s and 30s—by the time high cholesterol is causing problems, it’s been building up for a lifetime, and it’s never too soon to keep it in check.
  • Breast cancer. Women over 50 should have annual or biannual mammograms; women with a family history of breast cancer, particularly at a relatively young age, or who carry any of several genes for the condition would probably benefit from screenings in middle age. Men can get breast cancer too, and men with risk factors such as obesity should talk to their doctors about getting tested.
  • Colon cancer. People between 50 and 75, or between 40 and 75 with a family history or other risk factors, should be checked for colon cancer annually. One in 20 people will develop the condition, and it is the third leading cause of death, but it can be treated if it’s discovered in time.
  • Type 2 diabetes. If you can discover type 2 diabetes early, you can take steps to not only manage but minimize it, reducing the risk of permanent damage and possibly avoiding needing insulin. Screening, particularly in high-risk patients can also help find prediabetic conditions, enabling a patient to adopt a healthier lifestyle before becoming diabetic.

Get your annual checkup in the spring, and talk to your physician about what tests you might benefit from given your age and health history. If you take care of your health, you can enjoy the summer—and many summers after.

Predicting The Course Of Sarcoidosis

Patients with a disease called sarcoidosis have inflammation in different parts of the body. The disease causes small masses of cells called granulomas to form, usually in the eyes, on the skin, or in the lymph nodes; the disease almost always affects the lungs as well. Sometimes it goes away, but other times it can lead to organ damage or even death. Sarcoidosis is what killed the comedian Bernie Mac, and it affects millions of people, including boxer Evander Holyfield and actress Karen Duffy. Left untreated, chronic sarcoidosis can, depending on where granulomas are, cause trouble breathing, blindness, central nervous system disorders, facial paralysis, kidney failure, and heart failure.

It can be difficult to distinguish between the more serious and more benign types of the condition. Four in five cases will clear up without treatment, but treatment is important in other cases, and so it is vital for doctors to know what they’re dealing with. This is complicated, however, because the initial symptoms of both—wheezing, dry cough, shortness of breath, chest pain—are identical. Researchers have found, however, that patients the complicated form that gets worse have a particular sequence of 20 genes in blood samples that patients with the uncomplicated form that goes away do not have. A simple test can be used to tell the difference.

In addition to providing a valuable diagnostic tool, this research provides further evidence of a genetic component to sarcoidosis. While the exact cause of sarcoidosis is unknown, it is more common in African Americans, in women, and in people with a family history of the disease. Most cases of sarcoidosis are diagnosed in patients between 20 and 40. The disease is associated with the production of a specific protein and appears to be triggered by airborne contaminants; recent studies point to mold growth as a possible trigger, though there may be others in addition.

There is no cure for chronic sarcoidosis. If there is no indication that the affected organs are at risk of failure no management may be needed. If there is some risk, anti-inflammatory drugs such as corticosteroids can be used to get the inflammation to go down. Immune suppressants are sometimes also used.

Hay Fever And Your Asthma

As the weather gets warmer, the flowers bloom, the trees show their leaves—and the pollen comes out. For close to 40 million Americans, spring is time for seasonal allergies. For most people, seasonal allergies just mean coughing, sneezing watery eyes, and generally cold-like symptoms that last for months. For people with asthma, however, allergens in the air make it worse.

Allergies are similar to autoimmune disease, in that the immune system is defending the body against something that isn’t a thread—the body’s own organs in autoimmunity, and allergens such as tree pollen in allergies. In addition to tree pollen, inhaled allergens can include dust or mold, and these may be more prevalent in different weather conditions or seasons.

Not all allergic reactions lead to asthma symptoms, and not every allergy sufferer has asthma, but in people with both conditions—around half of all asthma sufferers are believed to also be allergic to inhaled particles—allergic reactions can lead into asthma attacks. That’s because the inflammation characteristic of asthma makes the bronchial tubes in the lungs particularly sensitive to irritation, which worsens the inflammation and makes breathing difficult. Other things can also trigger asthma, such as colds—which can occur in spring and summer as well as in colder months—smog, and cigarette smoke. Even cold air, particularly dusty air conditioning, can trigger an attack.

There are some treatments that are used for allergies and asthma alike. Medications to stop the immune system from responding to harmless allergens work by preventing the release of chemicals that signal the inflammation that leads to an asthma attack, meaning the allergens won’t cause a reaction or trigger asthma. A different sort of medication, called a leukotriene modifier, also modifies the immune response, in this case by acting directly on the chemical compounds in the body that are responsible for inflammation.

Meningitis

More than 25,000 people get meningitis each year, though the number is falling. The disease occurs when the membranes around the brain become inflamed and affect functioning. This leads to symptoms including fever, nausea and headache, loss of appetite, and seizures. It is important that anyone who exhibits fever, a severe headache, a stiff neck, confusion, and vomiting should see a doctor immediately, as this may indicate a particularly dangerous and fast-moving form of the disease.

Meningitis can be caused by either bacteria or a virus. The more common viral kind is often mild, but bacterial meningitis—caused by bacteria such as pneumococcus and listeria carried by as many as a quarter of the population, though usually dormant and harmless—can be fatal. In very rare cases a fungal infestation can cause chronic meningitis. People who haven’t been vaccinated are at particular risk, as are pregnant women and people who are immunocompromised.

Bacterial meningitis, left untreated, is fatal in about 15 percent of cases. Other effects of untreated meningitis include hearing loss, trouble with memory and learning, brain damage, chronic seizures, trouble walking steadily, and kidney failure. These effects can set in quickly, but they are more likely the longer it is before treatment is begun, which is why it’s important to get medical attention for suspected cases of bacterial meningitis right away.

Fortunately, there is treatment. Antibiotics must be administered quickly, along with corticosteroids to take care of the inflammation directly. On the other hand, mild cases of viral meningitis may not need to be treated at all, beyond plenty of rest and fluids and over-the-counter pain relievers. This common variety usually clears up on its own. More severe cases do respond to antiviral medications.

Preventing meningitis requires similar tactics to preventing the spread of colds, Handwashing and general hygiene practices can go a long way. Maintaining general good health, such as by getting enough sleep and eating a healthy diet, will also help prevent the disease. In addition, cooking food thoroughly can help avoid listeria, and there are vaccines available both for the more common bacteria that cause the disease and for meningitis itself.

Infant Immunization Week

In recent weeks, a deadly measles epidemic has swept through the United Kingdom. More than 800 people have been infected, and the death of a 25-year-old man in Wales has been linked to the disease. The tragedy is compounded by the fact that it could have been prevented—many of the people who got sick had not been vaccinated as children. Measles is one of 14 serious and often deadly diseases doctors recommend children get vaccinations for before age two.

The measles vaccine is usually administered as part of a compound vaccination called MMR that also protects against mumps and rubella. Other inoculations recommended for infants include diphtheria, several types of hepatitis, chickenpox, and whooping cough. Whooping cough is another disease that recently saw a large-scale outbreak as a result of inconsistent vaccination.

In fact, doctors estimate that tens of thousands of children and adults each year get diseases they wouldn’t have if they had been vaccinated. However, they also say that because the majority of people are vaccinated against these diseases, epidemics in the United States usually play themselves out relatively quickly. If it weren’t for the fact that a majority of people are immune, infections would spread much more rapidly and broadly.

However, vaccination is not without risk and, while they are recommended for all children who can safely receive them, it is not always possible to vaccinate every child. Vaccines are monitored for safety, but they sometimes have side effects. These can include soreness or redness around the injection site or a low-grade fever. Typically, when these do occur, they are minor and go away quickly. If you’re a parent worried about side effects, you can time inoculations—the recommended schedules are fairly flexible—so that the child doesn’t get too many injections all at once.

All in all, vaccination of children is among the most successful and cost-effective public health tools available. Vaccination is good for the child throughout his or her lifetime as well as for the community as a whole.

Fighting Resistance In Mesothelioma

Researchers say a potential new treatment for mesothelioma, a form of cancer, may be more effective than current chemotherapy regimens. A chemotherapy agent called cisplatin is the standard treatment for mesothelioma, but there is a tendency for the drug to lose its effectiveness over time as the the tumors develop resistance to it. Scientists discovered the mechanism the tumor cells use to resist the drug, and may have discovered a way to block the process.

Mesothelioma is one of the best-understood forms of cancer. Nearly all of the 3,000 cases diagnosed in the United States each year are the result of breathing in asbestos fibers. The cancer strikes the mesothelium, the layer of cells that forms the lining of several organs. Mesothelioma most commonly strikes the lungs, but it can also be found in the abdomen, genitalia, or heart.

Unfortunately, symptoms don’t always appear until years, sometimes decades, after exposure. In the most common form of the disease, in the lungs, these symptoms will include shortness of breath, coughing, and pain in the chest under the rib cage. The abdominal form causes pain and swelling. Lumps are often a sign of cancer, including mesothelioma.

Asbestos is very closely associated with mesothelioma, being one of the most consistent factors in the development of the condition. Asbestos is a highly heat-resistant fibrous mineral that was used for fireproofing until the health risks became clear. It continues to be used for some applications, and is still found in older insulation, flooring, shingles, and other products. Normally it requires significant exposure to asbestos to cause mesothelioma, and the disease is most prevalent in miners and other people who encountered it occupationally, but there are cases of people getting sick after very brief exposure. However, there is no risk if the asbestos is covered up and not disturbed.

Salt And The Immune System

An estimated one in 20 people in the United States have some form of autoimmune disease, conditions in which the immune system, ordinarily the body’s defense against infectious agents, turns on itself, attacking healthy tissue as though it were tumor or other harmful cells. That number is going up year after year. It’s not always clear why this happens, but new research points to salt as a possible factor in a broad spectrum of autoimmune conditions.

Researchers at Yale University put laboratory mice on a high-salt diet and found that they increased production of a type of T cells, the foot soldiers of the immune response, called Th17. Th17 cells are characteristic of autoimmune diseases. The mice developed a condition analogous to multiple sclerosis in humans. Follow-up studies in Boston found that an enzyme that is part of the body’s system for processing salt also activates the production of Th17.

Autoimmune diseases occur when Th17 cells mistake the body’s own organs for invaders. Common autoimmune conditions include type 1 diabetes, Guillain–Barré syndrome, multiple sclerosis, lupus, rheumatoid arthritis, Sjögren’s syndrome, and some kinds of hepat‍itis. Most of these conditions are partly heritable, but not everyone who is genetically predisposed to an autoimmune condition exhibits one. These discoveries about salt may help explain why. The researchers note that autoimmunity is not wholly genetic, nor wholly environmental; it’s a combination of both. People who, as a result of genetic inheritance, are prone to a type of autoimmune disease, only actually exhibit it when excessive salt in the diet triggers the immune cell production.

It is not yet known whether the salt and autoimmunity connection works the same way in humans as it does in mice, though the same signaling pathways may be involved, and most people probably ought to be watching their salt intake on general principles. There are a number of environmental factors that appear to be linked with autoimmune disorders; one of the most widely known and accepted is the “hygiene hypothesis” that postulates that clean surroundings cause the immune system, deprived of infections to combat, to turn on the body. Salt’s effect on the immune cells themselves may well also be a part of it.

Irritable Bowel Syndrome And You

As many as one in four people are estimated to have irritable bowel syndrome. While this intestinal disorder has no cure, it is highly manageable with proper treatment. Symptoms of IBS include abdominal cramping, gassiness and bloating, and often diarrhea. Although unpleasant and possibly embarrassing, irritable bowel syndrome is not a progressing disease and does no permanent damage.

What causes irritable bowel syndrome is unclear. When someone has the condition , their colon is unusually sensitive to stimuli, called triggers. A variety of foods can cause reactions, and which ones vary from patient to patient. Menstruation can also induce or worsen an IBS flare. Common IBS triggers include:

  • Caffeine
  • Dairy products
  • Alcohol
  • Spicy foods
  • Foods that produce gas

More than half of people with IBS are diagnosed before age 35, and most sufferers are women. A disproportionate number of patients are veterans returning from the Persian Gulf. Stress seems to be a significant factor in the development of irritable bowel, and this is believed to be part of the reason the condition is so prevalent among the veteran population.

There is no cure for the disease, but the symptoms can be managed. Patients are advised to avoid foods that they find triggering. Dairy is a very common culprit, and lactase supplements can minimize the adverse effects. Treatment generally focuses on the symptoms—fiber for constipation, anti-diarrhea medications, medications called anticholinergics for bowel spasms. There are some drugs that treat the condition more directly, but they are only recommended for severe cases.

Reye’s Syndrome: What To Look For, What To Do

Teenagers, particularly those with certain inherited conditions affecting metabolism, recovering from viral infections sometimes experience swelling in the liver—and the brain. The cause is a rare but serious, and sometimes fatal, condition called Reye’s syndrome. It’s not just teenagers—it can occur at any age—but it is particularly common in that age group.

The exact cause is unknown. Reye’s almost always develops within the first week after a viral infection such as chicken pox or flu, though patients should be monitored for three weeks after their illness. It generally strikes young people who were treated with aspirin, though the connection is unclear. Some insecticides and herbicides, as well as other toxins, can also trigger it. People with conditions called fatty acid oxidation disorders are especially prone to the disease.

Early diagnosis is vital, because the condition affects the brain and treatment is significantly more effective if it’s started early. Reye’s syndrome generally progresses in a specific sequence, and the symptoms usually occur in the same order:

  1. Continuous vomiting
  2. Listlessness
  3. Drowsiness
  4. Personality changes such as irritability, or slurred speech or touch sensitivity
  5. Disorientation or confusion
  6. Combativeness
  7. Delirium, convulsions, or loss of consciousness

Someone exhibiting relentless vomiting, particularly with listlessness, should get immediate medical attention from a professional who is trained in diagnosing and treating Reye’s syndrome. With proper treatment, given early, Reye’s has a 90 percent recovery rate.

Administration of aspirin—also called acetylsalicylate, acetylsalicylic acid, salicylic acid, and salicylate—is the single biggest predictor of Reye’s syndrome. Medications containing aspirin should not be given to children with viral infections. However, you should ask your doctor before giving an infected child anything, to be sure it won’t mask the symptoms of Reye’s until it’s too late.