Tag: microbiology

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Justin Bieber and Ramsay Hunt Syndrome

Maui, Hawaii. (Dr. Noorali Bharwani)
Maui, Hawaii. (Dr. Noorali Bharwani)

Canadian singer, Justin Bieber, recently announced he has taken time off from his tour to recover from Ramsay Hunt syndrome. We hope his recovery is quick and complete.

What is Ramsay Hunt syndrome?

Ramsay Hunt syndrome was first described in 1907 by James Ramsay Hunt in a patient who had ear pain associated with skin and mucosal rashes. Ramsay Hunt (1872 – 1937), was an American neurologist.

Ramsay Hunt syndrome is a viral infection. The varicella zoster virus, which also causes shingles and chicken pox, typically infects facial nerve near the inner ear, causing weakness, inflammation and sometimes pain in the surrounding areas.

After chickenpox clears up, the virus still lives in the nerves. Years later, it may reactivate. When it does, it can affect the facial nerve causing one-sided facial paralysis and hearing loss.

According to a report published in the Canadian Medical Association Journal (cmaj.ca/content/189/8/e320), Ramsay Hunt syndrome has an annual incidence rate of 3.2 to 4.2 cases per 1,000 people.

Ramsay Hunt syndrome can occur in anyone who has had chickenpox. It’s more common in older adults, typically affecting people older than 60. It is rare in children.

What is Bell’s palsy?

Ramsay Hunt syndrome can be confused with Bell’s palsy. A famous example of Bell’s palsy sufferer who experienced permanent effects is former Prime Minister of Canada, Jean Chretien, who had Bell’s palsy as a child.

Bell’s palsy is named after Sir Charles Bell, a Scottish doctor and surgeon in the 19th century. In 1821, Bell described the anatomy of the facial nerve and its association with the unilateral facial paralysis. Historically, the descriptions of the facial distortion were first told by early Greek and Roman physicians.

The cause of Bell’s palsy is unknown. Swelling and inflammation of the cranial nerve VII is seen. Most scientists believe that reactivation of an existing (dormant) viral infection may cause the disorder.

Bell’s palsy can strike at any time, and although most symptoms can improve within a few weeks and a complete recovery is usually anticipated, some people have lingering effects, and others may be burdened with symptoms for life.

What is the difference between Bell’s palsy and Ramsay Hunt syndrome?

Compared with Bell’s palsy (facial paralysis), patients with Ramsay Hunt syndrome often have more severe paralysis at onset and are less likely to recover completely. Overall, the chances of recovery are better if the treatment is started within three days.

Prevention and Management of Ramsay Hunt syndrome:

Shingles vaccination is the only way to protect against shingles and postherpetic neuralgia, the most common complication from shingles.

Shingrix, the shingles vaccine, can provide protection against both shingles and Ramsay Hunt syndrome. It’s available for adults age 50 and older, given in two doses two to six months apart, and is more than 90 per cent effective in preventing shingles.

Children are now routinely vaccinated against chickenpox, which greatly reduces the chances of becoming infected with the chickenpox virus. A shingles vaccine for people age 50 or older also is recommended.

Time is of the essence when it comes to treatment of Ramsay Hunt syndrome. If treatment begins within three days of the diagnosis, partial paralysis of the face resolves itself by 75 per cent. If treatment starts four to seven days after diagnosis, or more than eight days, paresis is resolved by 48 and 30 per cent, respectively.

Medical treatment may include: antiviral drugs, corticosteroids, and anti-anxiety medications. Drugs such as diazepam (Valium) can help relieve vertigo. The pain associated with Ramsay Hunt syndrome can be severe. Prescription pain medications may be needed.

Complications:

Complications of Ramsay Hunt syndrome may include permanent hearing loss and facial weakness.  Usually, it is temporary but can be permanent. There may be eye damage because of the weakness of eye-lids. There may be postherpetic neuralgia.

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Ten Things to Know About Monkeypox

Peaceful Hawaii ocean. (Dr. Noorali Bharwani)
Peaceful Hawaii ocean. (Dr. Noorali Bharwani)

In July, the World Health Organization (WHO) classified the escalating outbreak of the once- rare disease (monkeypox) as an international emergency. The outbreak marked the first time monkeypox has spread widely outside Central and West Africa.

The initial cluster of cases was found in the United Kingdom, where the first case was detected on 6 May 2022 in an individual with travel links to Nigeria. Since then, more than 18,000 people across 78 countries have been infected with monkeypox virus. So far, only five people have died, and no one outside of Central and West Africa.

1. What is monkeypox?

Monkeypox is a viral infection that manifests a week or two after exposure with fever and other non-specific symptoms. Then it produces a rash with lesions that usually last for two to four weeks before drying up, crusting and falling off.

Monkeypox belongs to the family of poxviruses, which includes smallpox. The disease got its name after scientists discovered it among laboratory monkeys in 1958. The first monkeypox case in a human was diagnosed in 1970.

2. Who is getting monkeypox?

According to WHO officials 99 per cent of all the monkeypox cases beyond Africa were in men and that of those, 98 per cent involved men who have sex with men. Experts suspect that monkeypox outbreaks in Europe and North America were ignited by sex at two raves in Belgium and Spain. Cases have emerged in other groups too, including few children.

3. Is this another pandemic?

No, this is not a pandemic (prevalent over a whole country or the world). Monkeypox has been endemic (prevalent in a particular area) for decades in parts of central and west Africa, where people have mostly been sickened after contact with infected wild animals like rodents and squirrels.

4. How does it spread?

Monkeypox spread typically requires skin-to-skin or skin-to-mouth contact with an infected patient’s lesions. People can also be infected through contact with the clothing or bedsheets of someone who has monkeypox lesions.

5. What are the signs and symptoms of monkeypox?

Fever, swollen lymph nodes, and a rash that forms blisters and then crusts over. The time from exposure to onset of symptoms ranges from five to twenty-one days. The duration of symptoms is typically two to four weeks. Cases may be severe, especially in children, pregnant women or people with suppressed immune systems.

6. How is it diagnosed?

The U.S. Food and Drug Administration is advising people to use swab samples taken directly from a lesion (rash or growth) when testing for the monkeypox virus.

7. Is there a vaccine?

IMVAMUNE vaccine has been authorized by Health Canada for active immunization against smallpox, monkeypox and related orthopoxviral infection.

With supplies limited, health officials are not recommending mass vaccination. They are suggesting the shots for health workers, people who have been in close contact with an infected person, and men at high risk of catching monkeypox.

8. Prevention

Prevention is always better than treatment. Get vaccinated. Maintain good hand hygiene and respiratory etiquette, including wearing a mask or covering coughs, along with limiting sexual partners and practising safer sex. Anyone with monkeypox lesions should isolate until they are completely healed, which can take up to three weeks.

9. What is the treatment?

There is no known cure. A study in 1988 found that the smallpox vaccine was around 85 per cent protective in preventing infection in close contacts and in lessening the severity of the disease.

Other measures include regular hand washing and avoiding sick people and animals.  Antiviral drugs, cidofovir and tecovirimat, vaccinia immune globulin may be used during outbreaks.

10. What is the prognosis?

The illness is usually mild and most of those infected will recover within a few weeks without treatment. Estimates of the risk of death vary from one per cent to 10 per cent.

Monkeypox can be serious in children, pregnant women and people with underlying health conditions, like cancer, tuberculosis or HIV.

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Promising breakthrough treatment for HIV using stem cells.

Senate Fountain beside the U.S. Capitol in Washington DC. (Dr. Noorali Bharwani)
Senate Fountain beside the U.S. Capitol in Washington DC. (Dr. Noorali Bharwani)

We will start by understanding what is HIV and what is stem cell. Then we will talk about the new breakthrough treatment for HIV and AIDS patients.

HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system. Over time, HIV weakens a person’s immune system so it has a very hard time fighting diseases. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome).

World-wide approximately 38 million people are currently living with HIV, and tens of millions of people have died of AIDS-related causes.

HIV spreads through sexual contact or blood, or from mother to child during pregnancy, childbirth or breast-feeding.

HIV presents with fever, chills, rash, night sweats, sore throat, fatigue and swollen lymph glands.

AIDS is a chronic, potentially life-threatening condition. There is no cure for HIV/AIDS, but medications can dramatically slow the progression of the disease. These drugs have reduced AIDS deaths in many developed nations.

What are stem cells?

Stem cells are primitive cells. They are body’s raw materials. From these cells all other cells with specialized functions are generated. They can help repair rebuild damaged cells. Stem cell therapy is mostly used for treating certain types of cancer or bleeding disorders, such as sickle cell disease.

Stem cells can be isolated from the body in different ways. They can be obtained from a donor’s bone marrow, from blood in the umbilical cord when a baby is born, or from a person’s circulating blood. Cord stem cells are often successful, even when their immune markers only partially match the recipient’s.

Now let us discuss recent newspaper headlines. “First Woman Has Been ‘Cured’ of HIV Using Stem Cells.” Another headline says, “Stem-cell treatment may have cured woman of HIV.” Why is this making headlines? Because this novel treatment using umbilical cord blood could help dozens of people with both HIV and aggressive cancers.

This exciting story is about a middle-aged woman of mixed race who had HIV and acute myeloid leukemia. A woman of mixed race has never been treated like this before. Doctors have cured HIV in two white men, and this is the first such report in a woman. It is also the first time a person who identifies as mixed race has received the treatment.

This lady first received high-dose chemotherapy for acute myeloid leukemia – a treatment that destroys blood cells – then she received the stem cell transplant from specialists at Weill Cornell Medicine, in New York City.

They used transplant cells from two sources: stem cells from a healthy adult relative and umbilical cord blood from an unrelated newborn. The stem cells, from umbilical cord blood, contained a gene variant that makes them resistant to HIV infection. Since the transplant 14 months ago the woman is doing well.

Scientists believe the success of the new method involving umbilical cord blood could allow doctors to help more people of diverse genders and racial backgrounds.

Why is this breakthrough treatment making news?

This was the first case of HIV treatment using umbilical cord blood, which is less invasive and more widely available than invasive bone marrow transplants that cured the two male patients. Cord blood donors don’t need to be matched as closely to the recipient as bone marrow donors, so it can be an option for patients with uncommon tissue types.

Scientists are carefully watching the situation. Despite the apparent success of the treatment, it won’t be available to most of the 38 million people living with HIV around the world just yet. In the meantime, scientists are carefully monitoring this lady’s long-term prognosis. Now, 14 months after the treatment, the HIV infection has not re-emerged. The patient has also been leukemia-free for four years.

We wish her well. Kudos to the doctors involved in her treatment. Let us hope we can get rid of COVID-19 soon so we can return to normal life. Take care and stay healthy.

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What have we learned about COVID-19?

Red Rock Coulee in Alberta, Canada. (Dr. Noorali Bharwani)
Red Rock Coulee in Alberta, Canada. (Dr. Noorali Bharwani)

Here is the good news. The spread of the COVID-19 pandemic in Canada is slowing down. But the bad news is, health officials warned it could come back with a vengeance this fall if contact tracing and testing aren’t stepped up.

What we are trying to do is to contain the virus because there is no vaccine or medications to kill the virus. Once the lockdown is lifted, it will leave many people vulnerable to infection as they begin to venture out again.

Unless there is a miracle, SARS-CoV-2 Vaccine will take time to be ready to be used.

The COVID-19 pandemic is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.

Alberta has the third-most number of cases of COVID-19 in Canada. By June 3, there were 7,076 confirmed cases and 145 deaths. The majority of cases have been in the Calgary zone, which has 4,909 cases.

What do we know about coronaviruses?

Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). In 2019, a new coronavirus was identified as the cause of a disease outbreak that originated in China.

There are people who are infected but have no symptoms. Others have mild to moderate to severe symptoms.

Classical COVID-19 symptoms may appear two to 14 days after exposure to the virus. That is the incubation period. The common presentation is fever, cough, and tiredness.

Other symptoms can include: shortness of breath or difficulty breathing, muscle aches, chills, sore throat, loss of taste or smell, headache, and chest pain.

Other less common symptoms have been reported, such as rash, nausea, vomiting and diarrhea.

People who are older or who have existing chronic medical conditions, such as heart disease, lung disease, diabetes, severe obesity, chronic kidney or liver disease, or have compromised immune systems may be at higher risk of serious illness.

It is important you contact your health care provider if you have any of these symptoms. You should call 911 if you have trouble breathing, persistent chest pain or pressure, inability to stay awake, new confusion, blue lips or face.

The virus appears to spread easily among people. Data has shown that it spreads from person to person among those in close contact (within about six feet, or two meters). The virus spreads by respiratory droplets released when someone with the virus coughs, sneezes or talks. These droplets can be inhaled or land in the mouth or nose of a person nearby.

It can also spread if a person touches a surface with the virus on it and then touches his or her mouth, nose or eyes.

Prevention is better than cure. Since there is no vaccine to prevent COVID-19 the next best thing is to reduce your risk of infection by doing the following:

  1. Avoid large gatherings
  2. Avoid close contact
  3. Stay home as much as possible
  4. Wash hands often
  5. Wear a mask in public places
  6. Avoid touching your eyes, nose and mouth.

Yes, face masks combined with other preventive measures, such as frequent hand-washing and social distancing, help slow the spread of the disease.

If you have COVID-19 related symptoms you are legally required to isolate yourself.

If you have symptoms, take the online assessment to arrange testing.

Take care. Stay healthy.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!