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A 16-year-old female presents to the hospital with a burning sensation in her leg. There is a noted ulcer that she has been trying to alleviate with antibiotics. The ulcer keeps returning. Her travel history indicated she had traveled to a remote part of Africa the previous year to visit family. An x-ray is performed and shows subcutaneous linear calcification, typical of calcified Guinea Worm Disease. The calcified worm was surgically removed.

Guinea Worm Disease (GWD) comes from stagnant water sources where the larvae of the worm reside and are ingested by drinking the water. The larvae end up in the abdomen, where the female and male larvae come together, shortly after, the male dies and the female (as a round worm) migrates to subcutaneous tissue. She then releases her larvae through blisters in the skin. When infected individuals return to the water source with open ulcerations on the skin, the water is then re-contaminated with the larvae which starts the cycle over again. The parasite can be up to 1 meter long and cause horrible pain of the skin. The only way to get rid of it is to physically remove the worm from the site of infection. This is a painful process that can take months. Guinea Worm can incubate up to a year before causing ulcers in the tissue and can become calcified if not removed. Open sores are prone to secondary infections.

GWD, also known as Dracunculus medinensis or Dracunculiasis, is a nematode roundworm parasite that has almost been eradicated completely. Since 1986, infections with Guinea Worm Disease have dropped from over a staggering 3 million, to just 25 cases total in 2019.

There are still many ongoing efforts through the Carter Center which is an organization that helps to improve lives by preventing diseases. Founded by Former U.S. President Jimmy Carter and Former First Lady Rosalynn Carter, The Carter Center has built local, national, and international partnerships to help in the eradication of GWD. Eradication efforts are ongoing in five countries that are still affected by the disease which include South Sudan, Mali, Chad, Ethiopia, and Angola. Their strategy is to educate all affected communities about the transmission of Dracunculus medinensis and by providing community-based interventions to teach individuals safe drinking practices.

Currently a challenge that the Carter Center has faced in being able to completely eradicate GWD is the presence of GWD in domesticated dogs in Chad. They believe the dogs are getting infected through eating fish remains containing the Guinea worm larvae. To help decrease the numbers of dogs affected health volunteers have urged people in those areas to bury fish remains and are paying people cash rewards for reporting infected animals. Unfortunately, there are some areas of affected countries that do not have access to these programs and interventions due to conflict which makes it unsafe to travel. If those people cannot be reached and educated, eradication of the disease could become more challenging.

If GWD is ever fully eradicated it would become the second human disease in history to be eradicated and the first disease to ever be eradicated without the aid of a vaccine or medicine.

Written By:  Lauren Belcher and Emily Gates

Edited by:  Lara Biagiotti

Ancylostoma duodenale

Human infection with parasitic worms can be devastating.  Over a quarter of all humans are infected by parasites.  Infection can be chronic,"leading to pain, malnutrition, physical disabilities, delayed development, deformity, social stigma or a burden on family members caring for the afflicted."  Often affecting the poorest parts of the world, these diseases "impede economic development through human disability" affecting livestock and crops as well.  Few drugs treat parasitic infections and repeated use of the same therapies over and over has led to increasing resistance. 

In an attempt to discover new treatments, research was performed on worm species genomes which included collaboration between University of Edinburgh and Washington University in Saint Louis. The original research and results can be found on, Nature Genetics. The researchers studied parasitic and non-parasitic worm genomes to determine how the worms migrate and live inside humans and animals. The study included 36 roundworms and flatworms, and had 45 worm species’ genomes. By studying the genomes of these worms, possible new medications can be developed since there are few medications or vaccines for parasitic worms, or enhance the medicines already available. With this study there can be a better understanding of the affects these worms can have on humans and animals.

Through the research, it was discovered that there are many gene families and these genes families can expand into different ones as well. Some of the parasitic nematodes can be put into one or more gene families but then may not be seen in a different one. The genes that were observed demonstrated how different worm species are meant for different parts of the body for example some nematodes demonstrated genes for the gut. Also there were genes that showed how the nematodes migrate into tissue and out if tissue.

In the study, the researchers observed that out of 289 drug targets that are available, 40 drug targets were considered high priority. Those 40 were also associated with other drug-like compounds. With this information there can better development of medicine or more medicine can be available for successful treatment and better outcomes for those infected.

Written by Sindi Pereira

Edited by Lara Biagiotti

Photo credit

Histoplasma capsulatumIn November 2018, the Louisiana Department of Health received a call about two patients, one thought to have viral pneumonia and the other an unknown respiratory illness. Both were hospitalized and treated with medicines for pneumonia, yet their symptoms would not go away. After consultation with an infectious disease specialist, the patients were tested and diagnosed with histoplasmosis. Histoplasmosis is an infection caused by a fungus, Histoplasma capsulatum, that is found in the droppings of birds and bats in humid areas. Upon further investigation, the Louisiana Department of Health discovered that the two patients had recently been on a camping trip and found that half of the campers on the trip were sick with histoplasmosis.

With an outbreak at hand, Louisiana Department of Health teamed up with the Centers for Disease Control, Mycotic Diseases Branch, to find the cause of the histoplasmosis outbreak. To find out how the camper got sick, officials investigated the activities of the campers for possible cause, particularly any that would bring them into contact with bird or bat droppings. Most people who encounter the fungus, do so through soil that contains large amount of bird or bat poop. Once the soil is disturbed, spores from the fungus are inhaled. Once inside the lungs, a person’s body temperature stimulates the fungus to transform into a yeast. The yeast can then travel throughout the body. Activities that the campers participated in ranged from hiking, collecting firewood, digging soil and geocaching. Geocaching is like a digital scavenger hunt where players locate objects and sites using an app. After touring several of the geocaching sites, they found one where an object was hidden in the soil at the bottom of a hollow tree. When officials took a closer look, they found it to be the home of bats. They immediately tested the soil, and it came back positive for Histoplasma capsulatum.

After a high-risk area is identified there are several steps the department of health takes in order to prevent further outbreaks. First, they educate the campground staff about the risk and symptoms of histoplasmosis, such as people with weakened immune systems being at a higher risk of severe infection. The second is to recommend that campers avoid disturbing soil in areas that may contain bird or bat droppings. Finally, they recommended that public health officials and health care providers increase the awareness about histoplasmosis at campgrounds, particularly in Louisiana.

Written by Lauren Clabough

MMDD 2019

The weather was beautiful on Friday, October 4th for Mustangs Make a Difference Day!  The day includes all of the First-Year Seminar classes, as well as some clubs and organizations. This campus-wide day of service for students, faculty and staff is designed to make a positive difference while furthering commitment to one of the university’s core values, that of promoting a sense of community.

Students in the Medical Laboratory Science Program created "goody bags" for parents of babies in the Neonatal Intensive Care Unit (NICU) at Sinai Hospital.  Inside the bags, students were able to place toiletries, note pads, game books and notes of encouragement for parents.  The bags will be delivered to the NICU nurses for distribution to the parents in the near future. 

Medical laboratory professionals are an integral part of the healthcare team, providing the valuable laboratory data that drives over 70% of medical decision making, even for the smallest patients. 

Blood SamplesImagine you are a Medical Laboratory Scientist (MLS) in a large teaching hospital. After running a routine specimen for a 38 year-old female who was admitted for abdominal pain and weakness, you obtain these lab results:

BUN: 18 (7-20 mg/dl)

Na: 140 (135-145 mmol/L)

K: 1.9 (3.5-5.1 mmol/L)

Cl: 128 (98-107 mmol/L)

CO2: 15 (21-21 mg/dL)

Glucose: 99 (70-99 mg/dL)

Creatinine: 0.78 (0.50-1.30 mg/dL)

Ca: 9.0 (8.5-10.1 mg/dL)

Anion Gap: 2.0 (7-16 mmol/L)

As an MLS, you are alarmed by the three abnormal and critical values that delta from previous results and need to decide what the next step is. Do you release the results as is? Do you ask the provider what they think about the results? Do you ask the nurse for a redraw?

Now before you decide too quickly, let’s take a second look at the values and what they mean in relation to each other. The potassium may catch your eye, telling you that something isn’t right. The fact that it is very low in conjunction with the chloride and carbon dioxide makes you highly suspect a spurious value. Because of your clinical laboratory education, you remember that if drawn improperly, normal saline (containing sodium and chloride) would cause the chloride to increase, potassium to decrease, thus causing a decrease in the anion gap. The CO2 would also be falsely decreased with IV saline. Because of your clinical laboratory training, you know that the IV contaminated specimen compromises the care of the patient, causing anything from unnecessary or delayed treatment and costs to severe harm and fatality. In order to help clinicians and protect patients, you as the laboratorian will decide to cancel the specimen and request a redraw, after communicating with the appropriate clinical staff.

While this is only one example, there are many pre-analytical variables that affect laboratory results. Spurious values can be caused by mislabeled specimens, infusions, blood transfusions, wrong tube pour-over, incorrect order of draw, among other technical errors. Although there are delta checks put into place, the laboratorian’s clinical judgment and knowledge is crucial to be able to differentiate an actual valid result from a spurious one. It is up to the clinical laboratorian to not only identify these situations, but also investigate to determine the cause and communicate with clinical staff as appropriate, making this role vital to patient safety and care. Medical laboratory professionals are essential members of the healthcare team.

Submitted by Jelinda Easo '19

 
 
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