How does the Wuhan coronavirus cause severe illness?


Allen Cheng, Monash University

We usually think of viral respiratory infections, like the common cold, as mild nuisances that pass in a few days. But the Wuhan coronavirus has proven to be different. Of those infected, around 2% are reported to have died but the true mortality is unknown.

There’s much we’re yet to learn about this new virus, but we know it often causes pneumonia, an infection of the lungs which produces pus and fluid and reduces the lungs’ ability to absorb oxygen.

Of the first 99 people with severe infection, three-quarters had pneumonia involving both lungs. Around 14% appeared to have lung damage caused by the immune system, while 11% suffered from multi-organ system failure, or sepsis.

Others are at risk of complications from being treated in hospitals, such as acquiring other infections.




Read more:
How contagious is the Wuhan coronavirus and can you spread it before symptoms start?


At this stage, we know some people develop only a mild infection, while others become critically ill, but the exact proportion of each is not yet clear.

Overall, there are four key ways the Wuhan coronavirus can cause severe disease – and some can occur at the same time.

1. Direct viral damage

For the SARS (severe acute respiratory syndrome) coronavirus, direct viral damage was probably the most common way the infection caused disease. This is likely the case with the Wuhan coronavirus.

Early studies have found the Wuhan coronavirus attaches to a particular receptor found in lung tissue. This is like a lock and key mechanism allowing the virus to enter the cell, and is the same receptor the SARS coronavirus used.

Viruses “hijack” the host cell’s mechanisms to make more copies of itself. Damage results from either viruses taking over the cell completely and causing it to die, or immune cells recognising the viral infection and mounting a defence, triggering cell death.

If large numbers of cells die, then the affected organ can’t function effectively.

Studies from patients who died from SARS coronavirus showed the virus caused damage to not only the lungs, but also other organs in the body. Early research suggests the Wuhan coronavirus can also damage other organs, including the kidneys.

2. Pneumonia

While we’re still piecing together the relationship between the Wuhan coronavirus and pneumonia, there’s much we can learn from influenza.

Influenza is a virus but it commonly leads to bacterial pneumonia – this is what’s known as a secondary infection.

It’s thought the influenza virus weakens the usual protective mechanisms of the lung, allowing bacteria to establish and multiply. This is especially true in children, older people and those with compromised immune systems.

Secondary bacterial pneumonia is more severe than influenza alone – in hospitalised patients, around 10% of those with influenza and pneumonia die, compared to around 2% of those who don’t have pneumonia.

The Wuhan coronavirus appears to cause pneumonia in two ways: when the virus takes hold in the lungs, and through secondary bacterial infections, however, the first way appears to be more common.

3. Sepsis

Sepsis is a serious condition that can be caused by many infections.

When we get an infection, we need to mount an immune response to fight off the pathogen. But an excessive immune response can cause damage and organ failure. This is what happens in the case of sepsis.




Read more:
What is sepsis and how can it be treated?


Although it can be difficult to determine whether organ damage from the Wuhan coronavirus is a result of direct viral infection or indirect “collateral damage” from the immune system, initial reports suggested around 11% of people severely ill with the Wuhan coronavirus experienced sepsis with multi-organ failure.

So far no drugs or interventions have been able to dampen this immune response. Although several treatments have been proposed for Wuhan coronavirus, none have yet been shown to work.

4. Complications of hospital care

Finally, patients who require hospital care may have complications. These include infections from intravenous lines (for drips/medication) or urinary catheters (flexible tubes inserted into the bladder to empty it of urine), pneumonia, or non-infectious complications such as falls or pressure sores.

Studies have found 10% of patients in hospital have some sort of health care-acquired infection, and around 5% have a pressure sore.

Hospitals work hard to try to prevent these complications, by making sure health care workers disinfect their hands and other equipment. However, complications still occur, particularly in patients who are debilitated from long hospital stays.




Read more:
1 in 10 patients are infected in hospital, and it’s not always with what you think


While most respiratory viral infections are mild, some can trigger serious complications, either directly or indirectly. It’s too early to tell how often this occurs with the Wuhan coronavirus. While we have initial data on those who were severely affected, many others may not have required medical care.The Conversation

Allen Cheng, Professor in Infectious Diseases Epidemiology, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What are parasites and how do they make us sick?



Giardia is an example of a parasite you don’t want to catch. Symptoms can include diarrhoea, abdominal cramps, fatigue, weakness and weight loss.
From shutterstock.com

Vincent Ho, Western Sydney University

A parasite is an organism that lives in or on an organism of another species.

Three main classes of parasites can cause disease in humans: protozoa, helminths, and ectoparasites. Protozoa and helminths largely affect the gut, while ectoparasites include lice and mites that can attach to or burrow into the skin, staying there for long periods of time.

The majority of protozoa and helminths tend to be non-pathogenic (meaning they don’t cause disease) or result in very mild illness. Some, however, can cause severe disease in humans.




Read more:
Health check: the low-down on ‘worms’ and how to get rid of them


Faecal-oral transmission, where parasites found in the stool of one person end up being swallowed by another person, is the most common mode of transmission of parasitic protozoa and helminths.

The initial symptoms tend to be gastrointestinal symptoms like diarrhoea. When parasites invade the red blood cells or organs, the consequences can become more serious.

Protozoa

Protozoa are tiny single-celled organisms that multiply inside the human body.

The protozoa giardia, for example, has a classic two-stage life cycle. In the first stage, called trophozoite, the parasite swims around and consumes nutrients from the small bowel. In the second stage it develops into a non-moving cyst.

Cysts excreted in faeces can contaminate the water supply, and ingesting contaminated food or water results in transmission. Close human to human contact and unsanitary living conditions can promote transmission.

Symptoms of giardia can include severe or chronic diarrhoea, abdominal cramps, fatigue, weakness and weight loss.

Once the parasite has been diagnosed, it can usually be treated effectively.
From shutterstock.com

Other important protozoa are the plasmodium species. Plasmodium develop in mosquitoes, and infected mosquitoes transmit the parasite to humans by biting them. Plasmodium destroys red blood cells which impacts organ function and causes a disease in humans known as malaria.

Malaria causes the most deaths of all parasitic diseases. In 2017 it was estimated malaria resulted in 435,000 deaths globally, most of them young children in sub-Saharan Africa.




Read more:
How our red blood cells keep evolving to fight malaria


Helminths

Helminths, often called worms, are large multicellular organisms usually visible to the naked eye in their adult stages. As a general rule, helminths cannot multiply inside the human body.

One major group of helminths are flatworms. Flatworms literally have flattened soft bodies. Their digestive cavity has only one opening for both the ingestion and removal of food. It’s thought 80% of flatworms are parasitic.

Tapeworms are one type of flatworm. The most common human tapeworm in Australia is the dwarf tapeworm. The prevalence of dwarf tapeworm in isolated communities in northwest Australia is estimated to be around 55%.

Infestation in humans comes from ingesting dwarf tapeworm eggs. Transmission from person to person occurs via the faecal-oral route. As with other parasites, the major risk factors are poor sanitation and shared living quarters. Symptoms include diarrhoea, abdominal pain, weight loss and weakness.

Some parasites, like plasmodium, which causes malaria, are transmitted to humans via mosquito bites.
From shutterstock.com

Another major group of helminths are nematodes, commonly known as roundworms. Nematodes are the most numerous multicellular animals on earth and can be found in almost every environment. Unlike flatworms, they do have a digestive system that extends from the mouth to the anus.

More than 50% of the world’s population are thought to be affected at one point during their life by at least one of six main classes of nematodes.

The eggs or larvae of these nematodes usually develop in soil before being transmitted to the human host. For this reason these nematodes are often called soil-transmitted helminths. A good example are hookworms which infest humans by penetrating the skin from contaminated soil. So wearing appropriate footwear is an important way to prevent hookworm transmission.




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The pinworm Enterobius vermicularis has a different life cycle to the other nematodes. Pinworm larvae develop in eggs on the skin near the anus or under the fingernails.

Pinworm, also known as threadworm, is the most common helminth parasite in Australia. Itching around the anus is a major symptom of pinworm. Pinworms are easily passed from one person to another and it’s common for entire families to be infested.

Ectoparasites

The term ectoparasites generally refers to organisms such as ticks, fleas, lice and mites that can attach or burrow into the skin and remain there for long periods of time.

Scabies, for example, a contagious skin disease marked by itching and small raised red spots, is caused by the human itch mite. Scabies usually is spread by direct, prolonged, skin-to-skin contact.

Head lice are small, wingless insects that live and breed in human hair and feed by sucking blood from the scalp.

Head lice, a type of ectoparasite, are common in children.
From shutterstock.com

Prevention and treatment

Some parasites can lie dormant for extended periods of time. This can make the diagnosis of parasitic infestation challenging as there may be no symptoms, or symptoms can be vague and non-specific.

The good news is we have very good medications to treat many different kinds of parasites once they’ve been diagnosed. These medications do have side effects but on the whole are very effective.




Read more:
Six human parasites you definitely don’t want to host


Treatment of parasites should be accompanied by preventative strategies such as improving sanitation and ensuring the availability of appropriate clothing and footwear in affected areas.

The World Health Organisation has recommended periodic medical treatment (deworming) to all at-risk people living in endemic areas, but widespread implementation remains challenging.The Conversation

Vincent Ho, Senior Lecturer and clinical academic gastroenterologist, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Does your mental state affect recovery from illness and disease? We asked five experts



A positive mindset can affect some aspects of disease, but grief is normal and to be expected.
from http://www.shutterstock.com

Alexandra Hansen, The Conversation

Many of those who’ve suffered from illness or disease would have received the advice to “stay positive”. Is this sage advice that can truly have a positive effect on health, or an added burden for someone who is already suffering – the need to also feel good about it?

We asked five experts in various fields whether a positive mindset can affect outcomes for those suffering from illness and disease.

Five out of five experts said yes

However, they had some important caveats. It depends on the disease – for example, one expert said studies in cancer have not found positive thinking affects disease progression or the likelihood of early death.

And while our mental health can have powerful effects on our physical health, the perceived need to “stay positive” can be an added burden during a difficult time. So it’s also important to remember grief is normal.

Here are the experts’ detailed responses:


If you have a “yes or no” health question you’d like posed to Five Experts, email your suggestion to: alexandra.hansen@theconversation.edu.au


Erica Sloan is a member of the Scientific Advisory Board of Cygnal Therapeutics. Jayashri Kulkarni receives funding from the NHMRC.The Conversation

Alexandra Hansen, Chief of Staff, The Conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Recuperation


This is a post I’m putting up at all my Blogs, even though that particular Blog may be unaffected due to scheduled posting, etc. Blog posts may be down a little at the moment and that for the last week or so. I have been ill with various illnesses and complaints for the last several weeks, so I have now decided to take the next week off from most Blogging activities in an attempt to rest and recover – if I can while still actually doing my very physically demanding actual job in the real world. I hope to return to Blogging full time in about a week’s time.