Thursday, August 13, 2015

Is the U.S. prepared to deal with tropical diseases?

Diseases once associated with 'elsewhere' are increasingly being found in the southern states of the USA.

...Poverty is a critical factor. But the American South's hot and humid climate, the influx of insects that carry diseases, and the ever-increasing movement of humans have combined with the region's high poverty levels to create a perfect storm of disease. While we might already have seen some of the storm's effects, the worst has yet to arrive.

...Paediatrician Morven Edwards, a soft-spoken petite woman in her 60s, is an infectious disease consultant at Texas Children's Hospital in Houston. She's the doctor other doctors call when they can't figure out what's going on with their patients. In 2010, she took a call from a local paediatrician whose 17-year-old patient had tested positive for Chagas disease after donating blood for her high school blood drive.

Edwards knows a few things about Chagas: it is caused by the parasite Trypanosoma cruzi and spread by a group of insects called Triatoma, or 'kissing bugs' (because they like to bite near the mouth). Most people with Chagas don't know they've been infected but that doesn't mean damage isn't occurring. Over time, the T. cruzi parasite can chew through cardiac muscle and cause heart failure. Chagas is a major problem in Latin America, where an estimated 8 million people are infected. It's also one of the leading causes of heart failure in the region and causes an estimated 11,000 deaths each year.

Edwards' new patient, however, had never been to Latin America. She had never even left the USA. She was, Edwards explains, "your All-American girl", hardly a candidate for a disease that mainly infected poor, rural populations in Central and South America. Edwards repeated the blood test, just to be sure. Again it turned up positive for Chagas. Given the girl's young age and the high risk for heart failure if the disease is untreated, Edwards decided to treat her with anti-parasitic drugs.

The case has stayed with Edwards for several reasons, the main one being the mystery of how the girl became infected if she'd never left the country. But south Texas is home to the same kissing bugs that transmit Chagas. The answer, then, had to be this: she had been infected with Chagas in Texas. And she was unlikely to be the only one.

...Of course, suspecting that a tropical disease might be the problem is only useful if a physician can easily diagnose and then treat it. Despite tremendous advances in other types of illness in recent decades, tropical medicine remains stubbornly stuck in the 1950s, leaving the USA as unprepared as low-income nations to treat any significant number of cases.

..."Most physicians have a hard enough time…dealing with the preauthorisations that they need to get drugs from the insurance companies, let alone having to do all of this paperwork to treat one patient," Meymandi says. Patients must also be monitored closely, which requires extra appointments for patients and extra paperwork for physicians.

...It is the nature of these diseases – neglected diseases, diseases of poverty, call them what you like – that they can go unnoticed for years, chewing away at the health of individuals and communities. As poverty, geography, climate and social factors combine to bring tropical diseases out of hiding once again in the US South, physicians, politicians and the general public have to take the warning signs seriously and recognise that the tools available for tackling tropical diseases are sorely lacking. With diseases like Chagas now known to be prevalent and transmissible within the USA, better awareness, better tests and better treatments are all urgently required. Otherwise, as Hotez says, the number of people affected and infected will only continue to rise as this perfect storm grows ever stronger.
Read more here.

How do you write a long article like this and not mention illegal immigration?

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