TROPICAL MEDICINE

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Tropical Diseases: The New Plague of Poverty

 

At a tropical disease clinic outside Houston where patients show up every Friday, just last month, the clinic’s director has treated a young woman with cutaneous leishmaniasis, three people with brain lesions from cysticercosis and a middle-aged man with Chagas disease.

 

The following is based on an article publish in the New York Times (18 August 2012) by Peter J. Hotez, MD, PhD,, Dean of the National School of Tropical Medicine at Baylor College of Medicine and the President and Director of the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development.

 

Dr. Jules T. Mitchel, President of Target Health, taught Tropical Medicine at the Cornell School of Medicine, and worked in the area of mosquito control, for malaria prevention. In 2012, Target Health has met with FDA to discuss the development of a drug to treat a neglected tropical diseases currently impacting the US.

 

In the US, 2.8 million children are living in households with incomes of less than $2 per person per day, a benchmark more often applied to developing countries and an additional 20 million Americans live in extreme poverty. In the Gulf Coast states of Louisiana, Mississippi and Alabama, poverty rates are near 20% and in some of the poorer counties of Texas, where the author lives, rates often approach 30%.

 

Poverty takes many tolls, but in America, one of the most tragic has been its tight link with a group of infections known as the neglected tropical diseases, which we ordinarily think of as confined to developing countries. Outbreaks of dengue fever, a mosquito-transmitted viral infection that is endemic to Mexico and Central America, have been reported in South Texas. Then there is cysticercosis, a parasitic infection caused by a larval pork tapeworm that leads to seizures and epilepsy; toxocariasis, another parasitic infection that causes asthma and neurological problems; cutaneous leishmaniasis, a disfiguring skin infection transmitted by sand flies; and murine typhus, a bacterial infection transmitted by fleas and often linked to rodent infestations.

 

In addition, among the more frightening is Chagas disease. Transmitted by a “kissing bug” that resembles a cockroach but with the ability to feed on human blood, it is a leading cause of heart failure and sudden death throughout Latin America. It is an especially virulent scourge among pregnant women, who can pass the disease on to their babies. Just last month, the first case of congenital Chagas disease in the United States was reported. A boy born two years ago has become the first known child to acquire Chagas disease, dubbed the “new AIDS of America,” from his mother. The mother, a 31-year-old immigrant from Bolivia, delivered the baby by Cesarean section in Virginia in August 2010, according to the July 6 issue of CDC’s Morbidity and Mortality Weekly Report. Two weeks after the birth, the mother admitted that she had been previously diagnosed with Chagas disease, prompting doctors to test to the boy, who showed signs of being infected by Trypanosoma cruzi, the parasite that causes the disease.

 

These are, most likely, the most important diseases you’ve never heard of and they disproportionately affect Americans living in poverty, and especially minorities, including up to 2.8 million African-Americans with toxocariasis and 300,000 or more people, mostly Hispanic Americans, with Chagas disease. The neglected tropical diseases thrive in the poorer South’s warm climate, especially in areas where people live in dilapidated housing or can’t afford air-conditioning and sleep with the windows open to disease-transmitting insects. They thrive wherever there is poor street drainage, plumbing, sanitation and garbage collection, and in areas with neglected swimming pools. Most troubling of all, they can even increase the levels of poverty in these areas by slowing the growth and intellectual development of children and impeding productivity in the work force. They are the forgotten diseases of forgotten people, and Texas is emerging as an epicenter. Just this past week, headlines are carrying frightening news of West Nile virus outbreaks, north of Dallas, TX, beginning to resemble an epidemic. Americans need to be more vigilant about their own health and the health of the larger group of citizens all around.

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