Why the Return of “Curable” Diseases?
A HOME has just been thoroughly cleaned. As the days, weeks, and months pass, however, the dust and dirt gradually reappear. One thorough cleaning, therefore, is not enough. Continual upkeep is essential.
For a time it seemed that modern medicine had thoroughly cleaned out malaria, TB (tuberculosis), and syphilis. But necessary upkeep through research and treatment was too often neglected. Now the “dust and dirt” have reappeared. “Globally, the malaria situation is serious and getting worse,” says Dr. Hiroshi Nakajima of WHO (World Health Organization). “People have to realize that TB is back—and back with a vengeance,” warns tuberculosis specialist Dr. Lee Reichman. And The New York Times announced early in this decade: “New cases of syphilis are at the highest level since 1949.”
Malaria—Threatening Almost Half the World
Now, almost 40 years since it was declared nearly eradicated, malaria poses a serious threat in Afghanistan, Brazil, Cambodia, China, India, Indonesia, Sri Lanka, Thailand, Vietnam, and various parts of Africa. “Two children die of the infection every minute,” reports the French newspaper Le Figaro. The yearly death toll is two million—far more than are killed by AIDS.
Close to 270 million persons are infected with the malaria parasite, but 2.2 billion are considered to be at risk. “How is it that malaria, once eliminated or largely controlled for 90 per cent of the world’s population, now threatens more than 40 per cent of us?” asks Phyllida Brown in New Scientist. The reasons are many.
Deforestation and colonization. The settlement of mosquito-infested rain-forest areas has stirred an outbreak of malaria in Brazil. “What we had was an invasion of the house of the mosquito,” says immunologist Claudio Ribeiro. Settlers, he says, “had no experience with malaria and no resistance to the disease.”
Immigration. Job-hunting refugees from Myanmar flock to the gem mines of Borai, a small town in Thailand. “Their constant movement makes malaria control all but impossible,” reports Newsweek. Some 10,000 cases of malaria are recorded monthly—just among the miners!
Tourism. Many who visit malaria-infested areas return home infected. Thus, in 1991 some 1,000 cases were diagnosed in the United States and 10,000 in Europe. Annually hundreds of tourists and overseas workers return to Canada infected. In a tragic instance, two children developed a fever soon after the family returned from Africa. The doctor did not suspect malaria. “By the time the parents took them to hospital, it was too late,” reports the Toronto Globe and Mail. “They died within hours of each other.”
Drug-resistant strains. WHO reports that drug-resistant strains of malaria have spread to all of tropical Africa. In Southeast Asia, says Newsweek, “drug resistance is advancing so rapidly that some strains could soon be untreatable.”
Lack of resources. In some places clinics lack the equipment to perform a simple test known as a blood smear. In others a large portion of the health budget is needed for other emergencies, resulting in a shortage of insecticides and medicines. Sometimes it is an issue of profit. “There is no money in tropical diseases,” admits New Scientist, “because, by and large, those who are affected cannot afford medicines.”
Tuberculosis—An Old Killer With New Tricks
Streptomycin, the drug that promised to bring tuberculosis under control, was introduced in 1947. At the time, it was thought that tuberculosis would be eliminated once and for all. But a rude awakening has come to some lands: TB rates have increased markedly in recent years. “In pockets of poverty in America,” reports The Washington Post, “TB rates are worse than those of the poorest countries in sub-Saharan Africa.” In Côte d’Ivoire there is what one journal calls “a brutal reawakening of tuberculosis.”
Dr. Michael Iseman laments: “We knew how to cure it. We had it in our hands. But we dropped the ball.” What impeded the fight against tuberculosis?
AIDS. Since it leaves a person defenseless against infection, AIDS is considered a major cause of the TB resurgence. “If they don’t die of something else first,” says Dr. Iseman, “virtually 100 percent of AIDS patients carrying TB bacteria will develop the illness.”
Environment. Prisons, nursing homes, shelters for the homeless, hospitals, and other institutions can become breeding grounds for tuberculosis. Dr. Marvin Pomerantz relates that one hospital’s use of an aerosolized treatment increased pneumonia patients’ coughing and thereby created a virtual TB epidemic among the staff.
Lack of resources. As soon as it looked as if tuberculosis was under control, funding dried up, and public attention went elsewhere. “Instead of eliminating TB,” says Dr. Lee Reichman, “we eliminated tuberculosis programs.” Biochemist Patrick Brennan says: “In the early 1960s I’d worked intensively on TB drug resistance but decided to get out of it because I thought TB was cured.” Thus, the return of tuberculosis caught many doctors unawares. “During one week [in the fall of 1989],” said one physician, “I saw four new cases of the illness that my medical school teacher said I’d never see again.”
Syphilis—A Deadly Comeback
Despite the effectiveness of penicillin, syphilis is still widespread in Africa. In the United States, it is making its strongest comeback in 40 years. According to The New York Times, syphilis is now “fooling a generation of doctors who have rarely, if ever, seen a case.” Why the resurgence?
Crack. Crack addiction has propelled what one doctor calls “marathon binges of cocaine use and sex.” While men often steal to support their addiction, women are more likely to trade sex for drugs. “In crack houses,” says Dr. Willard Cates, Jr., of the U.S. Centers for Disease Control, “there is sex and multiple partners. Whatever infection happens to be prevalent in those environments is going to be the one that gets transmitted.”
Lack of protection. “Despite the ‘safe sex’ campaign,” reports Discover, “teenagers are still lackadaisical about using condoms to protect themselves from disease.” A study in the United States revealed that only 12.6 percent of those with risky sexual partners used condoms consistently.
Limited resources. States The New York Times: “Budget cuts have strapped the public clinics where most syphilis and other sexually transmitted diseases are diagnosed.” Furthermore, testing methods are not always accurate. In one hospital a number of mothers gave birth to infected babies, yet the mothers’ previous blood tests gave no evidence of syphilis.
An End in Sight?
Man’s battle against disease has been a long and frustrating one. All too often success in fighting some ailments is offset by failure in fighting others. Is man doomed to a perpetual war that he can never win? Will there ever be a world without disease?
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The Ravages of Syphilis
SYPHILIS is caused by Treponema pallidum, a corkscrew-shaped spirochete, and is usually contracted through the sex organs. The spirochete then enters the bloodstream and spreads throughout the body.
Several weeks after infection, a sore called a chancre appears. It usually forms on the sex organs but may instead appear on the lips, tonsils, or fingers. The chancre eventually heals without leaving a scar. But the germs continue spreading through the body until secondary symptoms appear: skin rash, sore throat, aching joints, hair loss, lesions, and inflammation of the eyes.
If untreated, syphilis settles into a dormant phase that may last for a lifetime. If a woman becomes pregnant during this stage, her child may be born blind, deformed, or dead.
Decades later, some will move on to the later stage of syphilis, in which the spirochete may settle in the heart, brain, spinal cord, or other parts of the body. If the spirochete lodges in the brain, convulsions, general paralysis, and even insanity may result. Eventually, the disease may prove fatal.
Biophoto Associates/Science Source/Photo Researchers
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“A Great Mimic”
THAT is what Dr. Lee Reichman calls tuberculosis. “It can look like a cold, bronchitis, flu,” he says. “So unless a doctor is thinking about TB, he or she may miss the diagnosis.” A chest X ray is needed to confirm the infection.
Tuberculosis is passed from person to person through the air. A cough can create particles that are tiny enough to enter the lungs. However, the body’s defenses are normally strong enough to contain the infection. Dr. Reichman explains: “It is only [those] who have enough of the bacillus in their chest cavities—100 million organisms as opposed to less than 10,000 for inactive carriers—[who can] spread the disease.”
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Global Warming and Malaria
MALARIA could not begin without the infecting Anopheles gambiae mosquito. “Change the vector [insect] population and you change the incidence of the disease,” observes The Economist.
Laboratory experiments have shown that small increases in temperature can greatly affect the insect population. Thus, some experts conclude that global warming may have a grave impact on the incidence of malaria. “If the overall temperature of the Earth increases even one or two degrees Celsius [two to four degrees Fahrenheit],” says Dr. Wallace Peters, “it could increase the breeding areas of mosquitoes so that malaria could become more widely distributed than it now is.”
Dr. Tony Brain/SPL/Photo Researchers
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Shelters for the homeless can become breeding grounds for tuberculosis