Historical Dermatology & Vaccines GREG SIMPSON MD Disclosures - PDF document

9/24/2019 Historical Dermatology & Vaccines GREG SIMPSON MD Disclosures  I do not have any relevant financial endorsements to disclose.  I will be talking about the off label use of many medications UCSF Fresno Mini Med School 2019 1

9/24/2019 Outline  History of select Infectious disease  Infectious Disease and Vaccines Why the caduceus? UCSF Fresno Mini Med School 2019 2

9/24/2019 Case 1- 42 y.o. African male Dracunculiasis  Guinea Worm  Cyclops water flea in drinking water (carry the larvae)  1980’s- 3.5 million cases, 2018- 28 As of February 2019, only 7 countries remaining to be  certified Guinea worm free: Angola, Chad, Democratic Republic of the Congo, Ethiopia, Mali, South Sudan, and Sudan  Metronidazole or thiabendazole and stick  Clean water sources, Larvicide (ABATE) or filters UCSF Fresno Mini Med School 2019 3

9/24/2019 CDC eradication program ERADICATED  1. Small Pox  2. Rinderpest  GLOBAL ERADICATION UNDERWAY  1. Polio  2. Dracunculiasis  3. Yaws  4. Malaria  REGIONAL ELIMINATION ESTABLISHED OR UNDERWAY  1. Hookworm  2. Lymphatic filariasis  3. Measles  4. Rubella  5. Onchocerciasis  6. Bovine spongiform encephalopathy (CJD)  7. Syphilis  8. Rabies  Medical Significance?  Asklepios- Greek God of medicine (1200 BC)  Hippocrates 20 th generation “follower”  Today’s medical significance?  Caduceus- Hermes (Greek) staff  1902- US Army and pharmacies used it as a “stamp” on medical supplies UCSF Fresno Mini Med School 2019 4

9/24/2019  The Black Death is estimated to have killed 30% to 60% of Europe’s population. In total, the plague may have reduced the world population from an estimated 450 million to 350–375 million in the 14th century. It took 200 years for the world population to recover to its previous level. UCSF Fresno Mini Med School 2019 5

9/24/2019 Plague  Yersinia Pestis  Black Death-14 th Century  1900-1904- Chinatown in SF  Typically the disease moves back and forth between fleas and their rodent hosts  Yosemite-2015 two cases UCSF Fresno Mini Med School 2019 6

9/24/2019 37 yo AAF UCSF Fresno Mini Med School 2019 7

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9/24/2019 Syphilis (Treponema Pallidum)  Transmission by contact with lesion of primary or secondary stage, or transplacental (secondary is most contagious)  Primary Syphilis  Chancre: painless ulcer, raised indurated borders  Secondary Syphilis  Flu-like syndrome, generalized LAD, HSM  Cutaneous lesions in 80%, bilateral, symmetric macules, papules, pustules  palms/soles, condyloma lata, “moth-eaten” alopecia Syphilis  Latent: positive serology, o/w asymptomatic  Tertiary Syphilis  Generally 3-5 yrs. after infection (early as 6 mos)  Nodular, Ulcerative mucocutaneous lesions  Bone involvement  Cardiovascular: AI, CVA, aortic mycotic aneurysm  Neurologic: meningitis, CN d/o,  ICP, Charcot’s dz (arthropathy secondary to tabes dorsalis)  Famous People who may have died from syphilis?  Hitler, Al Capone, Vladimir Lenin, Oscar Wilde UCSF Fresno Mini Med School 2019 9

9/24/2019 Epidemiological Trends in Syphilis, 19 Fresno County Figure 2a (LEFT) Early Figure 2b (RIGHT) Early Syphilis*Incidence Rates for Syphilis*Incidence Rates for Females by Age Group (in Males by Age Group (in years) Fresno County, 2006– years) Fresno County, 2006– 2015 2015 Ironically, the most productive strain came from a moldy cantaloupe from a  Peoria fruit market. A more productive mutant of the so-called cantaloupe strain was produced with the use of X-rays at the Carnegie Institution. UCSF Fresno Mini Med School 2019 10

9/24/2019 Tuskegee Experiment  Tuskegee Alabama 1932-1972  400 AA men, “Bad Blood”  Tx- Bismuth, mercurials, Salvarsan (didn’t work)  1940’s penicillin- withheld from these men  1972  130 died of syphilis or complications  40 wives contracted it  19 children with congenital syphilis Tuskegee  “ Longest non-therapeutic experiment on human beings in medical history”  1974- National Research Act  Founded the Institutional Review Boards UCSF Fresno Mini Med School 2019 11

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9/24/2019 Small Pox Small Pox  Variola major, Variola minor  Inoculation in China-10th century  widely practiced by the 16th century, Ming dynasty 1802  In 1796, Edward Jenner- cowpox  Vaccine- Latin for cow ( vacca )  Killed up to 300 million people in the 20th century  1967, 15 million cases occurred a year  1977- Last naturally occurring case (Somalia)  1980- WHO declared eradication  By 1986, routine vaccination stopped UCSF Fresno Mini Med School 2019 13

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9/24/2019 Aral small pox incident Vozrozhdeniya Island UCSF Fresno Mini Med School 2019 15

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9/24/2019 Measles-First Disease (aka Rubeola) Paramyxovirus- ss rna  Spread via respiratory droplets  cough, coryza, conjunctivitis  Complications: superinfection, pneumonia, SSPE  Tx: supportive, Vit A?  pre-1963-US-500,000 cases  2001-world-30 million illnesses and 770,000 deaths  2018- 477,000 cases, 2019(through July)- 487,000  2019 (in US)- 1,234 reported this year- most in 25 years  UCSF Fresno Mini Med School 2019 17

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9/24/2019 Forschheimer’s spots UCSF Fresno Mini Med School 2019 19

9/24/2019 Third disease rubella  Togaviridae- ssRNA virus  50% asymptomatic, “rose-pink” macules and papules  1964- US- 12.5 million cases  11,000 miscarriages 20,000 cases of CRS  Congenital Rubella syndrome- cardiac, cerebral, ophthalmic and auditory defects. Premie, LBW  2,100 died, 12,000- deaf, 3,600-blind, 1,800-MR.  1969 live vaccine, early 1970s,(MMR)  First Trimester!!! UCSF Fresno Mini Med School 2019 20

9/24/2019 Dewdrop on a Rose Petal Vesicle becomes cloudy & umbilicated with irregular borders. Crust forms in center & eventually replaces the remaining portion of the vesicle at the periphery. “Chicken Pox” Varicella Zoster Virus Human Herpes Virus 3  Transmission via respiratory droplets (very contagious, from 5 days  before onset of symptoms until ALL lesions are dry/crusted) Successive crops of macules, papules  vesicles, pustules, crusting  (“dewdrop on a rose petal”) Face  scalp  trunk, resolves in 1-3 weeks  1995- vaccine approved (developed 80’s)  Complications (adults): pneumonitis, meningitis, encephalitis,  Reye’s syndrome… UCSF Fresno Mini Med School 2019 21

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9/24/2019 “Shingles” Varicella Zoster Virus Human Herpes Virus 3  VZV infection of the ganglion, partial immunity?  Groups of vesicles along sensory nerve in dermatomes  Complications: post herpetic neuralgia, facial paralysis, auditory symptoms  Tx: high dose IV acyclovir in immunocompromised hosts  2006- >60 y.o.- Zostavax  2017- >50 y.o.- Shingrix  Herpevac-2002-2010 (Herpes simplex virus 2- didn’t work),  Herpes Vaccine-2019- promising  UCSF Fresno Mini Med School 2019 23

9/24/2019 Anthrax Bacillus anthracis (GP spore-forming rod)  Derivation of name Anthrax?  Greek word- Anthracite (coal)- black skin lesions  Inhalational, GI, Cutaneous  Louis Pasteur in 1881 ( went on to develop vaccines for small pox, cholera  and swine erysipelas) September 18, 2001, Letters containing anthrax spores were mailed to  several news media offices and two Democratic US senators killing five people and infecting 17 others. UCSF Fresno Mini Med School 2019 24

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9/24/2019 Conclusions  Caduceus- Dracunculiasis  Plague  Syphilis  Small pox  Measles  Rubella  Chicken pox/ Shingles  Anthrax UCSF Fresno Mini Med School 2019 26

9/24/2019 THANK YOU FOR COMING! Cell- (901)485- 4170 Office (559)266- 4100 UCSF Fresno Mini Med School 2019 27