Body Horrors: Big Things Have Small Beginnings

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Hello everyone! I’m stepping out from behind the curtain to share some very big news: Body Horrors has a brand new home at Discover Magazine!

I know. I know! It’s terribly exciting! I’m elated and nervous and so very humbled to have my blog hosted by this fine institution, not to mention having this incredible opportunity to continue developing as a science writer and infectious disease scholar. Today in my “hello world!” post at the blog’s new home I wrote,

I began Body Horrors as an experiment in writing about the public health of infectious diseases and parasites – an experiment that is still running today, a carefully cultured organism that’s constantly evolving and growing.

Without the curiosity and interest of my readers, yes you!, this blog wouldn’t be the vibrant, thriving organism (or is it a parasite?) that it is and so I want to thank you for visiting, reading and commenting on my articles. Thank you thank you thank you! I know the reaction of some people to the content (viruses! microbes! parasites! oh my!) of this blog is this so I appreciate you hanging in there. Your visits and comments are greatly appreciated, truly. I put a tremendous amount of research into my articles as well as a fair amount of pre-publishing agony and anxiety over tone and sentences and images – you wouldn’t believe how much time I spend coming up with pun-riddled titles – and it’s gratifying to know that not only do people enjoy my work but that they’re learning from it. I am continually in awe that people get a kick out of the things I write. So thank you.

I’ll be doing very much of the same sort of gig at Discover that I’ve always done: writing about the history, sociology and anthropology of infectious diseases and parasites to ultimately figure out just how are we humans managing and molding the presence of infectious diseases in society and vice versa, which is otherwise known as the practice of “public health”:

This is the most complex and fascinating component of our relationship with the bacteria, viruses and parasites that we coexist with – how do we as a society educate ourselves on preventing and controlling disease and can we change our own behaviors so as to do so more effectively? Not only do these public heath needs serve as some of the most difficult challenges we face today (see: polio eradication) but they also have the potential to be the most enlightening and innovative achievements that humans can accomplish, ever since Antonie van Leeuwenhoek found squirming animalcules under a microscope and since John Snow controlled the 1854 cholera outbreak in London. It’s not rocket science but it is human science and that is also what this blog about – a celebration of the intersection between humans and microbiology.

I’ll also be starting up a recurring series of articles over there called “Microbial Misadventures,” detailing unfortunate mishaps where human meets microbe in novel and unusual circumstances that challenge our assumptions about how diseases are spread. Here’s just a hint of an upcoming  article: anthrax, hippies and drum circles. See? I told ya it’s gonna be good.

Remember: both microorganisms and humans need nutrients, love and a petri dish to grow so I do hope you’ll join me in my blogging (mis)adventure and venture over to Body Horrors at Discover! Sadly, in a week or two I’ll be shutting this ol’ girl down and making the final, permanent move to Discover. So go! Go to Discover! Godspeed!

Thoughts on the New Bird Flu H7N9 & It’s Animal Connection

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Much of the United States is mesmerized by the belligerent squawks from North Korea’s Kim Jong-un and the volatile tension straddling the Korean peninsula, but I’m more concerned about what is happening in China right now and the troubling trickle of news on a new bird flu strain H7N9.

At least 16 people have been infected, patients who were widely distributed through the geographic enormity that is China, and already six have died. But what makes this small cluster of flu cases unusual is its timing – we usually see flu outbreaks emerging in the fall and winter months and we are just now breaking into the month of April – and that this type of flu strain is not known to infect humans.

H7N9 seems to be following a well established pattern of other emerging viruses: originating in east Asia, the infection appears to have a tentative association with wet markets and butchering, and is of zoonotic or animal origin. We’ve seen this situation previously with Nipah virus in Malaysia infected pigs and slaughterhouse employees and with SARS and its birth in the wet markets of Guangdong Province in China.

Laurie Garret masterfully crafts an unnerving story, of unknown unknowns regarding these human flu cases and the potential linkage between the thousands of pigs and fowl carcasses that clogged Chinese waterways in March.

Here’s how it would happen. Children playing along an urban river bank would spot hundreds of grotesque, bloated pig carcasses bobbing downstream. Hundreds of miles away, angry citizens would protest the rising stench from piles of dead ducks and swans, their rotting bodies collecting by the thousands along river banks. And three unrelated individuals would stagger into three different hospitals, gasping for air. Two would quickly die of severe pneumonia and the third would lay in critical condition in an intensive care unit for many days. Government officials would announce that a previously unknown virus had sickened three people, at least, and killed two of them. And while the world was left to wonder how the pigs, ducks, swans, and people might be connected, the World Health Organization would release deliberately terse statements, offering little insight.

By the end of March, at least 20,000 pig carcasses and tens of thousands of ducks and swans had washed upon riverbanks that stretch from the Lake Qinghai area all the way to the East China Sea — a distance roughly equivalent to the span between Miami and Boston. Nobody knows how many more thousands of birds and pigs have died, but gone uncounted as farmers buried or burned the carcasses to avoid reprimands from authorities.

We are very early into this developing scenario and this spate of cases could fizzle into just a blip in the news cycle and on the infectious disease radar. You should read Maryn McKenna’s reasoned and calm analysis here and to devour a slew of delicious infectious disease geek resources at the tail end of her article.

The point I want to make here is a reminder of how closely intertwined the lives of humans are with the lives of the animals we breed and eat. Not many of us raise pigs in the backyard or hear the cock’s crow in the morning and it’s easy to forget that for thousands of years we have lived in close proximity to our poultry and livestock.

But this is still the case in developing nations and particularly those with industries reliant on raising and butchering animals for the global market as well as people supporting a family with their hens and chicks. It is these people and places that are at most risk of emerging zoonotic infections like H7N9 and they require careful surveillance and monitoring of the health and well-being of both people and animals. Remember: catching a novel disease from an animal is the rule not the exception.

Resources

The most important link I can give you: “The New Bird Flu, And How To Read The News About It” from Maryn McKenna.

A timeline of events from Laurie Garret’s article “Is This a Pandemic?” in the short news cycle of H7N9. Her article can be accessed here.

Shanghai will be temporarily closing its live poultry markets on Saturday due to fears of a spreading H7N9 .

Suck It: The Ins and Outs of Mouth Pipetting

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If you ever find yourself working in an infectious disease laboratory, whether it’s of the diagnostic or research variety, the overarching goal is not to put any microbes in your eye, an open wound or your mouth. Easy enough, right? Wear gloves, maybe goggles, work in fume hoods and don’t mouth pipette. When working with pathogenic bacteria and viruses, priority number one is Do Not Self-Inoculate.

This is obvious for anyone who has worked in a shiny biology or chemistry lab or seen an episode of CSI: Crime Scene Investigation (we’re all friends here, just admit it), but one of the most commonly used pieces of equipment in labs prior to the 1970s was the leading cause of laboratory-derived infections: the honorable pipette. How could that be possible, you ask? By using one’s oral cavity with the pipette to measure and transfer liquids.

Today our manual pipettes are rather sophisticated, plastic-y devices perfectly calibrated for moving precisely exact milliliters, microliters and picoliters of valuable solution from one vessel to another, whether it’s of a urine sample, some spare radioactive material you have lying about or toxic solvents. But before the development of cheap mechanical pipettes in the ’70s, using your mouth to pipette solutions was more than a common sight, it was a way of the lab.

Former Centers for Disease Control (CDC) parasitologist, Dr. Mae Melvin (Lt), examines a collection of test tubes while her laboratory assistant mouth pipettes a culture to be added to these test tubes. Source: David Senser/CDC.

Don’t worry, reader, I heard you tentatively whisper, “just what exactly is mouth pipetting, dare I ask?”

Like so: insert an open-ended glass capillary tube into your mouth. Place the opposite, tapered end of the tube into a solution of your choice. Microbial stews, blood, cell culture, it is totally your call. With a method that carefully mimics the sucking of a straw, draw a solution upwards through your man-made pipette to your desired volume using the tension created by the reduced air pressure – yes, suction! Maintain the tension with your mouth. Do not suck too hard and inadvertently slurp the solution into your mouth. Careful now. Gently move the pipette end from one vessel and release your precious cargo into yet another vessel.

That is mouth pipetting.

A wonderful demonstration of mouth pipetting by Dr. Armand Frappier, a microbiologist and expert on tuberculosis. Look closely: you can see him draw a dark liquid slowly towards his mouth. What could it be? Soda, a culture of TB, serum for cell cultures? You can watch the entire video clip that this GIF is based upon here. Source: Musée Armand Frapper.

The sparsity of history on pipetting techniques (itself a shocking shortcoming, I’m sure you’ll agree), forbids us from generalizing the prevalence of this phenomena. But we do know that it was the source of a ridiculous number of accidents, whether swallowing a corrosive or toxic substance or an infection with one’s research material  (1). A survey of 57 labs in 1915 found that 47 infections  were associated with workplace practices and more than 40% of those were attributed to the practice of mouth pipetting. A longitudinal study of 921 workplace laboratory infections from 1893 and 1950 found that 17% were due to “oral aspiration through pipettes or to splashes of culture fluids into the mouth (2).”

Infection through the use of one’s oral cavity was such an occupational hazard that it warranted an article, “The Hazards of Mouth Pipetting,” from two gentleman working for the U.S. Army Biological Laboratories. In 1966 they wrote,

although the use of pipettes in the early chemistry laboratories undoubtedly led to accidental aspiration of undesirable toxic and poisonous substances, the first recorded laboratory infection due to mouth pipetting occurred in 1893 … [with] the case of a physician who accidentally sucked a culture of typhoid bacilli into his mouth …

compared with the equipment and procedures required to avoid other types of microbiological laboratory hazards, the method of avoiding pipetting hazards is so elementary, so simple, and so well-recognized that it seems redundant to mention it [emphasis added by author]. However, continued accidents and infections in laboratories illustrate, even today, that there is a lack of acceptance of the simple precautionary measured needed (2).

By the 1970s, mouth pipetting had fallen out of favor as swanky, mechanically adjustable and cheap pipettes flooded the market (3). They were not only infinitely safer but also far more accurate. Instead of drawing a semi-approximate volume of solution with the imperfect measuring device that is your mouth, standardized and calibrated pipettes were available that could zip up a solution to one’s desired volume. More precision. Better experimental results. Less contamination. More ergonomic. Fewer infections. Nowadays, mouth pipetting is explicitly banned from laboratories.

A woman mouth pipetting to select specimens of ectoparasites. Source: National Library of Medicine

And, indeed, you might think that this old school technique is thankfully old news and good for a giggle but mouth pipetting is still practiced in some countries. A study looking at the lab practices and biosafety measures of Pakistani lab technicians found that mouth pipetting was reported by 28.3% technicians (4). This paper was published just last year, in August of 2012. Another study in 2008 found that Nigerian technicians working in clinical laboratories were not only improperly vaccinated against many of the preventable diseases that they were testing for (!) as well as eating and drinking in the lab but 1 in 10 also reported mouth pipetting (5).

Lest you think this is just happening in developing countries, be rest assured that American teenagers and young adults will always find a creative way to  jeopardize their health. In 1998, a 19-year-old nursing student in Pennsylvania was  hospitalized for several days following infection with a unique strain of Salmonella paratyphi she was working with in a lab; the case report strongly suggests that mouth pipetting was the culprit behind this particular microbial misadventure (6).

Another article from 1995 assessing lab accidents found that 13% of laboratory-acquired infections were a result of mouth pipetting. That’s 92 accidents attributed to someone in a lab deliberately putting a pipette or capillary tube into their mouth and sucking up some solution laden with microbes (7). Clearly, we still have a way to go in dissuading people to stop using pipettes as straws.

A techician mouth-pipetitng environmental water samples in Malta. Image: E Mandelmann. Source: History of Medicine

A technician mouth pipetting environmental water samples in Malta. Image: E Mandelmann. Source: History of Medicine

Mechanical manual pipettes have been a godsend to technology and the sciences, saving researchers time and resources in measuring and transferring liquids. Pipettes now serve as an icon of the scientific pursuit of knowledge – we’re all familiar with the close up of the gloved hand and pipette tip hovering over some glowing liquid. It’s banal, efficient and ubiquitous. It’s the dogged, unsung hero of the lab but there were several decades when our method of pipetting was also a microbial misadventure in the waiting.

Resources

“There are reports of laboratory infections by means of the pipette with quite a variety of microorganisms. In the intestinal group: typhoid, Shigella, salmonella, cholera; among others, anthrax, brucella, diphtheria, hemophilus iniluenzae, leptothrix, meningococcus, Streptococcus, syphilis, tularemia; among viruses, mumps, Coxsackie virus, viral hepatitis, Venezuelan equine encephalitis, chikungunya, and scrub typhus.” Download this neat article on the history and epidemiology of lab-acquired infections here.

Want to see more pictures of mouth pipetting? Of course you do! I’ve been collecting them on the Body Horrors tumblr here, here, here, here and here. Here’s a sign. And here’s a riff on a meme.

References

1) AG Wedum. (1997) History and epidemiology of laboratory-acquired infections. J Am Bio Safety Assc. 2(1): 12-29

2) Phillips GB &Bailey SP (1966) Hazards of mouth pipetting. Am J Med Technol. 32(2): 127-9

3) JA Martin (April 13, 2001) The Art of the Pipette BiomedNet Magazine100

4) S Nasim et al (2012) Biosafety perspective of clinical laboratory workers: a profile of Pakistan. J Infect Dev Ctries. 6(8): 611-9

5) FO Omokhodion (1998) Health and safety in clinical laboratory practice in Ibadan, Nigeria. Afr J Med Med Sci. 27(3-4): 201-4

6)B Boyer et al (1998) The microbiology “unknown” misadventure. Am J Infect Control. 26(3):355-8

7) DL Sewel (1995) Laboratory-Associated Infections and Biosafety. Clin Micro Rev. 8(3): 389-405

ResearchBlogging.org
HILL, N. (1999). Laboratory-acquired Infections: History, Incidence, Causes and Preventions, 4th edition. Eds. C. H. Collins and D. A. Kennedy. Butterworth Heinemann, Oxford 1999. Pp. 324. ISBN 0 7506 4023 5. Epidemiology and Infection, 123 (1), 181-181 DOI: 10.1017/S0950268899002514