Sunday, January 25, 2015

A two'fer

January: the peak of flu season, the aftermath of the holidays, and my birthday month. To celebrate all of those things, you get a two'fer today. Two subjects, one post.

Before I dive in to my two topics for today, I wanted to remind you that the Ebola outbreak is, unfortunately, still going strong. Just because the news no longer finds it new, doesn't mean it's over. Just because someone made "Ebola patient" Halloween costumes and oh, Halloween was so long ago, doesn't mean it's over (also, you should be ashamed of yourself if you donned that, or any version of that costume). As of yesterday, the outbreak has killed more than 8,600 people. I encourage you to stay informed via the Ebola Map.

Anyway...back to our regularly scheduled program:

Let's play GUESS THE DISEASE!

In 1757, a Scottish physician by the name of Francis Home proved that ___________ was caused by an infectious agent in the blood of afflicted patients.

In 1912, __________ became a "nationally notifiable" disease in the US, meaning that all health care workers were required to report all cases, as approximately 6,000 deaths were caused by _________ per year.

In the 1950s, nearly all children got __________ by the time they were fifteen years of age, causing scientists and the federal government scrambling to find a solution. In 1963, a vaccine was finally available. Thanks to the development and approval of the vaccine, the US government aimed to eradicate _________  by 1982. While this didn't completely happen, cases were decreased by 80% from 1980 to 1981.

In 2000, _________ was declared eliminated in the US.

Have you figured it out yet? Better yet, have you caught it, yet? (haha I'm so funny)

Still stumped? Here's one last hint:

Photo courtesy of the Centers for Disease Control and Prevention
It's Measles! The famous Morbillivirus is back in a big way, and is running rampant at one of the happiest places on earth. Measles (or Rubeola) is a highly contagious negative-sense single strand RNA virus of the paramyxoviridae family that is illustrated by symptoms in the respiratory tract, skin, and immune system. The obvious rash (seen above) is often accompanied by a hacking cough, Koplik's spots, red eyes, and high fever. Measles is an airborne virus and is dependent on aerosolization (coughing, sneezing) in order to spread properly. The virus can "live" in aerosolized droplets for up to two hours on a surface. Assuming there are no complications, measles usually runs its course in about 7 to 10 days (like a gross case of the flu).

So, why do we care? Why was the US government in a rush to eradicate such a disease?

Measles is really prominent in children, and children usually don't have an immune system that can withstand stubborn viruses with a history. A lot of children (actually one out of every 20 kids infected) end up developing pneumonia as a result of a measles infection, which is actually the leading cause of death from measles in young children. About one out of every 1,000 children that are exposed to measles can develop encephalitis, which can cause permanent brain damage due to excess swelling. Ear infections associated with measles (affecting 10% of infected kids) can result in permanent hearing loss.

It's estimated that over 16 million people visit Disneyland every year, with attendance fluctuations based on holidays and common school schedules (like summer break). That's almost 45,000 people PER DAY in a place were everyone is touching everything from handrails to harnesses, from interactive displays to the bric-a-brac in all of the shops.

In the latest measles outbreak, that officials are saying started at Disneyland, a handful of employees were also infected. I bet a lot of those employees were vaccinated as children, but since Disney hires people from around the world (I say this as a fact that I applaud because everyone should be able to live out their dream of working at Disneyland... and because I desperately want to be Maleficent), I bet a good chunk of their employees didn't grow up in areas that enforce strict vaccination requirements for school-aged kids. Vaccination requirements vary by state, by country, and some are better enforced than others. Plus, school-based vaccination requirements don't usually include home-schooled kids.

I'm not going to launch into some diatribe on how I feel about vaccinations (I'm sure you know already if you read my blog regularly), but I will say that the MMR vaccine (that's Measles, Mumps, and Rubella in a combination vaccine) has lead to a 99% reduction in infections, compared to the pre-vaccine era (prior to 1963). If you aren't sure about your vaccine history, I heavily encourage you to go get an Antibody Titer Test done. A titer will tell you what antibodies you have the ability to produce, whether from vaccines or direct exposure, and will tell you which ones your body isn't able to currently make, meaning you haven't been exposed, or you need an additional vaccination or booster. Not only could this simple test save your life, but it could also save the lives of others that may not be able to fight off diseases. If you're vaccinated, it's like saying "Hey disease! You'll have to get through me first before you can infect this baby, that old lady, or that person with a compromised immune system. OH WAIT, YOU CAN'T!"...and suddenly you're a hero.


I also want to remind you that its not just Disneyland, and its not just measles. Think about how many people you encounter every day, and how many people your family members encounter. Who knows what you've touched! I take the bus every day to work, and I can't tell if it's making my immune system stronger, or taking years off of my life.



Speaking of taking the bus, here's your second subject!!

I've been reading a lot since I've started taking the bus to work. I mean, reading for fun. This is the first time in probably 20 years that I've really had time to read for fun, to read for ME, and I love it. In fact, I've already finished my first book of the year, and while it wasn't science-related, there were some topics that really interested me.

The book I just recently finished (because I seriously couldn't put it down) was Unbroken by Laura Hillenbrand, which details the life of Louis Zamperini and his experiences during World War II. It is heartbreaking and amazing. I cried multiple times on the bus while reading this book (what, Zamperini reminded me a lot of my late grandfather, so it was extra emotional for me).

I won't spoil the book, but there are a number of chapters that talk about the life of American and Allied men that were caught and held as POWs in Japan. One of the most prominent health issues that was seen in these camps was beriberi. Beriberi is an illness that occurs as a result of severe thiamine (vitamin B1) deficiency, without infectious agent, and presents in two ways: wet beriberi and dry beriberi.

Wet beriberi affects the cardiovascular system, causing shortness of breath, increased heart rate, and swelling of lower extremities. Dry beriberi, or Wernicke-Korsakoff syndrome, affects the nervous system, and can cause loss of feeling, paralysis, difficulty walking, mental confusion, strange eye movements, pain and vomiting. Both wet and dry beriberi can become severe very quickly, and can lead to permanent damage and death.

Thiamine deficiency is common in developing countries, especially regions with restricted access to food due to war, severe economic conditions, and environmental conditions that make it difficult to grow or access food. I bring this up because it's easy to read a book like Unbroken, and think about beriberi as an issue that only hurt POWs during WWII, because you stop hearing about it once you finish the book. I encourage you, as you read books or whatever you're looking a online, to do further research and teach yourself something new. LeVar Burton would be proud of you.

Monday, December 1, 2014

World AIDS Day 2014

World AIDS Day 2014 Poster from CDC.gov
This morning I scrolled through the last few years of entries on this blog, looking for a World AIDS Day post to which to link. I then realized that I am lazy and less empowered than my younger self. My whole world used to be consumed by HIV, so to speak.

While in high school, I learned that one of my most honored relatives was HIV positive, and I instantly changed my path to learn everything about the unknown. They didn't stress how scary this virus can be, and usually is, while I was young. It was a monster from the 80s that wasn't scary anymore, which is entirely inaccurate (well, not the 80s part). All of the sudden, someone I knew had been infected, and by the time I went to college, that number had exploded.

I ran the free HIV testing clinic in college, and advocated for a better educated, a more empowered sexually active youth culture. I volunteered and then later worked for Planned Parenthood, and supported every client without judgement. As a health educator, I taught college freshman, whom had never had any exposure to sex ed, about the basics: everything from basic anatomy, dispelling menstruation myth, STIs, etc. I even researched HIV for my graduate thesis. There was a time in my life where I felt like I was talking about HIV every day. But people still weren't concerned.

New statistics show that only 4 out of 10 people in the US who are infected in HIV in 2011 were receiving HIV-specific medical care (meaning regular monitoring, access to medication, viral suppression, etc.). Approximately 3 in 10 people with HIV in the US had achieved viral suppression, which is a critical factor in continuing to live and thrive with the infection. According to the CDC, 76% of people who receive HIV medical care achieve viral suppression. That means 46% (yes, almost half) of people with HIV in the US either don't have access to adequate care, don't know about it, don't know that they have HIV, or are refusing care. I shouldn't have to point out that these are only statistics for the US, and access to care on a global scale is much worse. 

via CDC.gov


Now that I've made my way back into my field (after my 3 year stint with NASA),  I find myself getting really frustrated and feeling really helpless about HIV. It wasn't until this year that I realized how distanced I've become. Honestly, I'm a little embarrassed, because this is such an important topic for me.

So, I'm going to strive to reinvent my commitment to advocating for patients, for access to care, for continued funding, and for access to real education. We need to be frank about this subject, because it's not going away anytime soon. As far as I'm concerned, we probably wont find a cure within the next 10 years (as some people are claiming), and even if we do, the focus needs to shift to continuing to support those who are infected, and those who are at risk of becoming infected.

Even though World AIDS Day is coming to an end for this year, make it a point to start talking about HIV, and get empowered to get tested regularly. Use the resources that are available in your community, and learn how you can protect yourself. AIDS is everywhere, and we need to stop pretending that it's a thing of the past.



Tuesday, November 25, 2014

2014 Outbreaks: Plague Edition

This is the time of year where you are supposed to feel thankful for all the things you have in your life, whether its family, friends, stability, purpose, faith, or maybe even physical things. But, honestly, this year has been hard to feel truly thankful, scientifically speaking. There's been a lot of distrust, a lot of fear-mongering, and a lot of really terrible journalism that has made people (primarily Americans) really hate any scientist (or doctor, or medical professional) that isn't Neil DeGrasse Tyson. But guess what: we aren't lying to you, and we are doing the best we can to figure things out thoroughly and efficiently. Funding is at an all time low, support for major research is very political, and there is a surplus of newly graduated PhDs that aren't being utilized. Science is simultaneously really hard and really amazing right now.

Now that I've said all that, we can focus on what's happening right now in science: the plague.


You may remember learning about the bubonic plague in middle school, when your history classes were covering the middle ages, and it was the perfect time to talk about disease in science class (because let's face it, the middle ages were gross). I'm guessing you learned about it and immediately let yourself forget about it because you figured "well, that's over and done with so I'm safe."

Surprise! Approximately 40 people have died from the plague in Madagascar this month, and there have been approximately 120 cases reported.

But, look, this isn't shocking. In 2012, I even wrote about how there was a confirmed plague case in a rodent in Los Angeles. But, it is shocking in the sense that we haven't seen anything near "outbreak" proportions since the middle ages (and you have public health to thank for a majority of that!).

Yersinia pestis, the bacteria that causes the plague, is most often (not really often, per say) seen in animals, and is rarely transmitted to humans anymore. The middle ages were different, though. Animals (and fleas!) lived in very close quarters with families. Since hygiene wasn't really a fad yet, diseases like the plague would spread incredibly rapidly. In some countries, 50% of the population was wiped out.


There are three different forms/presentations of the plague:
  • Bubonic plague, which is transmitted by fleas and causes bulbous swelling ("buboes") around the lymph nodes
  • Pneumonic plague, which is respiratory, and spreads between humans via aerosolization and contact with fluids
  •  Septicemic plague, which is an infection of the blood
The bubonic plague can be treated with antibiotics, but pneumonic plague is incredibly deadly. In some incredibly severe cases, it can kill you after only 1 day of infection (not including the incubation period).
I am particularly nostalgic for the plague because it was the first real disease that caught my attention. Not only do I remember becoming completely infatuated with diseases, but I still have the report I wrote about the plague in 7th grade. Maybe if you really hope for it, I'll scan it and post it for you to laugh at. Tis the season for miracles, after all... right?

So, while you are sitting around, eating ridiculous amounts of food, try to be thankful for the advancements that have been made in science and health. If you have access to potable water and a waste treatment system, then you should be extra thankful. If you've had access to education, whether you've taken advantage of it or not (no judgement either way), then be overjoyed. Think of all the things that have changed since the middle ages, and be thankful.


Sunday, November 2, 2014

Secret Benefits to Thalassemia, Round 2: Email Inquiry

I get emails from people asking for me to diagnose them based on images of maggots that they found on their skin, a peculiar rash they've had for years, or something they found in their poop. I have to say, I love these emails. If anyone is worried about the NSA spying on their email activity, it should probably be me, because my inbox is full of stuff that could be considered private medical information, and I am not an MD.

But sometimes I get legitimate questions, like this one that I featured on my blog forever ago (don't worry, I always ask if they mind if I post their questions). Recently, I got a really interesting and smart question from an anonymous reader. The email said:
Dear Doc,  is there an immunity of reduction of Ebola with people who have beta-thalassemia? Or is it just the opposite, a more susceptible case for those with beta-thalassemia?
If you don't remember what beta-thalassemia is, or why it might be "beneficial" (I say this loosely, as it's not necessarily a good thing to have), feel free to brush up by reading this old post about it and it's relationship with malaria.

Image from the American Society of Hematology
To recap, thalassemia is a disease associated with globin gene mutations (both α- and β-globin genes can be mutated, yet α-globin mutations are most common). Since your α- or β-globin gene is recessively mutated if you have active Thalassemia, your red blood cells develop into malformed, or "sickled", cells, thus inhibiting their affinity to bind and transport oxygen (see image above for a great example). This lower affinity can cause extreme cases of anemia. In major cases, treatments such as chronic blood transfusion therapy, splenectomy, transplantation and iron supplementation are used. Thalassemia would make a great potential candidate for genome editing therapies that are still in the research stage (yes, I know that article is about hemophilia, but it's a good example).

So, why is this anonymous question a great one? Simply put, it doesn't really have an answer. There isn't any research being done to look into populations that aren't as affected by Ebola right now, as far as my searches have illustrated. This might be because most research that's being done is to either understand the physiology of the virus, to identify all possible vectors (yes, most evidence point to bats as the vector, but I'm still not convinced), or to come up with therapies/treatments and vaccines.

But the submitted question addresses an important point: thalassemia, specifically β-thalassemia is really prevalent in Nigeria (25% of the population are carriers for Sickle Cell Disease, while another 25% is hemizygous for the G6PD gene), and other parts of Africa. So, why isn't this being looked into? I can't answer that. I don't know. All I can say is maybe it isn't yet. I'm sure now that Ebola is in the spotlight, there will be a new emphasis on funding down the line for exploratory research.

In my fervent literature search to find an answer for the anonymous email, I did find that similar research has been done to look at the effects of thalassemia on hemorrhagic fevers (specifically Dengue Hemorrhagic Fever), mostly in Thailand and Southeast Asian countries. It turns out that patients with thalassemia don't necessarily have any higher risk, or even less of a risk (as seen with malaria), of getting hemorrhagic fevers, as my anonymous email inquiry asked. But, they do present differently, meaning their symptoms may seem different than infected people without thalassemia. Most normal (non-thalassemia) patients show signs of hemoconcentration (or an increase of solids in the blood), but patients with thalassemia present anemia (which is the opposite). This is the main symptom that presents differently, but its a really important one. Other symptoms also reference changes in AST and ALT levels, which illustrate the concentration of enzyme in the liver, heart and muscle cells, and can indicate liver function.

Hemoconcentration is really important during the diagnostic phase, and to track how the infection is progressing. So, if, instead, your patient is presenting with the exact opposite, it might lead to misdiagnosis. Also, if a patient with thalassemia, who is also infected with dengue hemorrhagic fever, is showing anemia, it needs to be watched. The three papers I linked to above talk about new suggested courses of action for patients with thalassemia, like frequent blood transfusions.

So, anonymous emailer, the answer is probably not. The biggest risk that thalassemia would give you is misrepresenting symptoms, which can lead to improper care. Yes, that can be really dangerous, especially with hemorrhagic fevers. But, luckily, if you have a high fever and other viral (standard) infection symptoms, your doctor will usually run other diagnostic tests (like an ELISA or PCR, etc.). That's why they always ask you questions about where you've been, what you've been in contact with, and other patient history questions.

This is definitely research that should be done, even if it starts with a retroactive epidemiology study.

Thanks for your question!

If any of you have other questions, feel free to email me at microscopic.blog@gmail.com!


Wednesday, October 15, 2014

Shift, Not Drift

There have been a few reasons why I haven't been updating my blog lately.

1. I've been trying to get a side-blog up off the ground with a good friend. It has nothing to do with science, but if you are interested in reviews of vegan candies from around the world, you can check it out here.

2. My main project at work was coming to an end, and I was in a mad dash to collect some final data and write up a massive report, summarizing all of the work I did to support the project for the last 3 years. I'm sure you can imagine how time consuming that was.

3. I've been working on creating some content on antibacterial resistance for Khan Academy, but the editing and re-writing process has taken longer than I initially anticipated.

aaaaand, lastly:

4. Given the fact that my previous project with NASA was ending (now: has ended), I decided that it was time for me to take the plunge back into my original research field: virology. Tomorrow is my first day as a researcher for Stanford University's School of Medicine, specifically in the pediatric department and infectious disease division! Yes, that's right, I'm leaving the world of life support and heading into a world of dengue fever and chikungunya!

Side note: how wild is it that I had just posted about chikungunya? Totally weird coincidence.

So, as I transition into this new job, I hope you can wait patiently for my next entry. I actually have the topic already picked out, and am slowly working on creating the content. The next entry will actually be based off of a question that I received via email, and I'm really excited to dive in. (Hint: it's something about Ebola).

Thank you for bearing with me while I make this ridiculously exciting jump to Stanford! Woo!

Wednesday, August 27, 2014

Clearing the Mass Miasma

I’ve had a number of inquiries about the Ebola outbreak, whether for clarification (“what is Ebola?” or “should I be scared?”) or desperation (“I don’t know what to believe anymore!”). Let me start by saying that it’s OK to be confused or a little nervous. The media has done a great job at reporting on this terrible and unfortunate situation, but has done an even better job at making people nervous or question their ability to prepare for such a situation in their own town.

It’s always been a little aggravating to me that most science reporters or science writers don’t have a science background. There are a lot of benefits to that, such as their vernacular may not be jargon-heavy, or they might be able to cover a wide range of topics on a broad, elementary level. But, there are also a lot of writers that are feeding into the media-based hysteria to get more clicks. How do you get people to read your stuff? Scare the crap out of them.

You really can’t escape it. I’ve seen posts on Facebook to articles that detail inaccurate methods of Ebola transmission (thanks, “friends”…), and I even heard about it on the radio. Whenever I drive into work, I usually have the radio on so I can get traffic updates. A week ago, one of the personalities on a stupid morning show was talking about the isolated testing for Ebola that was happening in Sacramento (which actually happened for some missionaries, that much is true), and it really made me sad, because it solidified how little people feel they need to research the stuff they read online. Everything the deejay said was inaccurate, and all I could think about was the hundreds (thousands maybe?) of people listening at that moment...and believing everything.

But I’m not writing this to call people stupid, or make anyone feel bad about their news choices. Instead, I’m writing to give you the facts of what I’ve gathered so far. I’m not on the front lines, and I may not be a popular blogger or writer for Jezebel or Huffington Post, so I’ll it up to you whether I’m contributing to they nonsense or not.

So you want to understand Ebola. Where do you start?
If you want to understand the virus itself, you can read some of my previous entries on Ebola.

There are only a few places in the world that are allowed to research and work with any and all strains of the Ebola virus. For a long time, that list was limited to only major governmental agencies (CDC, etc.), especially research agencies that have the capability to work with biosafety level – 4 (BSL-4) pathogens. You can read more about BSLs here, but I’ll break it down for you:
  • BSL-1: all microorganisms used are not known to consistently cause disease in healthy adults and present minimal potential hazards to lab members and the environment. A good example of this is non-pathogenic E. coli, which is used in almost every lab that has ever existed. Think everything from entry level biology classes to, well, most other labs.
  • BSL-2: In addition to being able to work with BSL-1 organisms, BSL-2s can work with organisms that pose a moderate risk or hazard to lab members and the environment. A good example of this is Staphylococcus aureus.
  • BSL-3: This is a restricted environment, as the hazards are increased from BSL-1 and BSL-2. The pathogens or organisms researched in these labs can often cause lethal diseases via respiratory transmission, like Mycobacterium tuberculosis which causes tuberculosis.
  • BSL-4: Lab work involves microorganisms that are dangerous and exotic, and may or may not have a defined method of transmission yet. This is where Ebola is researcher. Researchers who work with BSL-4 organisms have to change their clothes before entering the clean room, and must shower and decontaminate all materials before leaving the research space. These researchers have to wear full body, pressurized, and air-supplied suits. This is the solitary confinement of pathogen research.
Image from Frankfurter Rundschau

Get it? It’s incredibly dangerous, and you should thank the researchers that risk their lives to perform the groundbreaking experiments that they do. If you want to read the follow-up report regarding a researcher accidentally becoming exposed to Ebola, you can download that here.

Am I at risk of becoming infected?
Unless you are a health care worker who is working with individuals who are infected and currently experiencing symptoms, your chances of contracting Ebola are slim to none.

With that being said, the only known method of transmission for Ebola is direct contact with the bodily fluids of an infected individual. If you have traveled to Africa recently, and have had contact with someone else’s bodily fluids, you may want to check in with your doctor. Once someone has recovered from the virus, they are typically no longer contagious, but the Ebola virus has been shown to be present in semen for up the 3 months post-infection.

This isn’t like our seasonal flu. Ebola is an incredibly debilitating infection that can have symptoms including high fever, headaches, muscle pain, vomiting and diarrhea, and unexpected bleeding or bruising. There have been some really sad stories about churches, mortuaries, and even entire towns banning traditional funeral and burial practices because it puts otherwise healthy people at risk.

Will the outbreak spread to the US?
The CDC has not indicated any potential risks for the outbreak to spread. Yes, there have been medical professionals and missionaries that have contracted Ebola during this outbreak, and yes, they have been brought back to the US for treatment.

BUT, there is a reason for that. Almost all the major research that has been done to figure out the Ebola virus has been conducted in the US (or in collaboration with the CDC). Experimental treatments are here, better medical facilities with isolated rooms and chambers are here. 

Let me put it this way: As of right now, there are 2,615 cases of Ebola between Guinea, Sierra Leone, Liberia, and Nigeria. There are more than 1 million individuals who are infected with HIV in the US, and 1 in 6 of them are unaware of their infection (typically due to negligence with regular testing). HIV is also spread through direct contact with bodily fluids. But, every time you go into a hospital, you don’t panic about HIV because medical facilities are prepared to handle and minimize these types of risks. Take a deep breath and don’t believe everything Donald Trump says.



What. an. ass.
OK, I believe you about the risk of getting Ebola in the US, but I’m still paranoid and want to track it every day.
That’s fine. Check out this amazing website that will give you a detailed update every time something happens with the outbreak. You can also watch an illustration of the spread of the outbreak since March 14, 2014.

What about treatments? Why aren’t there treatments?
There are currently 3 companies working on developing experimental treatments against the Ebola virus: Tekmira, Biocryst Pharmaceuticals, and Mapp Biopharmaceuticals. All of them are in very early stages of development, meaning none of them have been approved for use in humans. ZMapp is the product that is getting the most media because the experimental monoclonal antibody-based therapy was given to two US patients in Liberia.

Since this experimental therapy has not been approved, it requires each patient to consent, and understand the potential risks associated with experimental, non-approved therapies. Compared to some of the other funded research, Ebola isn't seen as a major threat. Maybe that's because we haven't seen an outbreak this large before, or that it hasn't been a threat to the US yet. Either way, it's getting the attention it needs now to really get some momentum in terms of pushing drug and vaccine development through to (hopefully) a reality.

It is possible for patients to recover and survive an Ebola infection. In order to do this, the patient needs constant monitoring for fluid balance, oxygen and blood pressure, and additional treatments for complicating infections.


This is a lot of information to digest, so I'm going to leave it at that. If you have any other questions that you'd like answered, feel free to let me know!

Sunday, June 15, 2014

That Which Bends Up

 Just before leaving for my trip to Costa Rica, I purchased a some Ultrathon insect repellent and an insect repellent bracelet. This trip was going to be my first time traveling in Central America, and I had heard that the mosquitoes were "no joke". This was also my first international trip with a group, and I had to give myself time to adjust to the fact that I would have no control over our itinerary at all (which is a big deal, because I enjoy planning everything about my trips).

I'm usually not a major target for mosquitoes here in the states. I honestly cannot remember ever really getting a mosquito bite in the past, but if you are a regular reader, you'll remember that I've had my fair share of ticks and other things. I'm sure it wont surprise you to hear that I did my research before going, and made sure I was aware of any infectious disease-related hazards. Giant spiders and venomous snakes don't really worry me, but I did my research for everything else. There's a giant list of illnesses that are prevalent in Central America, but you can research those on your own. The only real possibility of exposure was Dengue fever. I've traveled to areas that have had outbreaks of Dengue fever before, without any insect repellent, so I was already doing a better job of being prepared.

I was traveling with a group of field biologists, and I learned right away that most field biologists have absolutely no time or motivation to worry about infectious diseases. Yes, they were all prepared with their massive spray bottles of OFF! and some with their insect repellent shirts and hats. But, I've never seen so many people willingly jump after poisonous frogs, handle venomous snakes, catch bats, and handle potentially dangerous insects without a bit of hesitance. Most of it was traumatic for me (I'm more of a "let's be as unobtrusive as possible and observe from afar" type of biologist), but seeing their childlike excitement was kind of inspiring.

Speaking of excitement, here's me at a beautiful waterfall near La Fortuna.

We brought microscopes with us and stayed at the Texas A&M Soltis Research Center during a majority of our trip. The microscopes we were able to pack weren't anything fancy, just two Leica dissecting scopes and three Primostars for fluorescence work. Here are some of the images I took (the primostars didn't have cameras, so these are all taken through the oculars with my iphone):

Clockwise from the upper left:
 tree moss autofluorescing under a DAPI filter, the wing of a fly under a FITC filter, 
floral structure under FITC filter, plant structure under DAPI filter.

Anyway, the point of this blog post was not to showcase my vacation photos, but to talk about what I experienced afterward. Upon returning to work the very next day (mistaaaaake!), some interested colleagues asked if I had "brought anything back" from my trip. They weren't asking if I bought coffee or chocolate, but if I had contracted any diseases while gallivanting through the rainforest. Sure, I might have made some jokes about wanting to get myself a pet botfly larvae, but I wasn't serious. I mentioned that there was a chance I could be in an environment with mosquitoes carrying Dengue fever, and one of my colleagues said, "but there's a new one, right? It's like Dengue, but not?"

That, my friends, is Chikungunya. Chikungunya, which means "that which bends up", has been an issue since the 1950s, but reached epidemic proportions in 2004. Since 2004, Chikungunya has spread rapidly in Africa, Asia, the Indian subcontinent, Europe and the Americas. Recent spread of Chikungunya through the Caribbean islands has caused isolated incidents to show up in North America, thanks mainly to tourism.

Chikungunya is a mosquito-borne RNA virus that shares initial symptoms with Dengue fever, which often results in misdiagnosis. Most regions affected by Chikungunya don't have clinics or labs with the capability to test for both Chikungunya and Dengue fever. 

While Chikungunya doesn't have a high mortality rate, the symptoms can be excruciating. Much like Dengue fever, fever, muscle pain, headache, nausea, and fatigue are common, but joint pain and rashes are the distinguishing symptoms. Dengue has been called "bone breaking" fever for the muscle and bone pain associated with infection, but Chikungunya, or "that which bends up" was named for the contorted posture associated with the debilitating joint pain. 

Via El National

The emergence of the Chikungunya epidemic and the warnings against Dengue fever at the World Cup bring up an interesting question: in the age of synthetic biology, should we try to wipe out mosquitoes once and for all? We've been down this road with malaria and using insecticides to reduce mosquito populations, and...well, malaria is still a problem. But, if you are interested in what's being done to control mosquito populations in specific areas, I highly suggest you listen to the Kill 'Em All episode of Radiolab.

By the way, the CDC has a map tracking cases and local transmission of Chikungunya that is updated as reports of cases come in.

Check back soon for my next blog post on a disease that causes self-cannibalism!