Rabies dispatch from Malaysia

Just a few days ago, I arrived here in the heart of Malaysia. 

The capital, Kuala Lumpur, is a clean, orderly and modern city. KL, as it is affectionately known, is a thriving gateway to Southeast Asia. 

Shiny sky scrapers are clustered about the city center, motorcycles and cars pulse through the streets, banyan trees and thickets of bamboo offer oases of shade, while thick humid air enshrouds everything in unbearable heat.  At night, the Petronas towers shine like crystal. Wow!

I came here for the 13th annual International Congress on Infectious Diseases.  Doctors and scientists from all of the world met to review the latest drugs, emerging diseases, HIV/AIDS, parasitic infections and tropical medicines - it was an exciting time. 

Luckily, there is no rabies here.  Decades ago, the government resolved to eliminate that threat.  Dog control with vaccination and round-up of street animals was authoritarian but effective.  Rabies had no place to hide.  The WHO officially recognizes Malaysia as rabies-free.   Occasional rabies cases may cross over from border countries, but are quickly stamped out.

Many countries in Asia still struggle with rabies. Depending on resources and commitment, the situation varies. In Thailand, for example, the government curbed human rabies by providing free anti-rabies vaccines to anyone exposed. Expensive, but effective, human rabies cases number only a dozen or so per year. In the Philippines, reductions in rabies suffering are anticipated with the passage of the “Anti-Rabies Act of 2007″ (Republic Act No. 9482).  This law commits to wiping out rabies by 2020 from those islands.  Hopefully it will occur sooner, and with more resources it certainly could. 

RFW is gearing up to support more dog vaccination projects in the Philippines through our click2vaccinate program.  Dispatching rabies from the Philippines remains our primary goal.  We have alot of work ahead of us!

Travelers to Malaysia should check out the CDC website and confer with a travel medicine specialist before their trip.

RW

MRSA - a ’superbug’ explained

There has been a lot of media buzz about MRSA recently. In a way, it is good that finally some attention is being paid to this problematic ‘superbug’. There should be more health education in this country, as evidenced by the palpable fear spread by these news headlines.

MRSA or Methicillin Resistant Staphylococcus Aureus has actually been around for decades. Humans and microbes have been engaged in an ongoing battle ever since the development of the first antibiotics. Penicillin came into widespread use in the 1940s. Staph aureus or ‘Staph’ pretty soon figured out a way to overcome this ‘poison’ and resistant strains started emerging. Penicillin at first seemed like a ‘miracle’ drug. Patients who were supposed to have died from infections were saved!

I remember an old retired doctor, Dr. Chotkowski, who lived at the end of our street. He described to me his first time using penicillin in 1943 to save the life of a young girl from Staph sepsis. In those days, big doses were given with big needles in the butt. Painful to think of, but at least this girl lived thanks to this new medical breakthrough.

The story of Rose, AIDS survivor

I just had lunch the other day with ‘Rose’, one of my AIDS patients.  It was the greatest thing, to see her – just like a ‘normal’ person. 

Who would believe that just last year, Rose nearly died from a terrible opportunistic infection called ‘Cryptococcus’. 

When Rose came into the hospital, she was thin, wasted and very weak.  She had been having fevers for sometime.  AIDS had been ravaging her immune system and without those defenses, she was extremely susceptible to infection.  Certain types of infections tend to occur in advanced AIDS, and she was now fighting a battle with Cryptococcus neoformans, a nasty fungus.  By the time she came in, this fungus was ‘everywhere’ – it was growing out of her blood. 

We put her on the most powerful medicine we could – amphotericin, or ‘ampho-terrible’.  It was a difficult medicine to take, especially for someone so sick.  Her blood levels dropped to less than half of what they should have been, her electrolytes were profoundly deranged , she felt weak and feverish.  There weren’t any options though – we had no choice but to try and treat her, or face certain death. 

HIV needlestick!

A good friend of mine who works as a nephrologist was putting in a dialysis catheter. She had done many ‘lines’ before and this one was just routine. The catheter looked like a very large needle with tubing attached. The catheter or dialysis line provides access to the blood stream to provide the patient with life saving hemodialysis. When the kidneys fail, a patient will die in a very short time without dialysis, as toxic levels of metabolites build up.

She accessed the neck veins and got a good flow of blood, indicating the line was in position. She finished up the placement and was preparing to give some fluids to flush the line clean. Now that the ‘hard’ part of placing the line was done, her attention lapsed ever so slightly. While preparing the fluids, she inadvertently stabbed the needle through her glove and into her finger. A lancinating pain ran up her arm – it was a bad ‘stick’ or injury. The needle had penetrated through and through her finger.