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Historical Dermatology & Vaccines 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 20th 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-14th 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 9/24/2019 UCSF Fresno Mini Med School 2019 8 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 9/24/2019 UCSF Fresno Mini Med School 2019 12 9/24/2019 Small Pox Small Pox Variola major, Variola minor Inoculation in China-10th century widely practiced by the 16th century, Ming dynasty In 1796, Edward Jenner- cowpox 1802 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 9/24/2019 UCSF Fresno Mini Med School 2019 14 9/24/2019 Aral small pox incident Vozrozhdeniya Island UCSF Fresno Mini Med School 2019 15 9/24/2019 UCSF Fresno Mini Med School 2019 16 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 9/24/2019 UCSF Fresno Mini Med School 2019 18 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”) Facescalptrunk, 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 9/24/2019 UCSF Fresno Mini Med School 2019 22 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 9/24/2019 UCSF Fresno Mini Med School 2019 25 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.
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