Deadly Tropics Game
Donnie Ehlen
Melioidosis, a difficult to diagnose deadly bacterial disease, is likely to be present in many more countries than previously thought, reports a paper published online today in the journal Nature Microbiology. The study predicts that melioidosis is present in 79 countries, including 34 that have never reported the disease.
It recommends that health workers and policy makers give melioidosis a higher priority, and expects the number of melioidosis cases to rise as diabetes increases across the tropics, especially among the poor, and international travel increases the risk of introducing the pathogen to new areas.
'Melioidosis is a great mimicker of other diseases and you need a good microbiology laboratory for bacterial culture and identification to make an accurate diagnosis. It especially affects the rural poor in the tropics who often do not have access to microbiology labs, which means that it has been greatly under estimated as an important public health problem across the world,' said Dr. Limmathurotsakul.
We do know that killer whales found in the tropics look different from killer whales in the northeast Pacific. Like killer whales seen in other tropical areas, killer whales seen around Hawaii have faint to non-existent saddle patches (the pale area behind the dorsal fin). Adult males tend to have a shorter dorsal fin, proportionally, than their northeast Pacific brethren.
Background: Acute diffuse peritonitis is a common surgical emergency worldwide and a major contributor to non-trauma related death toll. Its causes vary widely and are correlated with mortality. Community acquired peritonitis seems to play a major role and is frequently related to hollow viscus perforation. Data on the outcome of peritonitis in the tropics are scarce. The aim of this study is to analyze the impact of tropic latitude causes of diffuse peritonitis on morbidity and mortality.
The power of the tropics and the strength of the storm surge will never be controlled. It is up to the individual and the community to educate themselves about their local hazards and to stay informed when any tropical system threatens.
The aim of this study is to identify the most common causes of diffuse peritonitis in the tropical latitudes and their relative contribution to morbidity and to death toll. The ultimate goal is to help surgeons identify cases which are likely to require a more aggressive therapy and rationalize the decision to refer patients towards a center with an intensive care unit. We hypothesized that peritonitis secondary to peptic ulcer perforation was the highest contributor to death toll in the tropics.
Our study suggests that spontaneous perforation of small bowel, usually typhoid fever related is a substantial problem especially in paediatric populations. Also, peptic ulcer perforation is still a major concern in these areas of the world. Septic complications of illegal abortions also require a specific attention. Large proportion of patients with diffuse peritonitis still present to the hospital with unacceptable delays and this probably accounts for the high incidence of sepsis and high MPI scores at the time of diagnosis with the consequences that it entails in terms of outcome. In settings with limited technical background, the diagnosis of this common clinical entity can still rely largely on clinical arguments. Patients operated on for diffuse peritonitis are likely to develop wound dehiscence, sepsis, prolonged paralytic ileus or multi-organ failure. These complications often occur in combination especially in those with typhoid related small bowel perforation, and can be deadly in more than 15 % of cases. The highest contributors to death toll are all cases of peritonitis originating from bowel perforations, especially those related to complications of typhoid fever which is endemic in the region.
Morbidity and mortality rates are extremely variable and do not seem to be superior in settings with a limited technical background [4, 8, 9, 18, 28, 29, 39, 45, 52], even in tertiary peritonitis [38]. The mortality rate reported in our study is unacceptably high. This is probably a direct consequence of some of the local conditions of surgical practice such as the scarcity of surgeons, the lack of appropriate diagnosis and management tools and the socio-economic conditions characterized by the total absence of social security even for such critical and potentially deadly conditions. Also, they are no clear standards and guidelines for the management of surgical emergencies which are adapted our settings. However, this heavy mortality rate is not exceptional. It is comparable to what have been reported in other regions and countries with similar settings [43, 46]. Even in some western countries, overall complication rates as high as 41 % have been reported [39, 45].
The tropics typically have less variable temperatures. For example, Singapore sits almost on the equator and its daily maximum is about 32C year round, while a typical maximum in London in mid summer is just 24C. Yet London has a higher record temperature (40C vs 37C in Singapore).
World Weather Attribution, an international rapid response climate science organization, said its analysis of the storms was hampered by a shortage of weather data for this part of Africa, so they could not quantify exactly how much climate change influenced the event. Lack of accurate long-term data has also hampered efforts to prepare for other deadly climate extremes like heat waves in southern Africa.
The pace of the storms was so intense that millions of people were repeatedly exposed to deadly threats in just the span of just six weeks, without any time in between to recover. Tropical Storm Ana hit in late January, followed by Tropical Cyclone Batsirai, in early February, and then Tropical Storm Dumako and Tropical Cyclones Emnati and Gombe.
Global warming not only intensifies individual events, it also compounds impacts, such as the multiple tropical storms that hit southeastern Africa, and the deadly Pacific Northwest heat wave last summer that was quickly followed by extreme fires.
The Indian Ocean has made its mark on the global news cycle this year. In March, tropical cyclone Idai made headlines as one of the most severe storms to have made landfall in Mozambique. Current estimates indicate that more than 1,000 people died. This makes it the most deadly tropical cyclone ever to have made landfall on the southern African subcontinent.
Habitat loss and overexploitation are two of the main causes of biodiversity loss on the planet [1]. Amphibians are also threatened by chytridiomycosis [2], [3], an infectious disease caused by the chytrid fungus Batrachochytrium dendrobatidis (Bd). In recent decades, more than 40% of amphibian species have become vulnerable to extinction [1], and Bd has been detected in at least 48% of the amphibian species studied worldwide [4], [5]. In the tropics, drastic amphibian declines in forested protected areas have been clearly associated with chytridiomycosis [6], [7].
In the Neotropics, dramatic amphibian declines associated with Bd infection have been extensively documented in highland forests [6], [8], [9], [10] where the greatest losses in species diversity and population abundance in response to establishment of the pathogen have been described [11]. Moreover, a wave of infection spreading from Mexico down through Central America to Panamá has been thoroughly described [12], [13], [14]. In addition, Bd infection has been spreading across highland forests in South America including the Colombian Andes [15], [16], [17]. Thus, the Darién region of Panamá and Colombia is considered one of the last Bd naïve areas in Central America. Although invasion of Bd was thought to be inevitable, no surveys before this study have confirmed the presence of the pathogen into this region. However, in 2010, two frogs out of 93 individuals were infected with Bd in Tortí, a site at the Panamá Province close to the Darién [18].
Previous studies in the Neotropics have focused on studying Bd infection in all or the majority of the species present in a site [6], [10], [13], [15], [19], [20]. Instead, we focused on obtaining larger samples of three species that are abundant in the lowlands to test for differences in pathogen infection levels. In this respect, our study shows that infection levels on C. fitzingeri can be significantly higher than A. callidryas and D. ebraccatus in sites like Soberanía. These three species persist in infected sites in both the highlands and lowlands of Panamá (Hughey and Ibañez, pers. obs.); however, differences in their life history and behavior may play a major role in the way they contend with chytridiomycosis. Evidence for differential patterns of Bd infection has been previously shown in amphibian species with different habitats and breeding behaviors [19], [22], [32], [33]. Treefrogs like A. callidryas and D. ebraccatus live in a very different habitat in comparison with terrestrial species such as C. fitzingeri. Bd has previously been detected in C. fitzingeri and other leaf litter dwellers from the Craugastoridae and Dendrobatidae families occurring in the lowlands, and therefore it has been suggested that Bd could be present in the moist forest floor [10], [18], [43]. Moreover, environmental variation, such as temperature and moisture, in local habitats (terrestrial versus canopy habitats) may play a major role in the persistence and colonization capacity of the pathogen [22], [34], [44], as well as in the potential host response to Bd exposure [45]. In addition, environmental fluctuations throughout seasons are also important factors involved in the fungal disease dynamics [22], [46]. The data shown here were obtained only during the breeding season (rainy season) and therefore our study does not address the infection prevalence and intensity fluctuations that might occur throughout the year. Collecting seasonal data for these species will be important to understand disease dynamics in the lowlands.
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