Lymphogranuloma venereum (LGV) is a sexually transmitted disease caused by a variant of Chlamydia trachomatis different from the variant causing urethritis in men and cervicitis in women. In contrast, it causes genital ulcer in the first stage, while the second stage can be swollen, tender, and enlarged lymph nodes or proctocolitis with rectal discharge. It is endemic in tropical areas of the world. However, it has been increasingly reported in developed countries since 2003. There has been outbreaks reported in Western Europe and North America, primarily in men who have sex with men (MSM) who are also HIV-infected, mostly presenting as proctitis.
LGV is not a reportable disease in Texas. However, the last known case of it in this state was in 2013. Beginning last year, several MSM with HIV have been diagnosed with it here in Austin. Providers here in Austin should be aware of this. LGV can present as proctitis and can get mistaken for Inflammatory Bowel Disease and not get appropriately treated causing complications for the patient such as fistulae, strictures, and infertility; as well as spread of the infection itself as well as of HIV.
First of all, where did this information come from? This came from the vaccine effectiveness estimate from Australia (http://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2017.22.43.17-00707 ). More specifically, the 10% effectiveness was only for one strain, the A(H3). The estimates for the other strains were higher at 50% for strain A(H1) and 57% for strain B. The overall vaccine effectiveness was reported to be 33%. These data are out already as the flu season in Australia is during their cold season in May to September.
Given where this data came from, can this be applied to the US? On one hand, yes, because the composition of the flu vaccine in Australia is similar to that of the flu vaccine in the US. Each flu season, the WHO gives recommendation on the composition of the flu vaccine for the northern hemisphere and another for the southern hemisphere (http://www.who.int/influenza/vaccines/virus/recommendations/en/). However, in Australia, flu vaccination is recommended only for the elderly, pregnant and chronically ill (http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/ATAGI-advice-influenza-vaccines-providers). Contrast this to the CDC recommendation for the US, which is everyone 6 months and older, excluding only those with medical contraindications. This difference is important to consider because the elderly and the chronically ill are known to not respond as well to vaccines compared to other members of the population. Therefore, despite receiving vaccination, this group has increased risk of not developing immunity, as if they did not receive any vaccine at all.
Having already claimed the lives of 53 children in the US this season, flu is definitely showing its deadly side. However, it still more commonly presents like a mild illness that goes away on its own after a week or so. Thus, some wonder how people die from the flu.
What usually kill people with the flu are the complications that happen from it.
Sometimes, the whole body responds to the infection with overwhelming and dysregulated inflammation which can then lead to multiple organ failure and death. This is sepsis. In other times, the virus directly affects the lungs causing pneumonia. Bacteria can take advantage of the damage being caused by the virus and cause pneumonia as well. Also, inflammatory response can also involve the heart, causing what is called myocarditis; the brain, causing what is called encephalitis; the covering of the brain, causing what is called meningitis; the spinal cord, causing what is called myelitis; and the covering of the nerve cells, causing a paralyzing illness called Guillain-Barré syndrome.
Flu may not always kill, but it can in so many ways. So, take your flu shot. It may not completely prevent you from getting the flu. It can, however, protect you from dying from the flu.