LGV mimicking IBD in Austin


Original Title: Lam_184cc.jpg
Depicted in this 2007 photograph, CDC microbiologist Dr Cheng-Yen Chen, was shown preparing a pyrosequencing experiment in order to differentiate between Chlamydia trachomatis L-serovars responsible for lymphogranuloma venereum (LGV), and other chlamydial serovars. Organisms of the same genus are further subdivided into serovars, or serotypes, which group these organisms based upon their constituent intracellular antigenic profiles.Dr. Chen is a National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) staff member, who works inside the center’s Laboratory Reference and Research Branch (LRRB). Image credit: CDC/ Hsi Liu, Ph.D., MBA, James Gathany



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.

False: Flu vaccine is only 10% effective this season

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.

Historically, vaccine effectiveness in the US has ranged from 10%-60% beginning 2004-2005 season to 2016-2017 season (https://www.cdc.gov/flu/professionals/vaccination/effectiveness-studies.htm). Do we have the number yet for this season? No, because the flu season has not ended yet and therefore all the numbers that are given out are just estimate and are subject to change. Even if turns out to be 10% at the end of the season, does that mean we shouldn’t have used the vaccine? No, because if people are going to get sick, you want all the protection you can get from complications and death (one example: http://pediatrics.aappublications.org/content/early/2017/03/30/peds.2016-4244?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token). We know flu kills. Car accident kills. Would you want to be in an accident without a seat belt?

How flu kills

CDC/ F. A. Murphy

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.