Mystery Cases - odd infections

       The initial reports of 1981, including the full-length articles published in the prestigious and widely read New England Journal of Medicine in December 1981, described other odd infections.  These infections were so uncommon in industrialized countries that most physicians in the United States had never heard of them. Nevertheless, they were serious, aggressive, and deadly. Doctors and public health officials were trying to grasp what was happening—vigorous young men were being hospitalized for and dying from infection in the latter part of the twentieth century. It just was not computing.

Acquired Immunodeficiency Syndrome(AIDS): A Late-Twentieth- Century Infectious Disease

     Prior to 1981, it was generally believed that medical science in industrialized countries had advanced to the point where infections and infectious diseases were no longer a threat. For one thing, several effective antibiotics were available. Penicillin and related antibiotic drugs (e.g., ampicillin) that destroy bacteria—as well as newer, more powerful, antibiotics— were able to tame infections that had been at one time life-threatening diseases (e.g., tuberculosis, pneumonia, and syphilis). In addition, strep throat (an infection caused by the bacterium Streptococcus pyogenes), common ear infections, and dermatologic (skin) infections could all be handled by a 7- or 10-day course of antibiotics taken at home in the form of pills, a liquid solution, or ear drops.

     Other antimicrobial drugs to fight microorganisms other than bacteria were available or would be soon. For example, antiviral drugs that attack viruses were just coming to the fore in the early 1980s. The antiviral drug acyclovir, in particular, was almost revered as a wonder drug by physicians and medical researchers. Acyclovir could halt the herpes viruses that cause cold sores, chicken pox, and genital herpes, leading to the disappearance of outward signs of infection. Just prior to 1981, newly discovered antifungals were found capable of inhibiting the growth of yeast and molds responsible for fungal infections that affected diabetics, organ or bone marrow transplantation recipients, and frail elderly patients.

   In many ways one can think of the middle of the twentieth century as the end of one of the most important social revolutions in history, the virtual elimination of infectious disease as a significant factor in social life. —Sir F. Macfarlane Burnet, M.D., Nobel Laureate, 1962

Twenty-first century will continue to produce major advances in medicines

   The twenty-first century will continue to produce major advances in medicines and medicine delivery. Nature is, however, a resilient foe. Diseases and organisms develop resistance to existing drugs, and new drugs must constantly be developed. (This is particularly true for anti-infective and anticancer agents.) Additionally, new and more lethal forms of existing infectious diseases can develop rapidly.

    With the ease of global travel, these can spread from Timbuktu to Toledo in less than 24 hours and become pandemics. Hence the current concerns with avian flu. Also, diseases that have previously been dormant or geographically circumscribed may suddenly break out worldwide. (Imagine, for example, a worldwide pandemic of Ebola disease, with public health agencies totally overwhelmed.) Finally, there are serious concerns regarding the possibility of man-made epidemics occurring through the deliberate or accidental spread of disease agents—including manufactured agents, such as smallpox with enhanced lethality. It is therefore imperative that the search for new medicines continue.

The Use and Abuse of Drugs

       For thousands of years, humans have used a variety of sources with which to cure their ills, cast out devils, promote their wellbeing, relieve their misery, and control their fertility. Until the beginning of the twentieth century, the agents used were all of natural origin, including many derived from plants as well as elements such as antimony, sulfur, mercury, and arsenic. The sixteenth-century alchemist and physician Paracelsus used mercury and arsenic in his treatment of syphilis, worms, and other diseases that were common at that time; his cure rates, however, remain unknown.

    Many drugs used today have their origins in natural products. Antimony derivatives, for example, are used in the treatment of the nasty tropical disease leishmaniasis. These plant-derived products represent molecules that have been “forged in the crucible of evolution” and continue to supply the scientist with molecular scaffolds for new drug development.