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New Delhi, Drugs to treat common infections in children and babies are no longer effective in large parts of the world, including India, due to high rates of antibiotic resistance, a study has found.  The team led by researchers at the University of Sydney in Australia found many antibiotics recommended by the World Health Organization (WHO) had less than 50 per cent effectiveness in treating childhood infections such as pneumonia, sepsis (bloodstream infections) and meningitis. <br /><br /> The findings, published in The <keyword id="6361830" type="General" weightage="100" keywordseo="lancet" source="Orion">Lancet</keyword> regional Health-Southeast Asia journal, show global guidelines on antibiotic use are outdated and need updates. <br /><br /> The most seriously affected regions are in Southeast Asia and the Pacific where thousands of unnecessary deaths in children resulting from antibiotic resistance occur each year, the researchers said. <br /><br /> The WHO has declared that antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity. In newborns, an estimated three million cases of sepsis occur globally each year, with up to 570,000 (5.7 lakh) deaths. <br /><br /> Many of these are due to lack of effective antibiotics to treat resistant bacteria. <br /><br /> The study adds to mounting evidence that common bacteria responsible for sepsis and meningitis in children are often resistant to prescribed antibiotics. <br /><br /> The research shows the urgent need for global antibiotic guidelines to be updated, to reflect the rapidly evolving rates of AMR. The most recent guidelines from the WHO were published in 2013. <br /><br /> The study found that one antibiotic in particular, ceftriaxone, was likely to be effective in treating only one in three cases of sepsis or meningitis in newborn babies. <br /><br /> Another antibiotic, gentamicin, was found likely to be effective in treating fewer than half of all sepsis and meningitis cases in children, according to the researchers. <br /><br /> Gentamicin is commonly prescribed alongside aminopenicillins, which the study showed also has low effectiveness in combating bloodstream infections in babies and children. <br /><br /> "Antibiotic resistance is rising more rapidly than we realize," said study lead author Phoebe Williams from the University of Sydney. <br /><br /> "We urgently need new solutions to stop invasive multidrug-resistant infections and the needless deaths of thousands of children each year," Williams said. <br /><br /> The study analysed 6,648 bacterial isolates from 11 countries across 86 publications to review antibiotic susceptibility for common bacteria causing childhood infections. <br /><br /> The data collated largely arose from urban tertiary hospital settings with over-representation from particular countries, especially India and China. <br /><br /> Williams said that the best way to tackle antibiotic resistance in childhood infections is to make funding to investigate new antibiotic treatments for children and newborns a priority. <br /><br /> "Antibiotic clinical focus on adults and too often children and newborns are left out. That means we have very limited options and data for new treatments," she noted. <br /><br /> "This study reveals important problems regarding the availability of effective antibiotics to treat serious infections in children," said study senior author Paul Turner, a professor at the University of Oxford, UK. <br /><br /> "It also highlights the ongoing need for high quality laboratory data to monitor the AMR situation, which will facilitate timely changes to be made to treatment guidelines," Turner added.

Antibiotics for common childhood infections no longer effective in many parts of world: Lancet

<ul class="summary-list"><li>Doctors acknowledge that <keyword id="6385081" type="UNKNOWN" weightage="60" keywordseo="antibiotics">antibiotics</keyword> are overprescribed.</li><li>The pandemic is just making the problem worse, they say.</li><li>Overuse of antibiotics leads to increases in infection from antibiotic-resistant superbugs. </li></ul><p>The overuse of antibiotics among pediatric patients is rampant, and likely contributing to a spike in cases of antibiotic-resistant "superbugs" in children's hospitals around the United States. The coronavirus <a href="https://www.insider.com/kids-are-gaining-more-independence-during-pandemic-experts-say-2020-12">pandemic</a> could make the problem even worse, some doctors say. </p><p>A<a href="https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciaa036/5707319?redirectedFrom=fulltext"> study</a> published in October found that among hospitalized children receiving antibiotics, 26% were getting suboptimal treatment - drugs that either weren't right for the infection they had, or were unnecessary. </p><p>The data for the study was collected in 2016 and 2017, before the pandemic. Although viruses can't be treated with antibiotics, some doctors are still prescribing antibiotics to COVID-19 pediatric patients in hopes that it might help, or at least prevent subsequent bacterial infections. </p><p>Mark Schleiss, a pediatrics professor at the University of Minnesota Medical School<a href="https://khn.org/news/childrens-hospitals-are-partly-to-blame-as-superbugs-increasingly-attack-kids/"> told</a> Kaiser <keyword id="6354750" type="UNKNOWN" weightage="60" keywordseo="health">Health</keyword> News (KHN) that the pandemic "has thrown a little bit of gas on the fire."</p><p>Overprescribing antibiotics is dangerous because can cause bacteria to morph, becoming resistant to antibiotics and therefore harder to treat. Antibiotics also work on a broad scale, wiping out dangerous bacteria, but also the helpful bugs in our microbiome that are critical to keeping us healthy. </p><p><em><strong>Read more:</strong> <a href="https://www.insider.com/nearly-a-quarter-of-american-parents-are-vaccine-hesitant-study-2020-11">Nearly a quarter of American parents are 'vaccine hesitant.' That will have implications for COVID-19 vaccination.</a></em></p><p>That can help explain why superbugs - infections that are resistant to antibiotics - are becoming more common. Rates of one type of infection, multidrug-resistant Gram-negative enteric <em>Enterobacteriaceae</em>, rose more than<a href="https://academic.oup.com/jpids/article/7/1/36/3038169"> 700%</a> between 2007 and 2015. Other<a href="https://www.jpeds.com/article/S0022-3476(20)30150-5/fulltext"> studies</a> have also found significant increases in the rates of infection. </p><p>Dr. Joshua Watson, the director of the antimicrobial stewardship program at Nationwide Children's Hospital in Ohio, told KHR that too often doctors prescribe antibiotics - and parents ask for them - without thinking about the risks. </p><p>"I hear a lot about antibiotic use for the 'just in case' scenarios," he said. "We underestimate the downsides."</p><p>The Centers for Disease Control and Prevention<a href="https://www.cdc.gov/drugresistance/index.html"> says</a> that antibiotic resistance is "one of the biggest public health challenges of our time."</p><p>Oftentimes, common childhood illnesses like cold, flu or ear infection don't need antibiotic treatment. The CDC<a href="https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/ear-infection.html#:~:text=Antibiotics%20are%20often%20not%20needed,longer%20than%202%E2%80%933%20days."> recommends</a> that parents talk to their doctor about waiting two to three days to see if a child begins feeling better before using antibiotics. </p><p>"If we don't solve the problem of finding new antibiotics or somehow making old antibiotics work again, we are going to see sharply increasing deaths from bacterial infections we thought we had beaten decades ago," Corrie Detweiler, a professor of molecular, cellular and developmental biology at the University of Colorado Boulder, <a href="https://www.colorado.edu/today/2020/12/23/covid-19-exacerbating-threat-superbugs-researchers-id-new-weapon"> told</a> CU Boulder Today. </p><p>"The COVID-19 situation is definitely putting us at risk for increasing resistance to antibiotics, so it's more important now than ever that we come up with alternative treatments," she said.</p>

Antibiotic overuse in children's hospitals is leading to more 'superbug' infections in kids

<ul class="summary-list"><li>2,000-year-old bones add  evidence against the idea  Columbus brought syphilis to Europe. </li><li>A European outbreak of the STI in the late 1400s was long blamed on the conquistadors. </li></ul><p>The idea that Christopher Colombus brought back <a target="_blank" href="https://www.businessinsider.com/cdc-syphilis-in-babies-rates-up-killing-hundreds-2022-4">syphilis</a> from the New World might be completely wrong.</p><p>A long-standing hypothesis held that Spanish conquistadors had picked up the sexually-transmitted infection (STI) and introduced it to Europe in the late 1400s.</p><p>But a paper published Wednesday in the peer-reviewed journal <a target="_blank" class="" href="https://affiliate.insider.com?h=5665415566a290e3874cf144166e9a89d6ce0502d9dfc72d2b75f86ed975163d&amp;postID=65b22af6d40d73d7027d0397&amp;postSlug=columbus-likely-didnt-bring-syphilis-to-europe-ancient-dna-suggests-2024-1&amp;site=bi&amp;u=https%3A%2F%2Fwww.nature.com%2Farticles%2Fs41586-023-06965-x">Nature</a> adds to a mounting body of evidence that the conquistadors didn't spread the disease following their invasion of now South America.</p><p>Instead, the bacteria may have emerged a lot sooner than previously thought, Verena Schünemann, professor of Paleogenetics from the University of Basel, told Business Insider.</p><p>"Of course, we cannot prove it wrong — it doesn't work yet. But it seems that there's a much more complex story developing than these hypotheses are capturing currently," she told BI.</p><div type="image" title="An engraving shows columbus speaking with the then king of Spain after his first expedition." height="643" width="895" msid="107153529" hostid="261" sizebytes="241148"></div><h2>The timing of the arrival of syphilis in Europe is suspicious</h2><p>Looking at historical literature, you would think syphilis definitely arrived with the conquistadors.</p><p>There was a big outbreak of syphilis in Europe in the late 1400s, mostly in harbor towns, seemingly out of the blue.</p><p>This lined up suspiciously with the return of sailors who accompanied<a target="_blank" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956094/"> Columbus</a> on his voyage to South America.</p><p>Records of syphilis outbreaks before then were poor. Later excavations revealed bones in South America that carried lesions typically associated with a syphilis infection.</p><p>Altogether, this prompted historians to look at the voyage as an early example of how infections can spread across the globe.</p><p>Except, it's likely not that simple.</p><p>Later observations revealed some <a target="_blank" href="https://www.science.org/content/article/medieval-dna-suggests-columbus-didn-t-trigger-syphilis-epidemic-europe">skeletons found in European</a> sites may also carry lesions typical of a syphilis infection, long before the first contact with pre-Columbian indigenous Americans.</p><p>As the plot thickens, scientists have started looking to more modern methods of investigation to uncover what really happened.</p><h2>DNA analysis reveals a more complicated story</h2><p>To understand the history of syphilis better, Schünemann and her colleagues looked at 2,000-year-old bones carrying the characteristic lesions, which were found about 20 years ago in now Brazil.</p><p>They drilled tiny holes in the lesions using dentists' tools and extracted the ancient DNA left behind by the bacteria in the bone.</p><p>The analysis found that some of these lesions weren't caused by the bacteria behind sexually-transmitted syphilis but by a closely related cousin.</p><p>While this microbe is very similar to the one behind syphilis — it is part of the same family, called Treponema — it causes a completely different disease, called Bejel, which is not sexually transmitted.</p><p>It is still around today, mostly in Asia and Japan.</p><p>"We actually didn't expect to find it there," said Schünemann.</p><p>"Usually it's in arid regions, not so much in those humid coastal, tropical region. That's why we were quite surprised — this is a completely different environment than where you expect to find it," she said.</p><p>This suggests that the bones lesions alone don't guarantee that syphilis was present in South America before Columbus, poking holes in the evidence used to support the hypothesis.</p><p>The study is "really exciting because it is the first truly ancient treponemal DNA that has been recovered from archaeological human remains that are more than a few hundred years old," says Brenda Baker at Arizona State University, <a target="_blank" href="https://www.newscientist.com/article/2413971-syphilis-like-bacteria-found-in-2000-year-old-human-remains-in-brazil/">per New Scientist.</a></p><div type="image" title="A 3D rendering shows a spiral-shaped bacterium" height="1299" width="2309" msid="107153531" hostid="261" sizebytes="78898"></div><h2>The mystery remains</h2><p>The findings don't decisively close the door on the Columbus theory. But they do offer precious clues to better understand what happened.</p><p>"It helps us indirectly," said Schünemann.</p><p>With this ancient genome, Schünemann and colleagues were able to discover that the whole Treponema<em> </em>family is much older than had ever been expected.</p><p>The analysis suggests that these closely-related bacteria have a common ancestor about 14,000 years ago, said Schünemann.</p><p>That means these bacteria could easily have traveled around the world several times with the different human migrations, much earlier than Columbus's expeditions.</p><p>"We can now play around and say, okay, which hypothesis can we maybe develop from that?" said Schünemann</p><p>For Schünemann, it's more likely that the bacteria causing syphilis, Bejel, and other cousins of the Treponema family were already around in Europe, India, and the Americas, long before the first contact between Columbus and indigenous Americans.</p><p>"I think there's definitely a potential that they were around before the contact," she said.</p><p>It will be interesting, she said, to try to do the same analyses on the European bones carrying lesions and to find even older samples that could draw a better picture of the Treponema family tree.</p><p>The importance of the work goes beyond solving this historical mystery. <a target="_blank" href="https://www.businessinsider.com/gonorrhea-syphilis-cdc-pandemic-lockdowns-did-not-slow-spread-2022-4">Syphilis</a> and its cousins are still rampant in the world today.</p><p>While they are kept under control by <a target="_blank" href="https://www.who.int/news-room/fact-sheets/detail/yaws">antibiotics</a>, they are learning quickly how to side-step the treatments.</p><div type="image" title="An illustration shows pox and necrosis linked with untreated syphilis." height="4433" width="6792" msid="107153532" hostid="261" sizebytes="1296496"></div><p>Left untreated, <a target="_blank" href="https://www.cdc.gov/std/syphilis/the-facts/syphilis_bro_508.pdf">syphilis</a> can cause permanent damage to the heart, brain, and other internal organs. Bejel, or yaws, is a childhood disease that can be disfiguring and debilitating.</p><p>By looking back at how it has evolved with humans in the past, for instance how the microbes pass genetic information back and forth, we can better predict how it will progress going forward.</p><p>"When it comes now to this increase in antibiotic resistance and so on, then it can help in the future to develop new strategies to fight this bacteria," she said.</p>

Ancient human DNA suggests Columbus may not have brought syphilis to Europe after all

5 concerning conditions that cause a bloody cough and what to do about it

<ul class="summary-list"><li>Polio, monkeypox, marburg virus, and other infectious diseases are surging around the globe.</li><li>Experts say there's not one thing driving the surge — a multi-layered perfect storm has been brewing for some time.</li></ul><p>2022 has been a banner year for global infectious disease spread — and it's not just COVID.  </p><p>First, there were the reports of little kids with <a href="https://www.businessinsider.com/cdc-5-dead-109-ill-pediatric-hepatitis-outbreak-2022-5">mysterious and life-threatening liver failure</a> across the US and Europe. Then <a href="https://www.insider.com/monkeypox-gay-bisexual-men-affected-but-who-warns-stigma-2022-5">monkeypox</a> cases <a href="https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html">surged</a> across the globe like never before.</p><p><a href="https://www.insider.com/meningococcal-disease-meningitis-outbreak-florida-2022-6">Meningitis</a> has killed at least a dozen people in Florida this year, according to state epidemiologists, while a fatal <a href="https://www.insider.com/healthy-newborn-died-parechovirus-signs-symptoms-2022-7">parechovirus infected newborns</a> across several states — at least one baby died in Connecticut. In Australia and Belgium, <a href="https://theconversation.com/diphtheria-is-back-in-australia-heres-why-and-how-vaccines-can-prevent-its-spread-186348">diphtheria made a comeback</a>, and cases of the <a href="https://www.cdc.gov/vhf/marburg/outbreaks/chronology.html">Marburg virus</a> are being identified for the first time ever in Ghana.</p><p>Then, just last week, New York City announced that there is <a href="https://www.health.ny.gov/diseases/communicable/polio/wastewater.htm">polio in its wastewater</a>, mirroring a highly unusual trend picked up in <a href="https://www.insider.com/polio-found-in-london-sewage-water-uk-health-officials-investigating-2022-6">London's sewers</a> in the spring. </p><p>"It's like all the biblical plagues are coming back, right?" Dr. Madhukar Pai, a global health expert at McGill, told Insider. </p><p>It didn't happen overnight, and it's not a direct result of the pandemic either, but disease experts agree: the <a href="https://affiliate.insider.com?u=https%3A%2F%2Fwww.nature.com%2Farticles%2Fs41579-021-00639-z">pace of these infectious outbreaks</a> is <a href="https://www.cfr.org/timeline/major-epidemics-modern-era">quickening</a>. </p><p>Pai and other top-tier experts say there is no single, "simplistic" explanation. Instead, there is a wide web of at least seven powerful, interwoven issues undergirding the trend. </p><p>"It's definitely not something that we hoped would happen in public health, but it's also a situation which we feared might happen," Dr. Jay Varma, an expert in disease control and prevention at Cornell, said. "If you think about it almost like a sports event, the offense has gotten more intense — if you consider the viruses and pathogens that are out there — and our defense has weakened at the same time."</p><p>Here are the top seven factors driving disease outbreaks in 2022.</p><h2>ONE: Humans and animals have more close contact</h2><div type="image" title="mink covid-19" height="1848" width="2464" msid="93614982" hostid="261"></div><p>As climate change pushes people and animals out of their homes, <a href="https://www.businessinsider.com/heres-how-the-us-handled-its-first-ever-monkeypox-outbreak-2022-5">pets</a> and animal products travel the globe, and worldwide demand for meat reaches <a href="https://www.globenewswire.com/news-release/2021/03/22/2197061/0/en/Global-Animal-Protein-Market-to-Reach-58-50-Billion-by-2027-AMR.html">all-time highs</a>, we're collectively coming in contact with all kinds of animals far more often than we used to.</p><p>"The human-animal interface has been broken," as Dr. Larry Brilliant, who helped eradicate smallpox, <a href="https://www.youtube.com/watch?v=RyFcfL6iF4o&amp;t=872s">recently put it</a>. </p><p>The <a href="http://www.emro.who.int/fr/about-who/rc61/zoonotic-diseases.html">World Health Organization</a> estimated in 2014 that 75% of today's emerging pathogens have "originated in animals," a number that has been accelerating in recent decades. </p><p>Human-animal interaction is how <a href="https://www.science.org/doi/10.1126/science.abp8715">COVID</a> first spread into people. Ebola, HIV, MERS, SARS, <a href="https://www.businessinsider.com/pandemic-flu-comes-from-birds-first-2019-7">influenza</a>, and monkeypox all have animal reservoirs, too. When a disease pivots from animals into people, it always has the potential to spawn a new outbreak. </p><p>"The first factor that's driving transmission is increasing interaction between humans and animals, in <a href="https://thehill.com/opinion/energy-environment/583117-why-stopping-deforestation-must-be-a-priority-for-public-health/amp/">settings that are not entirely natural</a>, or settings that are different from the way they have been in the past," Varma said.</p><p>Deforestation, sequestration of livestock, and <a href="https://www.worldwildlife.org/initiatives/reducing-zoonotic-disease-risk-from-wildlife-trade">illicit wildlife trade</a> — they all play a role.</p><p>"Human population is now so enormous that we will infiltrate into all sorts of ecosystems where we will encounter novel organisms — organisms to which we don't have much prior immunity," Pai added. </p><h2>TWO: The pace of global travel and migration</h2><div type="image" title="flight attendant riding moving walkway at aiport with suitcase" height="3000" width="3999" msid="93614985" hostid="261"></div><p>The global, interconnected, social nature of modern life helps spread diseases between people more efficiently than ever. Any infectious disease anywhere in the world is just one flight away. </p><p>"Every time someone gets on a plane, there is some very tiny risk that they'll be carrying something new with them," Dr. Eric Rubin, editor in chief of the New England Journal of Medicine, told Insider. "The more people get on planes, the more that risk goes up."</p><p>It's a <a href="https://www.businessinsider.com/emirates-plane-flu-harvard-doctor-says-were-lucky-it-wasnt-mers-2018-9">numbers game</a>. And with the number of air <a href="https://www.transportation.gov/briefing-room/air-travel-consumer-report-consumer-complaints-against-airlines-rise-more-300-percent">travelers now skyrocketing</a>, new pathogens can travel very fast, and very far.</p><p>In 2022, both monkeypox and polio hitched a ride on planes, infecting people on new continents. Conversely, when global travel ground to a halt in 2020, the <a href="https://www.businessinsider.com/two-flu-varieties-disappeared-lockdown-extinct-2021-6">flu essentially disappeared for a year</a>.</p><h2>THREE: The worsening climate crisis</h2><div type="image" title="A photo of an insurance adjuster inspecting flood damage." height="600" width="1200" msid="93614987" hostid="261"></div><p>A paper released in the journal <a href="https://affiliate.insider.com?u=https%3A%2F%2Fwww.nature.com%2Farticles%2Fs41558-022-01426-1">Nature on August 8</a> suggests that most of the human pathogens on Earth will be "aggravated" by climate change in some way. Many of them already have been. </p><p>"Insect-borne diseases are <a href="https://www.cdc.gov/lyme/stats/graphs.html">really changing their patterns</a>, because the insects that carry them now have a much broader range," Rubin said, <a href="https://www.who.int/news-room/feature-stories/detail/the-history-of-zika-virus#:~:text=First%20identified%20in%20Uganda%20in,countries%20experiencing%20Zika%20virus%20outbreaks.">citing the way that Zika</a> — once a disease contained to Africa — has been allowed to spread across Asia and the Americas. </p><p><a href="https://www.ecdc.europa.eu/en/chikungunya-monthly">Chikungunya</a>, too, is now a global disease, not the regional threat it once was.</p><p>"The tropics has moved into Europe and North America," Varma said. </p><h2>FOUR: Not enough routine vaccines for kids</h2><div type="image" title="A boy getting the polio vaccine" height="2250" width="3000" msid="93614988" hostid="261"></div><p>During the pandemic, vaccination rates plummeted across the globe in a way that hasn't been documented in decades. The <a href="https://www.who.int/news/item/15-07-2022-covid-19-pandemic-fuels-largest-continued-backslide-in-vaccinations-in-three-decades">WHO calls it</a> the "largest sustained decline in childhood vaccinations in approximately 30 years." </p><p>Add to that the vaccination <a href="https://www.businessinsider.com/what-is-vaccine-court-is-it-real-2019-3">backsliding that was already underway in many rich countries</a>, fueled by <a href="https://www.businessinsider.com/experts-fact-check-vaccine-claims-by-robert-malone-rogan-podcast-2022-2">misinformation</a> and vaccine hesitancy, and it was inevitable that an uptick in vaccine-preventable disease spread would happen once lockdowns, social distancing, and masking measures eased. </p><p>"We need everyone to be getting vaccinated, or we all face risks," Varma said. </p><p>In some areas of Rockland County, New York, where polio has left at least one young, unvaccinated man paralyzed this year, <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7133e2.htm?s_cid=mm7133e2_w">just 37% of little kids are up to date</a> on their polio vaccines. (For context: nationally, nearly 93% of babies are vaccinated against polio.)</p><h2>FIVE: The whole world is paying the price for years of neglecting developing countries' disease outbreaks</h2><div type="image" title="Provider measures monkeypox vaccine." height="3003" width="4759" msid="93614990" hostid="261"></div><p>"All these years, Africans had monkeypox, nobody did a thing, nobody gave them vaccines," Pai said. "Now, suddenly, all the rich nations are going after — and getting — monkeypox vaccinations?"</p><p>Eventually, he said, "we pay the price" for such "archaic," "parochial," and short-sighted disease management. </p><p>"If monkeypox had been handled better in Africa, it wouldn't have spread around the world. If COVID had been handled better in low and middle income countries, new variants would not have emerged. If Ebola had been contained in West Africa, even before it spread, then it wouldn't have arrived in the US."</p><h2>SIX: Our shifting perception of disease threats </h2><div type="image" title="screenshot of promed map with dots all around the globe on august 16 2022" height="539" width="851" msid="93614992" hostid="261"></div><p>We've also been shaped by our experiences during the pandemic, and we can't help but bring that knowledge into infectious disease news we read now. </p><p>In some cases, it's overblown, Pai said. "Some <a href="https://www.reuters.com/article/us-china-cattle-disease-idUSKCN24G1DK">little outbreak happens</a> in some corner of some market <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2202705">in China</a>, immediately everybody across the world is freaking out."</p><p>In many, heightened concern is <a href="https://www.npr.org/sections/goatsandsoda/2022/07/28/1114183886/a-doctor-in-nigeria-tried-to-warn-the-world-that-monkeypox-had-become-a-global-t">warranted</a>.</p><p>These days, scientists also have better tools than ever for noticing what's going on — <a href="https://www.bu.edu/neidl/2021/12/southern-africa-is-not-a-hotbed-of-variants-its-just-very-good-at-sequencing-and-spotting-them/">sequencing</a> viruses, testing cases, and sounding alarm bells they couldn't have years ago. </p><p>"COVID has really changed the way we notice these things," Rubin said, speaking about average news readers and professional scientists alike. "Every day there's a disease of some sort <a href="https://promedmail.org/">reported somewhere</a> in the world," he said — and that is, in part, because we are all paying more attention to them than we used to. </p><h2>SEVEN: We're still not sure how COVID exposure has affected our immune systems</h2><div type="image" title="Dr. Francis S. Collins, who serves as the Acting Science Advisor the president is the highest-paid White House employee." height="1828" width="2438" msid="93614993" hostid="261"></div><p>New disease threats are especially alarming right now because it's <a href="https://www.cdc.gov/ncird/investigation/hepatitis-unknown-cause/parents.html/">not yet clear</a> to us what effect <a href="https://www.sciencedirect.com/science/article/pii/S2531043721000040">prior COVID</a> could be having on our <a href="https://www.businessinsider.com/common-long-covid-symptoms-hair-loss-vertigo-low-libido-2022-7">immune defenses</a>. </p><p>"We will learn in the coming months and years," Pai said, "whether COVID does mess up the immune system to some degree or the other, which makes us more susceptible." </p><p>Already, he's worried that doctors' overdependence on steroid <a href="https://www.cdc.gov/drugresistance/pdf/covid19-impact-report-508.pdf">and antibiotic prescriptions</a> during the pandemic may spur more <a href="https://www.wired.com/story/the-pandemic-fueled-a-superbug-surge-can-medicine-recover/">fungal infections, superbugs,</a> and antimicrobial resistance.</p><h2>Another pandemic is coming. We could stop it — but experts fear 'we've given up'</h2><div type="image" title="A sign outside of a New York clinic reads &quot;appointment only&quot;" height="1333" width="2000" msid="93614995" hostid="261"></div><p>Scientists <a href="https://www.pnas.org/doi/10.1073/pnas.2105482118">estimate our odds of experiencing another pandemic</a> "may double in coming decades," as disease outbreaks fueled by this wide array of interrelated, complex factors become more and more common.  </p><p>But when it comes to disease prevention, "you're better off <em>not</em> thinking that the 10 plagues have been released simultaneously," Rubin said. "Each disease is distinct," with different biological features, distinct reasons for emerging, and varying modes of transmission and prevention.</p><p>"The answer is more investment in public health, right?" Pai said. It's often "stuff that we've given up on," he said, interventions that are "undermined," like clean drinking water, good sanitation, vaccines, equitable access to treatment and clinical care, as well as robust disease research.</p><p>"Our racism in the way we think about infectious diseases," he says, "eventually will come back and haunt us — which is what is happening." </p>

Yes, there are more infectious diseases popping up these days &mdash; experts say there are 7 clear reasons why

<p><div class="KonaFilter image-container display-table"><div><div class="image on-image"><p class="source"><span><a href="https://www.shutterstock.com/image-photo/alzheimers-disease-on-mri-677114992?src=usb8QlAckiEzQVsP5K8gzg-9-72">Atthapon Raksthaput / Shutterstock</a></span></p><p class="caption">2019 could be the year we get good news out of a late-stage Alzheimer's trial.</p></div><p></p></div></div></p><ul class="summary-list"><li>2019 could bring a lot of surprises for biotech companies - both good and bad. </li><li>In a December note, Cowen's biotech analysts listed the top 10 "surprises" they're keeping an eye out for in the coming year, from the most to least probable. </li><li>Those surprises include biotech giant Celgene going private, an Alzheimer's trial success, and a comeback for biotechs developing cancer immunotherapies. </li></ul><p>Amid the usual refrain of drug-pricing pressure and new technologies that push the envelope of what we're able to do with medicine, 2019 could have some surprises in store.</p><p>Those surprises could rock the biotech market, so analysts at Cowen worked to take them into account before they transpired.</p><p>"In an effort to stimulate discussion and aid out-of-the-box thinking, we have scanned our large-, mid-, and small-cap coverage universe for potential surprises," the Cowen biotechnology team wrote in a December note. The team includes senior analysts Ritu Baral, Phil Nadeau, Boris Peaker, and Chris Shibutani.</p><p>To be clear, the list below doesn't contain predictions, exactly. Instead, each event has a chance of occurring of less than 40%, the Cowen team figures. But if the events do occur, they could have big implications for investors.</p><p>Cowen ranked the surprises from most (No. 10) to least (No. 1) likely to happen. </p><h2>10. Opioids meant to deter abuse stumble</h2><p><span>Between 1999 and 2016, more than 200,000 people in the US </span><a href="https://www.cdc.gov/drugoverdose/data/overdose.html">died from overdoses related to prescription opioids</a><span>. President Donald Trump in 2017 declared the opioid epidemic a </span><a href="https://www.businessinsider.com/trump-opioid-crisis-public-health-emergency-declaration-2017-10">public-health emergency</a><span>, escalating the amount of attention and funding that can go toward addressing the issue.</span></p><p>While there are a number of strategies proposed to alleviate the opioid crisis, the pharmaceutical industry has championed the development of opioids specifically designed to discourage abuse, such as pills that can't be crushed and snorted.</p><p>"<a href="https://www.businessinsider.com/ap-new-fda-chief-cites-promise-of-harder-to-abuse-pain-drugs-2016-3">Abuse-deterrent</a>" drugs, which aim<span> </span><a href="https://www.pharmacytimes.com/contributor/jeffrey-fudin/2015/01/abuse-deterrent-opioid-formulations-purpose-practicality-and-paradigms">to prevent users from manipulating pills</a><span> </span>and abusing them, are a busy development category right now.<span> So far, the Food and Drug Administration has approved 14 versions. </span><span></span></p><p><span>But that could start to backfire as skepticism around these abuse-deterrent formulations grows. The FDA has raised concerns about how the medications are perceived by patients. And in 2017, the FDA requested one painkiller, an <a href="https://www.businessinsider.com/endo-international-removes-opana-er-from-the-market-after-fda-request-2017-7">extended-release opioid painkiller Opana ER</a> come off the market. </span></p><p><span>"After initial excitement regarding abuse -deterrent formulations, views of the drug class appear to have cooled at the FDA even as curbing opioid abuse has become a top priority," the analysts wrote. </span></p><p><strong>Likelihood: 40%</strong></p><h2>9. Vertex Pharmaceuticals moves a drug that hasn't entered human trials yet into a trial that could gear it up for an approval</h2><p>Vertex, which is known for its cystic fibrosis treatments, is researching a drug for a rare disease called Alpha-1 antitrypsin deficiency. The drug hasn't entered human trials yet, but the company might be able to show that it can influence a key protein found in the body that's impacted in the disease in an early-stage trial. That could set Vertex up for a late-stage trial by the end of 2019. </p><p>"We believe Vertex is particularly well positioned to use a biomarker-based endpoint in clinical development in AAT," the analysts wrote. </p><p>If it were to happen, it'd be in the last few months of 2019, the analysts wrote.  </p><p><strong>Likelihood: 25%</strong></p><h2>8. Injecting into tumors becomes a big area </h2><p>In 2015, the FDA approved the first oncolytic viral therapy, a treatment called Imlygic that's for certain kinds of melanoma, a dangerous form of skin cancer. The basis of the drug is a modified herpes virus. That means it won't infect the person with herpes, but instead attack the cancerous cells directly after being injected into the tumor. That may stimulate an immune system response to tumors especially in combination with other cancer drugs.</p><p>So far, its use has been pretty limited, but it's currently being studied in combination with the blockbuster cancer immunotherapy drug Keytruda in patients with metastatic melanoma. Should that trial be successful, it could broaden how the treatment is used. </p><p>"Approval in this setting would potentially broaden the scope of T -Vec use and, we expect, unlock interest and boost efforts in overcoming the challenges to adoption in practice," the analysts wrote. </p><p><strong>Likelihood: 20%</strong></p><h2>7. Cancer-drug makers developing drugs that act on the immune system make a comeback </h2><p>We're still beginning to understand how well drugs that target the immune system to treat cancer work and why some people respond while others don't. It's led to the creation of a class of drugs known as checkpoint inhibitors.</p><p>These drugs help take the brakes off the body's immune system so that it can attack cancer cells. Specifically, Cowen projects, the checkpoint inhibitors that have to do with the proteins PD-1 and PD-L1 will have $49 billion in sales by 2024. The catch: the majority of patients who get these drugs aren't showing any benefit. </p><p>Now, drugmakers are in search of something that will make those drugs more effective for those who aren't responding. 2018 had <a href="https://markets.businessinsider.com/news/stocks/incyte-stock-price-after-ido-cancer-drug-trial-failure-2018-4-1020683045">some setbacks</a> after some trials came up short, but 2019 could be the year to reverse that. Results from companies including Nektar Therapeutics and Array BioPharma could lead to that change, the analysts noted. </p><p><strong>Likelihood: 20%</strong></p><h2>6. Re-organization at the FDA could make the agency less flexible</h2><p>Under the Trump administration, it's been good to be a drugmaker. In 2018, <a href="https://www.fda.gov/drugs/developmentapprovalprocess/druginnovation/ucm592464.htm">59 new drugs</a> were approved, a<a href="https://www.businessinsider.com/new-drugs-twice-fda-approved-last-year-2016-12"> record-breaking amount</a>.</p><p>But that could change as the FDA goes through a period or re-organization that's throwing together centers that have a whole bunch of disease areas under their purview. </p><p>"The re-organization has resulted in certain "franken-centers" that combine seemingly disparate therapeutic and disease areas," the analysts noted. </p><p>For example, one center will house cardiology, hematology, endocrinology, and nephrology, while the Office of Immunology Inflammation will cover everything from pulmonology, rheumatology, and hepatology, to dermatology and dentistry. That could shake up the way drugs are reviewed, making it more difficult for a drugmaker to get approval than it might have been in the past. </p><p><strong>Likelihood: 15% </strong></p><h2>5. An Alzheimer's drug succeeds in late-stage trials </h2><p><span>The search for new Alzheimer's disease treatments hasn't been going well. Alzheimer's affects more than 5.7 million Americans, a number that's expected to balloon to </span><a href="http://www.alz.org/facts/">14 million by 2050.</a><span> There are only four drugs that have been approved to treat the symptoms of the disease, and the most recent drug approval happened in 2003.</span></p><p><span>Over the past few years, the biotech world has been littered with <a href="https://www.businessinsider.com/alzheimers-drugs-in-development-and-the-amyloid-hypothesis-2018-4">late-stage trial failures.</a> That could begin to change in 2019 with a drug made by biotech Biogen called aducanumab. The drug is going after certain proteins that accumulate in the brain. This idea of targeting beta amyloid deposits in the brain to clear them out is known as the "<a href="https://www.ncbi.nlm.nih.gov/pubmed/12130773">amyloid hypothesis.</a>"</span></p><p>Aducanumab is expected to have results in 2019 or early 2020, but the Cowen analysts said it's possible the trial could show success at slowing cognitive decline in patients with Alzheimer's at an interim stage, which could mean results come out sooner than expected. </p><p><strong>Likelihood: 12%</strong></p><h2>4. A new depression drug doesn't work</h2><p><span>Sage Therapeutics's depression treatment, Sage-217</span><strong>,</strong><span> acts on GABA, one of the neurotransmitters in the brain. The idea is that by modulating GABA, it may help to treat depression by applying a brake to slow down parts of the brain that could be getting overexcited. Because it targets a different part of the brain than other depression treatments, the drug seems to work faster and last longer, meaning that instead of taking a pill daily it might be used episodically. </span></p><p><span><em><strong>Read more:</strong> <a href="https://www.businessinsider.com/most-promising-new-depression-drugs-treatments-predictions-2019-2018-12">A fresh crop of promising drugs is poised to change the way depression is treated for the first time in decades. Here are the ones to watch in 2019.</a></em></span></p><p><span>But it's possible that the drug might not work in its next, later-stage trial, leading to a surprising failure. That could happen because of a response from participants who took the placebo medication. It could also not have as strong a response as the company observed in its smaller phase 2 trial, which looked at 89 patients. </span></p><p>"If there was any depression trial that was supposed to work cleanly, it was the '217 trials. Skepticism of depression trials in the investment community would run at an all-time high, and the indication would be more out of style than a pink velour hoodie, rivaling Alzheimer's as a black hole of value," the analysts wrote of the possibility that Sage-217 fails.</p><p><strong>Likelihood: 10%</strong></p><h2>3. Antibiotic drug development could start to make money</h2><p>In 2018, a number of drugmakers <a href="https://www.businessinsider.com/major-pharmaceutical-companies-dropping-antibiotic-projects-superbugs-2018-7">exited the antibiotic drug development business</a> including the likes of drug giant Novartis. </p><p>It's not an easy business. Bacteria have found ways to grow resistant to commonly used antibiotics, and have started to resist newer antibiotics as well. It takes a long time to develop antibiotics, making it an expensive process, and <a href="https://www.businessinsider.com/woman-died-antibiotic-resistant-bug-why-2017-1">even those that have made it through development face stumbling blocks</a>.</p><p>But the Cowen analysts think that could start to change in 2019 thanks to new legislation that creates more economic incentives for drugmakers to develop the drugs, including options such as having hospitals license the antibiotics for the right to use them instead of paying based on how much of the potent antibiotics they use. </p><p><strong>Likelihood: 8%</strong></p><h2>2. Celgene goes private</h2><p>Big biotechs like Celgene have had a tough year, even amid doing big-ticket deals like the <a href="https://www.businessinsider.com/celgene-acquires-juno-therapeutics-2018-1">$9 billion acquisition of Juno Therapeutics</a> and picking up <a href="https://www.reuters.com/article/us-impact-biomedicines-m-a-celgene/celgene-to-buy-impact-biomedicines-for-up-to-7-billion-idUSKBN1EW0U9">Impact Biosciences in a $7 billion</a> deal. In 2018, Celgene's stock fell about 40%, and the company faces competition for its blockbuster cancer treatment Revlimid.  </p><p>That could open up the smallest possibility that Celgene could stand to go private.</p><p>"The revenues of the biopharmaceutical industry are among the least correlated of any industry. So it would only make sense if private equity began looking to do deals in health care," the analysts wrote. </p><p><strong>Likelihood: 3% </strong></p><h2>1. A decade-old viral infection that took down a biotech's manufacturing facilities returns</h2><p>A virus called the Vesivirus contaminated biotech Genzyme's manufacturing plant in <a href="https://news.genzyme.com/press-release/genzyme-reports-progress-related-allston-plant">2008 and 2009</a>, and Cowen analysts think a decade later it could make a return. That could be a big issue for biotech companies.  </p><p>"Though a decade has passed, biologic manufacturing remains complex and fragile, particularly for some of the newer technologies such as gene and cell therapy," the analysts wrote. "Therefore, it is only a question of "when", and not of "if" manufacturing issues constrain the production of a key biologic at a biotech company." </p><p><strong>Likelihood: 1%</strong></p><ul class="read-more-links"><li><strong>Read more:</strong></li><li><a href="https://www.businessinsider.com/pharmaceutical-drugs-investors-to-watch-next-year-2018-12" data-read-more-link="" data-e2e-name="read-more-link">From the gene therapy that spurred a $9 billion acquisition to a CBD medication for rare types of childhood epilepsy, here are the 12 promising drugs to watch in 2019</a></li><li><a href="https://www.businessinsider.com/pfizer-drugmakers-to-increase-drug-prices-in-2019-trump-tweet-2018-12" data-read-more-link="" data-e2e-name="read-more-link">Trump may have shamed Pfizer for increasing drug prices, but that isn't stopping drugmakers from planning more of the same</a></li><li><a href="https://www.businessinsider.com/venrock-vc-cami-samuels-biotech-predictions-2019-moderna-plunges-2018-12" data-read-more-link="" data-e2e-name="read-more-link">A biotech that made history with its record $7.5 billion IPO will plunge to $3 billion in 2019, according to a top investor</a></li><li><a href="https://www.businessinsider.com/relay-therapeutics-raises-400-million-from-softbank-vision-fund-2018-12" data-read-more-link="" data-e2e-name="read-more-link">A startup that's bringing together 2 'disparate but unstoppable trends' just raised $400 million from investors led by SoftBank</a></li></ul><p class="tagline"><a href="http://www.businessinsider.com/intelligence/ai-in-us-healthcare?IR=T&amp;utm_source=businessinsider&amp;utm_medium=ctgr&amp;utm_term=ctgr_leadgen&amp;utm_content=dhealth_ctgr_leadgen&amp;utm_campaign=dhealth_ctgr_leadgen_ai_in_us_healthcare"></a></hr></p>    <div class="margin-top">        <h3>NOW WATCH: <a href="https://www.businessinsider.com/mistletoe-tradition-history-kiss-under-parasites-2016-12">Mistletoe is actually a tree-killing parasite - here's how it became a Christmas icon</a></h3>        <div>                    </div>    </div>

10 surprises that could rock biotech stocks in 2019, from success in Alzheimer's to a stumble in depression

<p><div class="KonaFilter image-container display-table float_right"><div><div class="image on-image"><p class="source"><span><a href="http://de.wikipedia.org/wiki/Elephantiasis">Wikimedia Commons</a></span></p></div><p></p></div></div>Parasitic diseases affect billions of people worldwide, mostly in the world's poorest countries.</p><p>The <a href="http://www.nobelprizemedicine.org/the-nobel-prize-in-physiology-or-medicine-2015/">Nobel Prize in Physiology or Medicine</a> was awarded on Monday to three scientists who discovered treatments for two of the most devastating of such diseases.</p><p>Irish-born scientist William C. Campbell and Japanese scientist Satoshi Omura were jointly awarded half the prize for their discovery of a therapy to treat infections caused by roundworm parasites. Chinese scientist Youyou Tu received the other half for her discovery of a new therapy for Malaria.</p><h2>Digging up a cure</h2><p>Campbell and Omura discovered the drug Avermectin, a modified form of which has dramatically reduced cases of river blindness and lymphatic filariasis/elephantiasis (pictured above). <span class="s1">It has also been effective against a growing number of other parasitic diseases.</span></p><p>Both are caused by parasitic worms, which afflict an estimated third of the world's population and are most prevalent in sub-Saharan Africa, South Asia, and Central and South America.</p><p><a href="http://www.cdc.gov/parasites/onchocerciasis/epi.html">River blindness</a> (onchocerciasis), which afflicts at least 25 million people worldwide, causes chronic inflammation in the cornea that ultimately causes blindness. <a href="http://www.cdc.gov/parasites/lymphaticfilariasis/epi.html">Lymphatic filariasis</a>, which affects more than 120 million people, causes chronic swelling. It results in life-long stigmatizing and disabling symptoms such as <a href="https://rarediseases.org/rare-diseases/elephantiasis/">elephantiasis</a> (lymphedema), extreme enlargement of a part of the body caused by blockage of the lymphatic system, and <a href="http://www.mayoclinic.org/diseases-conditions/hydrocele/basics/definition/con-20024139">scrotal hydrocele</a>, or swelling of the scrotum caused by a fluid-filled sac around the testicle.</p><p>Omura, an expert in isolating natural products, isolated new strains of the soil bacteria Streptomyces, which are known to produce a wide array of antibacterial compounds (including Streptomycin, the first antibiotic treatment for tuberculosis). He grew thsounds of these strains in the lab, and selected 50 of the most promising to test further.</p><p>Campbell studied Omura's strains and found that a component in one of them effectively killed parasites in household and farm animals. The compound, which was purified and named Avermectin, was later chemically modified to a more effective form called Ivermectin. Campbell and Omura's work led to a new class of drugs that are extremely effective against the parasitic diseases above and others.</p><p>Today, Ivermectin is freely available and used in all places where parasitic diseases are found. It is so effective that these diseases are on the verge of being eradicated. </p><h2>An old remedy, a new drug</h2><p class="p1"><span class="s1">Malaria - a disease that is caused by the Plasmodium parasite that infects red blood cells - causes fever, and in severe cases, brain damage and death.</span></p><p>It kills more than 450,000 people every year, mostly children. Worldwide, more than 3.4 billion people are at risk of contracting the disease.</p><p><div class="KonaFilter image-container display-table"><div><div class="image on-image"><p class="source"><span>Thomson Reuters</span></p></div><p></p></div></div></p><p>Malaria was traditionally treated with the drug chloroquine, or quinine, but the parasite started becoming resistant to it and eradication efforts failed.</p><p>To develop a new drug in the 1960s, Chinese medical scientist Youyou Tu turned to old knowledge: traditional Chinese medicine. She screened many herbal remedies for malaria in animals, and found one, a compound found in the sweet wormwood plant (Artemisia annua), that seemed promising.</p><p>To help her find a way to extract the compound, she consulted the ancient Chinese medical literature. Now known as Artemisinin, this compound is highly effective at treating malaria (though some strains in Asia <a href="http://who.int/malaria/media/artemisinin_resistance_qa/en/"> are resistant</a>).</p><p>A 2010 study found that Artemisinin is estimated to reduce childhood deaths from Malaria by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033534/"> 30% more than quinine</a>.</p><p><a href="http://www.nobelprizemedicine.org/wp-content/uploads/2015/10/Press_ENG.pdf">In a statement</a>, the Nobel Assembly said, "Campbell, Omura and Tu have transformed the treatment of parasitic diseases. The global impact of their discoveries and the resulting benefit to mankind are immeasurable."</p>    <div class="margin-top">        <h3>NOW WATCH: <a href="http://www.businessinsider.com/killing-off-disease-spreading-mosquitoes-2015-6">Should we kill off one of the most dangerous creatures in the world?</a></h3>        <div>            <div>        <div class="ooyala-video-player" data-video-autoplay="false" data-video-id="lpd3lodTpxXMq8NSPc-xe5q-zK106WUF" data-player-variable="ooyalapopvideo" id="ooyalaplayer_popvideo" style="width:1280px;height:720px"></div>        </div>        </div>            </div>

Scientists who developed drugs to treat parasites that affect nearly 3.5 billion people just won a Nobel

<p><div class="KonaFilter image-container display-table"><div><div class="image on-image"><p class="source"><span>Caroline Walsh</span></p></div><p></p></div></div></p><ul><li><strong>When she was 24 years old, Caroline Walsh started having disturbing symptoms, like forgetfulness and sudden behavior changes.</strong></li><li><strong>Doctors incorrectly diagnosed her several times before</strong><strong> she was properly diagnosed with autoimmune encephalitis, a disease in which the body attacks itself and targets the brain.</strong></li><li><strong>New research suggests the disease may affect up to 90,000 people each year.</strong></li></ul><p><br />There's a blank year in 26-year-old Caroline Walsh's once-spotless memory.</p><p>She's pieced parts together from stories her friends have told her and a collection of photos on Facebook. But she cannot remember the day it all began - when her father found her in the middle of a seizure, her body writhing on the floor. She also can't remember waking up with her hands tied to a hospital bed, begging her sister to help her escape, or the next day when she proclaimed she was the Zac Brown Band.</p><p>Instead, Walsh's first recollection of that time is of a recovery room filled with family and flowers. By then, her doctors had diagnosed her with a mysterious disease called autoimmune encephalitis, or AE. While there's lot we still don't know about the condition, experts believe it's part of a larger class of illnesses in which the body turns on itself. A <a href="http://onlinelibrary.wiley.com/doi/10.1002/ana.25131/full">new study from Mayo Clinic researchers</a> suggests it's a lot more common that previously thought. In fact, AE may occur just as frequently as cases of regular encephalitis, the brain swelling caused by viral infections. If that's the case, it could be impacting roughly 90,000 people around the world every year.</p><p>In Walsh's case, the disease attacked her brain, setting off a chain reaction of symptoms that mimicked those of other mental illnesses like depression and schizophrenia. If treated properly and early enough, people with AE can make a near-complete recovery. But if they go undiagnosed or land in a psychiatric ward, they can die.</p><h2>Something brewing</h2><p>A stroll down a real street called Memory Lane in London leads you to the London Institute of Psychiatry, where J.A.N. "Nick" Corsellis sliced into the brains of three corpses and found the first evidence of AE.</p><p>Deep in the dense part of the brain called the limbic system, the normally lithe network of rubbery-smooth tissue had become puffy and inflamed. It was as if something had attacked it from within.</p><p>Most of the people these brains once belonged to had been diagnosed with cancer, then seemed to make a full recovery. But their personalities <a href="https://academic.oup.com/brain/article-abstract/91/3/481/258399/LIMBIC-ENCEPHALITIS-AND-ITS-ASSOCIATION-WITH?redirectedFrom=fulltext">began to change</a>. A partner or friend was usually the first to notice an odd shift in their behavior - usually a progressive increase in forgetfulness, though others experienced a sudden bout of mania or depression. A 58-year old bus driver found himself waking up most days not knowing where he was.</p><p>Corsellis saw inflammation in parts of the brain linked with memory and mood, but he couldn't explain what had caused the swelling that triggered the symptoms.</p><p>"The first question to arise ... is whether the assertion of a connection between carcinoma [cancer] and 'limbic encephalitis' is now justified, even if it cannot be explained," he wrote in a 1968 paper in the journal Brain. It was first time the condition was mentioned in a scientific journal.</p><p>Walsh's symptoms became noticeable one day at work when she started repeating herself. She joked with a co-worker that she was coming down with early-onset Alzheimer's.</p><p>"I was just getting very confused all the time," Walsh said.</p><p>The next week, more mysterious problems cropped up - Walsh had a knack for remembering names, but one day when she met up with some new friends, she introduced herself half a dozen times and struggled to commit anyone's name to memory.</p><p>"They'd say it and then a couple minutes later I'd have no clue what their name was or what we were even talking about," she said.</p><p>At the office the next day, things got worse. "My personality was just off. I thought it was work. I pulled my boss aside into a conference room and I started to cry, which was just not me," she said. When she wasn't feeling stressed and anxious, she felt depressed.</p><p>"Something was just brewing, I could feel it," she said.</p><h2>When the body attacks itself</h2><p>Our immune system is our body's defense against the outside world.</p><p>Most of the action is coordinated by white blood cells, which direct the lines of attack like football coaches, churning out antibodies that target the opponent for destruction.</p><p><div class="KonaFilter image-container display-table float_right"><div><div class="image on-image"><p class="source"><span>Shutterstock</span></p><p class="caption">A new way of boosting white blood cells.</p></div><p></p></div></div>But sometimes the process can go awry. In generating an immune response against a virus or other disease, the body can wind up up attacking itself - such issues are known as autoimmune diseases.</p><p>It's as if "some wires get crossed," <a href="https://www.researchgate.net/profile/Brendan_Kelley">Brenden Kelley</a>, a neuroradiologist at Henry Ford hospital in Detroit who's part of the small community researching autoimmune encephalitis, told Business Insider last year.</p><p>Sometimes, this abnormal response can be caused by a virus like the flu or a bacterial infection. Other times, certain types of cancer appear to be the source.</p><p>"In picking targets that match the cancer, the body may also pick targets that match places in your body that don't have cancer," Kelley said.</p><p>The Mayo Clinic's new <a href="http://onlinelibrary.wiley.com/doi/10.1002/ana.25131/full">study, published in February in the journal Annals of Neurology,</a> suggests that cases of autoimmune encephalitis aren't nearly as rare as researchers once believed. By drawing on data from the Rochester Epidemiology Project, a medical records database in Olmsted County, Minnesota, the researchers were able to estimate that roughly 1 million people across the globe had autoimmune encephalitis at some point in their life. Each year, roughly 90,000 people may develop AE, they estimated.</p><p>"No prior studies evaluated this," Eoin Flanagan, the lead author on the paper and an autoimmune neurology specialist at the Mayo Clinic, <a href="https://newsnetwork.mayoclinic.org/discussion/when-the-body-attacks-the-brain-immune-system-often-to-blame-for-encephalitis-study-finds/">said in a statement</a>.</p><p>Kelley, who is working on his own forthcoming study of the frequency of AE in young people, said his work echoes Flanagan's findings.</p><p>"You can't diagnose something you don't know about, or that you don't recognize," Kelley told Business Insider.</p><p>Last summer, he <a href="http://www.ajnr.org/content/38/6/1070">published a study in the American Journal of Radiology</a> to help radiologists like himself better diagnose and understand diseases like AE.</p><h2>Knee deep in the water</h2><p>Three months after Walsh first started noticing changes in her personality, she relocated to her childhood home outside of Boston, and saw two doctors who both incorrectly diagnosed her with the flu.</p><p>Then one morning around 4 a.m., as her dad got ready for work, he heard a loud crash. He found his daughter on the ground, her limbs thrashing. He screamed her name, but she didn't respond.</p><p>The most common cause of the type of seizure that Walsh had - known as a grand mal seizure (literally "great sickness" in French) - is epilepsy. Other causes can include extremely low blood sugar, high fever, and stroke.</p><p>At the hospital, Walsh's doctors tested her extensively. But even lumbar punctures or "spinal taps" - how doctors first spot autoimmune encephalitis in many cases - didn't show enough characteristic markers of inflammation to draw a definite conclusion.</p><p><div class="KonaFilter image-container display-table"><div><div class="image on-image"><p class="source"><span>Caroline Walsh</span></p></div><p></p></div></div></p><p>When Walsh's sister Alana arrived at the hospital, Caroline was lying motionless on her hospital bed under the harsh lighting. Her hands had been encased in heavily padded mitts that looked like boxing gloves, and were fastened to the railings on her bed to keep her from pulling out the IV tubes keeping her hydrated. She asked Alana to come closer so she could whisper something into her ear.</p><p>"You have to fight 'em, you have to get me out of here," Caroline said, motioning her head towards the nurses as she eyed them suspiciously.</p><p>When Alana asked her sister what she was talking about, Caroline explained that she'd been abducted while she was asleep and was now being held hostage at the hospital.</p><p>A few hours later, after drifting into the sleepy, dazed state she was in for much of her hospital stay, she woke with a jolt and proclaimed she was the country singer the Zac Brown Band. She started belting out her favorite song of his, a catchy tune about taking a break from reality called "Knee Deep."</p><p><em>"Gonna put the world away for a minute," </em>she sang, getting louder with every verse. <em>"Pretend I don't live in it."</em></p><p>When her family couldn't stop Caroline's crooning, Alana got up and closed the doors to her room in an attempt to keep her from waking up everyone on the ward. Caroline continued.</p><p><em>"Mind on a permanent vacation, t</em><em>he ocean is my only medication, w</em><em>ishin' my condition ain't ever gonna go away."</em></p><p>Over the next week, Walsh proceeded to seize more than a hundred times. Alana recalls that nearly every time she sat down to talk with her, Caroline would seize half a dozen times. They weren't massive seizures like the one that had landed her in the hospital, but small, barely perceptible ones.</p><p>"You'd know because her eyes would drift away and she'd stare in one spot, she was having little ones almost every minute," Alana said. "She was very shaky and confused; her heart rate was extremely high, and the doctors just seemed so confused by everything every time we talked to them."</p><p>Eventually, the doctors decided to put Walsh in a medically-induced coma.</p><h2>Smoke from the fire</h2><p>In children, infections like strep throat appear to be a trigger of AE. <a href="http://nyulangone.org/doctors/1962593632/susan-schulman">Susan Schulman</a>, a pediatrician in New York, told Business Insider last year that she had seen hundreds of cases of a related condition, called PANS (pediatric acute-onset neuropsychiatric syndrome), in her patients. Her first case, in 1998, was a five-year old girl from Brooklyn who flew into a panic about keeping special holiday clothes separate from her regular clothes.</p><p>"She was driving her mother crazy," Schulman said last year. At first, she believed the girl had <a href="http://pedsinreview.aappublications.org/content/34/1/19">childhood obsessive-compulsive disorder</a>, but medication made the child's symptoms worse. She later returned to Schulman's office with a nasty case of strep throat and strangely, after Schulman treated the strep with antibiotics, the OCD symptoms vanished.</p><p>"I said you know what, that's odd," Schulman said.</p><p><div class="KonaFilter image-container display-table float_right"><div><div class="image on-image"><p class="source"><span>Caroline Walsh</span></p></div><p></p></div></div>Around the same time, an NIH pediatrician named Susan Swedo published an <a href="http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.155.2.264">article in the American Journal of Psychiatry</a> describing 50 cases of a phenomenon she called "pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections." Schulman realized that the sudden psychiatric symptoms she had observed in her young patients - which ranged from OCD to rage and paranoia - were likely connected to their infections.</p><p>"I see infection as the match that lights the autoimmune reaction. The inflammation is the fire; the symptoms you see is the smoke coming out of the fire," Schulman said.</p><p>Autoimmune conditions that affect the brain only represent a fraction of all autoimmune diseases. Scientists have identified as many as <a href="https://www.niams.nih.gov/Health_info/Autoimmune/default.asp#2">80 others</a>, which range from type 1 diabetes, which develops when the body attacks its insulin-producing cells, to multiple sclerosis, psoriasis, and rheumatoid arthritis. More are being recognized each year.</p><p>Through his research, Kelley hopes to find out what autoimmune diseases that affect the brain have in common so the team can figure out what causes them.</p><p>"A lot of these conditions are variants on the same theme," he said.</p><p>In Walsh's case, "these are people who tend to not have a lot of other medical problems and then all of a sudden they feel like they're going crazy, they're losing themselves," Kelley said. "It tends to be very clear that something's not right, but precisely what's going on can be difficult to piece together."</p><h2>Putting the pieces together</h2><p>When Walsh woke up in her hospital room, she wasn't sure why she was there.</p><p>"I was like why are all these people in my room? Why is it decorated with all of these flowers?," she recalled.</p><p>A day or so before, a specialist had diagnosed Walsh with autoimmune encephalitis and started her on a regimen of powerful steroids, now considered one of the best treatments for the disease. The drugs began to reduce the inflammation in her brain. The affected area was Walsh's hippocampus, the region responsible for making and storing memories.</p><p>"I just remember I kept asking, 'What?' you know, 'Wait, why am I here?' and they would tell me, but I kept forgetting," she said.</p><p><div class="KonaFilter image-container display-table float_right"><div><div class="image on-image"><p class="source"><span>Caroline Walsh</span></p></div><p></p></div></div></p><p>The treatment for autoimmune encephalitis can vary based on the trigger, but timing is always key. If doctors treat whatever is triggering the condition, many people with the disease can go on to lead fairly normal, full lives.</p><p>"It's a race against time in a way," Kelley said.</p><p>In patients whose autoimmune encephalitis seems to be triggered by cancer (as opposed to Walsh's, which may have been set off by the flu), the treatment focuses on treating or removing the cancer first. "When you remove the cancer, you remove the stimulus," Kelley said.</p><p>As Walsh began to regain her ability to remember, she realized she'd have to re-learn a lot of basic things.</p><p>"I remember going to get up to use the bathroom, and one of the nurses went to bring me a wheelchair and I was like, 'Oh no I don't need that,'" Walsh said. "So then I just thought about standing and suddenly I just had no idea, I couldn't function to walk."</p><p>She regained those skills over the next 10 days at Spaulding Rehabilitation Center, the same place the survivors of the Boston Marathon bombing were brought after the attack. There, Walsh re-learned how to put one foot in front of the other and how to hold a spoon.</p><p>She now works part-time as a nanny and volunteers with Spaulding and the Boston Boys and Girls Club. Instead of going back to sales, she plans to work with children in some capacity. She recently attended a Spaulding fundraising event with her sister, Alana, where she bumped into the physical therapist who helped her walk in a straight line for the first time.</p><p>"We were in our dresses and we were both dancing together," Walsh said, "and Alana was like, 'You know she taught you to walk again?'"</p><p> </p><p><em>This story was originally published in May 2017, and has been updated to include recent findings on the prevalence of autoimmune encephalitis.</em></p>     <div class="margin-top">        <h3>NOW WATCH: <a href="http://www.businessinsider.com/how-to-tell-you-have-cold-flu-just-allergies-symptoms-2016-10">How to tell if you have a cold, flu, or just allergies</a></h3>        <div>                    </div>    </div>

A 24-year old got a mysterious disease where her body attacked her brain - and scientists are learning it's more common than they thought

<p class="source"><span>Caroline Walsh</span></p><p class="caption">Caroline, in the middle, with her family.</p>There's a blank year in 25-year-old Caroline Walsh's once-spotless memory.<p>She's pieced parts together from stories her friends have told her and a collection of photos on Facebook. But she cannot remember the day it all began - when her father found her in the middle of a seizure, her body writhing on the floor. She also can't remember waking up with her hands tied to a hospital bed, begging her sister to help her escape, or the next day when she proclaimed she was the Zac Brown Band.</p><p>Instead, Walsh's first recollection of that time is of a recovery room filled with family and flowers. By then, her doctors had diagnosed her with a mysterious disease called autoimmune encephalitis, or AE for short. While there's lot we still don't know about the condition, experts believe it's part of a larger class of illnesses in which the body turns on itself.</p><p>In Walsh's case, the disease attacked her brain, setting off a chain reaction of symptoms that mimicked those of other mental illnesses like depression and schizophrenia. If treated properly and early enough, people with AE can make a near-complete recovery. But if they go undiagnosed or land in a psychiatric ward, they can die.</p><h2>Something brewing</h2><p>A stroll down a real street called Memory Lane in London leads you to the London Institute of Psychiatry, where J.A.N. "Nick" Corsellis sliced into the brains of three corpses and found the first evidence of AE.</p><p>Deep in the dense part of the brain called the limbic system, the normally lithe network of rubbery-smooth tissue had become puffy and inflamed. It was as if something had attacked it from within.</p><p>Most of the people these brains once belonged to had been diagnosed with cancer, then seemed to make a full recovery. But their personalities <a href="https://academic.oup.com/brain/article-abstract/91/3/481/258399/LIMBIC-ENCEPHALITIS-AND-ITS-ASSOCIATION-WITH?redirectedFrom=fulltext">began to change</a>. A partner or friend was usually the first to notice an odd shift in their behavior - usually a progressive increase in forgetfulness, though others experienced a sudden bout of mania or depression. A 58-year old bus driver found himself waking up most days not knowing where he was.</p><p>Corsellis saw inflammation in parts of the brain linked with memory and mood, but he couldn't explain what had caused the swelling that triggered the symptoms.</p><p>"The first question to arise ... is whether the assertion of a connection between carcinoma [cancer] and 'limbic encephalitis' is now justified, even if it cannot be explained," he wrote in a 1968 paper in the journal Brain. It was first time the condition was mentioned in a scientific journal.</p><p>Walsh's symptoms became noticeable one day at work when she started repeating herself. She joked with a co-worker that she was coming down with early-onset Alzheimer's.</p><p>"I was just getting very confused all the time," Walsh says.</p><p>The next week, more mysterious problems cropped up - Walsh had a knack for remembering names, but one day when she met up with some new friends, she introduced herself half a dozen times and struggled to commit anyone's name to memory.</p><p>"They'd say it and then a couple minutes later I'd have no clue what their name was or what we were even talking about," she says.</p><p>At the office the next day, things got worse. "My personality was just off. I thought it was work. I pulled my boss aside into a conference room and I started to cry, which was just not me," she says. When she wasn't feeling stressed and anxious, she felt depressed.</p><p>"Something was just brewing, I could feel it," she says.</p><h2>When the body attacks itself</h2><p>Our immune system is our body's defense against the outside world.</p><p>Most of the action is coordinated by white blood cells, which direct the lines of attack like football coaches, churning out antibodies that target the opponent for destruction.</p><p class="source"><span>Shutterstock</span></p><p class="caption">A white blood cell.</p>But sometimes the process can go awry. In generating an immune response against a virus or other disease, the body can wind up up attacking itself - a larger class of illnesses known as autoimmune diseases.<p>It's as if "some wires get crossed," says <a href="https://www.researchgate.net/profile/Brendan_Kelley">Brenden Kelley</a>, a neuroradiologist at Henry Ford hospital in Detroit who's part of the small community researching autoimmune encephalitis.</p><p>Sometimes, this abnormal response can be caused by a virus like the flu or a bacterial infection. Other times, certain types of cancer appear to be the source.</p><p>"In picking targets that match the cancer, the body may also pick targets that match places in your body that don't have cancer," says Kelley.</p><h2>Knee deep in the water</h2><p>Three months later, Walsh relocated to her childhood home outside of Boston, and saw two doctors who both incorrectly diagnosed her with the flu.</p><p>Then one morning around 4 a.m., as her dad, a Boston police officer, got ready for work, he heard a loud crash. He found his daughter on the ground, her limbs thrashing. He screamed her name, but she didn't respond.</p><p>The most common cause of the type of seizure that Walsh had that day - known as a grand mal seizure (literally "great sickness" in French) - is epilepsy. Other causes can include extremely low blood sugar, high fever, and stroke.</p><p>At the hospital, Walsh's doctors tested her extensively, doing multiple lumbar punctures or "spinal taps," a painful, dangerous procedure that involves collecting and analyzing the protective fluid surrounding her brain and spinal cord. In most cases, this is where doctors will first spot autoimmune encephalitis, Kelley says.</p><p>But sometimes, as in Walsh's case, the characteristic markers of inflammation are too subtle to draw a definite conclusion.</p><p class="source"><span>Caroline Walsh</span></p><p class="caption">Caroline at the hospital.</p>When Caroline's sister Alana arrived at the hospital, Caroline was lying motionless on her hospital bed under the harsh lighting. Her hands had been encased in heavily padded mitts that looked like boxing gloves, and were fastened to the railings on her bed to keep her from pulling out the IV tubes keeping her hydrated. She asked Alana to come closer so she could whisper something into her ear.<p>"You have to fight 'em, you have to get me out of here," said Caroline, motioning her head towards the nurses as she eyed them suspiciously.</p><p>When Alana asked her sister what she was talking about, Caroline explained that she'd been abducted while she was asleep and was now being held hostage at the hospital.</p><p>A few hours later, after drifting into the sleepy, dazed state she was in for much of her hospital stay, she woke with a jolt and proclaimed she was the country singer the Zac Brown Band. She started belting out her favorite song of his, a catchy tune about taking a break from reality called "Knee Deep."</p><p><em>"Gonna put the world away for a minute," </em>she sang, getting louder with every verse. <em>"Pretend I don't live in it."</em></p><p>When her family couldn't stop Caroline's crooning, Alana got up and closed the doors to her room in an attempt to keep her from waking up everyone on the ward. Caroline continued.</p><p><em>"Mind on a permanent vacation, t</em><em>he ocean is my only medication, w</em><em>ishin' my condition ain't ever gonna go away."</em></p><p>Over the next week, Walsh proceeded to seize more than a hundred times. Alana recalls that nearly every time she sat down to talk with her, Caroline would seize half a dozen times. They weren't massive seizures like the one that had landed her in the hospital, but small, barely perceptible ones.</p><p>"You'd know because her eyes would drift away and she'd stare in one spot, she was having little ones almost every minute," says Alana. "She was very shaky and confused; her heart rate was extremely high, and the doctors just seemed so confused by everything every time we talked to them, they were like she can't be going into these seizures all the time, it's just too much."</p><p>Eventually, the doctors decided to put her in a medically-induced coma.</p><h2>Smoke from the fire</h2><p>In children, infections like strep throat appear to be a trigger of AE. <a href="http://nyulangone.org/doctors/1962593632/susan-schulman">Susan Schulman</a>, a pediatrician in New York, says she's seen hundreds of cases of a related condition, called PANS (pediatric acute-onset neuropsychiatric syndrome), in her patients. Her first case, in 1998, was a five-year old girl from Brooklyn who flew into a panic about keeping the clothes she wore on the Jewish holiday of Shabbat separate from her regular clothes.</p><p>"She was driving her mother crazy," Schulman says. At first, she believed the girl had <a href="http://pedsinreview.aappublications.org/content/34/1/19">childhood obsessive-compulsive disorder</a>, but medication made the child's symptoms worse, and she returned to Schulman's office with more intense OCD symptoms and a nasty case of strep throat. Strangely, after Schulman treated the strep with antibiotics, the OCD symptoms vanished.</p><p>"I said you know what, that's odd," Schulman says.</p><p class="source"><span>Caroline Walsh</span></p>Around the same time, an NIH pediatrician named Susan Swedo published an <a href="http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.155.2.264">article in the American Journal of Psychiatry</a> describing 50 cases of a phenomenon she called "pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections." Schulman realized that the sudden psychiatric symptoms she had observed in her young patients - which ranged from OCD to rage and paranoia - were likely connected to their infections.<p>"I see infection as the match that lights the autoimmune reaction. The inflammation is the fire; the symptoms you see is the smoke coming out of the fire," Schulman says.</p><p>Autoimmune conditions that affect the brain only represent a fraction of all autoimmune diseases. Scientists have identified as many as <a href="https://www.niams.nih.gov/Health_info/Autoimmune/default.asp#2">80 others</a>, which range from type 1 diabetes, which develops when the body attacks its insulin-producing cells, to multiple sclerosis, psoriasis, and rheumatoid arthritis. More are being recognized each year.</p><p>Kelley and others at Henry Ford are currently researching autoimmune diseases that affect the brain. By working with scientists who specialize in the brain and the immune system, Kelley hopes to find out what these conditions have in common so the team can eventually figure out what causes them.</p><p>"A lot of these conditions are variants on the same theme," he says. </p><p>In Walsh's case, "these are people who tend to not have a lot of other medical problems and then all of a sudden they feel like they're going crazy, they're losing themselves," Kelley says. "It tends to be very clear that something's not right, but precisely what's going on can be difficult to piece together."</p><h2>Putting the pieces together</h2><p>When Walsh woke up in her hospital room, she wasn't sure why she was there.</p><p>"I was like why are all these people in my room? Why is it decorated with all of these flowers?," she recalls.</p><p>A day or so before, a specialist had diagnosed Walsh with autoimmune encephalitis and started her on a regimen of powerful steroids, now considered one of the best treatments for the disease. The drugs began to reduce the inflammation in her brain. In Walsh's case, the affected area was her hippocampus, the region responsible for making and storing memories.</p><p>"I just remember I kept asking, 'What?' you know, 'Wait, why am I here?' and they would tell me, but I kept forgetting," she says.</p><p class="source"><span>Caroline Walsh</span></p><p class="caption">Caroline at Spaulding Rehabilitation Hospital.</p>In patients whose autoimmune encephalitis seems to be triggered by cancer (as opposed to Walsh's, which may have been set off by the flu), the treatment focuses on treating or removing the cancer first. "When you remove the cancer, you remove the stimulus," Kelley says.<p>The treatment for autoimmune encephalitis can vary based on the trigger, but timing is always key. If doctors treat whatever is triggering the condition, many people with the disease can go on to lead fairly normal, full lives.</p><p>"It's a race against time in a way," Kelley says.</p><p>As Walsh began to regain her ability to remember, she realized she'd have to re-learn a lot of basic things.</p><p>"I remember going to get up to use the bathroom, and one of the nurses went to bring me a wheelchair and I was like, 'Oh no I don't need that,'" says Walsh. "So then I just thought about standing and suddenly I just had no idea, I couldn't function to walk."</p><p>She regained those skills over the next 10 days at Spaulding Rehabilitation Center, the same place the survivors of the Boston Marathon bombing were brought after the attack. There, Walsh re-learned how to put one foot in front of the other and how to hold a spoon.</p><p>Walsh now works part-time as a nanny and volunteers with Spaulding and the Boston Boys and Girls Club. Instead of going back to sales, she plans to work with children in some capacity. She recently attended a Spaulding fundraising event with her sister, Alana, where she bumped into the physical therapist who helped her walk in a straight line for the first time.</p><p>"We were in our dresses and we were both dancing together," Walsh says, "and Alana was like, 'You know she taught you to walk again?'"</p>  <h3>More from Erin Brodwin:</h3><ul><li><a href="http://www.businessinsider.com/rare-disease-body-attacks-brain-2017-5" rel="nofollow">A 24-year old got a mysterious disease where her body attacked her brain - and everyone thought it was in her mind</a></li><li><a href="http://www.businessinsider.com/shark-video-california-oc-hides-bigger-threat-2017-5" rel="nofollow">A video of 15 sharks circling near paddleboarders in California hides a bigger problem</a></li><li><a href="http://www.businessinsider.com/seaweed-tastes-like-bacon-review-2017-5" rel="nofollow">We tried the seaweed that 'tastes like bacon' and is healthier than kale - here's the verdict</a></li><li><a href="http://www.businessinsider.com/microdosing-lsd-effects-risks-science-2017-5" rel="nofollow">Scientists are about to find out how Silicon Valley's LSD habit really affects productivity</a></li><li><a href="http://www.businessinsider.com/healthiest-fast-food-chipotle-panera-shake-shack-2017-5" rel="nofollow">15 of the healthiest fast-food menu items</a></li></ul>            <h3>NOW WATCH: <a href="http://www.businessinsider.com/nasa-cassini-saturn-dive-video-grand-finale-2017-5">NASA released its first incredible video of our closest look at Saturn yet</a></h3>                                    Please enable Javascript to watch this video

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