Health Risks of Black Henna Tattoos

The Florida Health Department is issuing advisory against the use of Black Henna tattoos, with the onset of spring break season, according to the Outbreak News blog. Henna is not naturally black in color, and is usually a reddish powder that turns brown when water is added and it is allowed to stand for a while. To induce the black color, a pigment, called para-phynelenediamine is added to it.

Short term exposure to PPD may precipitate dermatitis, asthma, gastritis, renal failure, vertigo, tremors, convulsions and even coma in human beings. The effect of chronic exposure to it are not known in man, though in experimental rats it has been shown to only cause a failure to gain weight, and nothing else.

“About two years ago I had a reaction to a “henna” design of a dragon. The colour faded quickly which surprised me, and about two weeks afterwards my skin welted up about a quarter of an inch in the exact pattern of the dragon. The itching was bad enough to keep me awake at night for several days. The swelling went away, but the pattern stayed for almost a year.

The carcinogenicity of PPD is unknown and its effect on the reproductive or developmental processes are also not clearly known. PPD is basically an allergen that evokes histamine release and a cell-mediated immune response, leading to a cascade which may precipitate the above mentioned conditions.

The primary method of prevention is to ban or restrict the use of PPD in tattooing chemicals, and increasing user awareness so that they may demand to know the composition of the dye being used for tattoo.

“This is how my daughter’s PPD black henna tattoo turned after returning from Bali The worst of it though is she has been feeling ill for the whole week that we have been home. Muscle weakness, headaches, sore throat, stomach ache and light headedness. We are off to the doctors today to show them this information on PPD to see if her symptoms are related.”
This tattoo was applied on the 20th April 2001. This photograph was taken 10 days later “Thought you might like to see how they (the black henna tattoos) look today. The one on her arm is now 1 week and 3 days old.

Images from: East on West, Black Henna Warning

Anthony Fauci: Ebola Virus Not Showing Accelerated Evolution

One of my modern day medical idols is Dr. Anthony Fauci, one of the lead editors of the two-volume Bible of Internal Medicine, “Harrison’s Internal Medicine”, and also the Director of the National Institute of Allergy and Infectious Diseases. In an NIH News piece he has commented:

“The Ebola virus in the ongoing West African outbreak appears to be stable—that is, it does not appear to be mutating more rapidly than viruses in previous Ebola outbreaks, and that is reassuring,”…. “We look forward to additional information to validate this finding, because understanding and tracking Ebola virus evolution are critical to ensuring that our scientific and public health response keeps pace.”

This news article presents good news in context of the proportions that the Ebola outbreak has assumed in the Western African countries, accounting for 25,000 odd cases and about 10,000 deaths.

Novel Zoonotic Orthopoxvirus in Georgia

According to a recent article published in the New England Journal of Medicine, a novel zoonotic orthopoxvirus caused lesions in two men in the country of Georgia. Another sample, tested retrospectively after being stored for suspected Anthrax, also turned out to be positive for this new pox virus.

The article abstract states:

During 2013, cutaneous lesions developed in two men in the country of Georgia after they were exposed to ill cows. The men had never received vaccination against smallpox. Tests of lesion material with the use of a quantitative real-time polymerase-chain-reaction assay for non–variola virus orthopoxviruses were positive, and DNA sequence analysis implicated a novel orthopoxvirus species. During the ensuing epidemiologic investigation, no additional human cases were identified. However, serologic evidence of exposure to an orthopoxvirus was detected in cows in the patients’ herd and in captured rodents and shrews. A third case of human infection that occurred in 2010 was diagnosed retrospectively during testing of archived specimens that were originally submitted for tests to detect anthrax. Orthopoxvirus infection should be considered in persons in whom cutaneous lesions develop after contact with animals.


Vora NM, Li Y, Geleishvili M, et al: Human infection with a zoonotic orthopoxvirus in the country of Georgia. N Engl J Med. 2015;372(13): 1223-30. doi: 10.1056/NEJMoa1407647. Available from: LINK.

New Species Behind Leprosy?

There have been discussions on the role of a novel species of Mycobacterium, M. lepromatosis, in the causation of Leprosy for a long time now. In 2008, Han and colleagues (1) found the novel bacterium as the causative organism behind diffuse lepromatous leprosy. A new paper (2) published in the Proceedings of the National Academy of Sciences (PNAS) has further strengthened the premise of a novel species causing leprosy by conducting a whole genome study.

The concept that Mycobaterium leprae is the only causative organism behind the disfiguring disease which has almost been eliminated from many parts of the world, now stands challenged by the emergence of this new evidence. The contribution of this new species to the overall case load and what implications it holds for public health approaches to control the disease in the long run needs to be reexamined.
The new paper, by Singha et al, has isolated Mycobacterium lepromatosis from the skin lesions of a patient suffering from diffuse lepromatous leprosy and has conducted a whole genome sequencing, followed by comparison with that of the Mycobacterium leprae, to establish the unique identities of the two different organisms.


1. Han XY, Seo YH, Sizer KC, Schoberle T, May GS, Spencer JS, Li W, Nair RG. A new _Mycobacterium_ species causing diffuse lepromatous leprosy. Am J Clin Pathol. 2008 Dec;130(6):856-64. doi: 10.1309/AJCPP72FJZZRRVMM.
2. Singha P, Benjaka A, Schuenemannb VJ, Herbigb A, et al. Insight into the evolution and origin of leprosy bacilli from the genome sequence of Mycobacterium lepromatosis. PNAS. March 18, 2015. doi: 10.1073/pnas.1421504112.

Ross River Virus Hits Australia

Ross River Virus (RRV), a zoonotic alpha virus, is spread by a wide range of mosquitoes, including the Culex and Aedes mosquitoes. Queensland seems to be the worst hit with this disease, with as many as 3292 cases being reported till the end of March 2015. New South Wales has also seen a surge in the number of RRV cases as over 320 cases were registered by the middle of March 2015. It has rapidly emerged to be the most important vector borne disease in Australis, as far as number of cases are concerned, with over 5000 cases being consistently reported annually.

RRV causes a disease which is rarely fatal and manifests primarily as acute polyarthralgia. However, the pain in the joints, which can sometimes be debilitating, may persist for weeks after the acute phase of the disease is over. This was the basis for its previous nomenclature, epidemic polyarthritis.

RRV transmission to human beings is associated with the rainy season, when there is an abundance of breeding opportunities for mosquitoes. The main methods to stave off the disease encompasses methods of vector control and vector avoidance.

The virus is named after the Ross river in Townsville, where it was first identified to be the causative organism behind the epidemic polyarthritis.

Hemorrhagic Fever with Renal Syndrome Established in Saratov, Russia

According to a (translated) report in Free News Volga, the Saratov regions remains active for the transmission of Hemorrhagic Fever with Renal Syndrome (HFRS). In January 2015, as many as 121 people were identified to be suffering from HFRS, which represents a four fold increment to the number of cases reported in January 2014.

HFRS is a group of symptomatologically similar diseases caused by a group of viruses belonging to the family Bunyaviridae. The viruses that cause HFRS include Hantaan, Dobrava, Saaremaa, Seoul and Puumala viruses.

These viruses are primarily carried by rodents and human beings get affected when they come in contact with rodent urine or saliva or even aerosolized dust from rodent nests. Known carriers

include the striped field mouse (Apodemus agrarius), the reservoir for both the Saaremaa and Hantaan virus; the brown or Norway rat (Rattus norvegicus), the reservoir for Seoul virus; the bank vole (Clethrionomys glareolus), the reservoir for Puumala virus; and the yellow-necked field mouse (Apodemus flavicollis), which carries the Dobrava virus.
Control measures, therefore, center around measures for rodent control and exposure limitation. None of the HFRS have a specific treatment and supportive therapy, with maintenance of hydration, electrolytes, appropriate antibiotics to treat any secondary infections and dialysis for renal support being the pillars of disease management. Depending on the causative virus and the patient profile, mortality varies from as low as 1% to as high as 15%.

Mystery Illness Strikes People Blind, then Dead in Nigeria

A strange illness has claimed at least 25 lives  in OdeIrele in Irele local government area of Ondo State of Nigeria, according to several news reports (Sahara Reporters, Daily Post). The disease, which seems to have ravaged the area in the past ten days or so, affected all the hospitalized patients simultaneously. While news reports have stated at least 25 deaths, how many people were affected as not been reported.

The patients supposedly develop a headache, followed up sudden loss of vision which precedes death; in the interim, the patients may also suffer from loose stools, difficulty hearing and speaking and in a couple of cases, swelling of the tongue.

The temporal association and lack of secondary cases indicates that a toxic cause is more likely than an infectious one, however, until further reports are available, it would only be a speculation, at best. Given the constellation of symptoms, the possibility of methanol poisoning cannot be entirely excluded.

The villagers are, of course, blaming spirits for the outbreak, especially since an old shrine in the locality was ransacked and damaged by unknown individuals.

Meningitis Epidemic in Niger Claims 75 Lives

A meningococcal meningitis (caused by Neisseria meningitidis) outbreak in Niger, which started in January this year, has kept gaining momentum. Currently, the numbers of cases in the country stands at 697, with 75 deaths attributed to this disease. A previous report stated that it had affected 345 people between January 1 to March 29 of this year, and of those, 45 people had died. The increasing numbers point to the trend that the disease is increasingly spreading through the susceptible people in the community.

According to the World Health Organization (WHO), Niger, which is one of the poorest nations in the world, is prone to frequent epidemics of meningococcal meningitis because of its position in the meningitis belt, stretching from Senegal from the west to Ethiopia in the east.
Vaccinations are the primary mode of controlling the spread of the epidemic by inducing immunity in the susceptible population. Over 13,500 doses of the vaccine has been distributed as part of a vaccination campaign that is being launched to combat the epidemic. More vaccines will be deployed once the campaign is moving.


First Isolation of Leishmania from Northern Thailand

A case report published in the PLoS Neglected Tropical Diseases reports the first isolation of  Leishmania from Northern Thailand. From the published abstract:


Since 1996, there have been several case reports of autochthonous visceral leishmaniasis in Thailand. Here we report a case in a 52-year-old Thai male from northern Thailand, who presented with subacute fever, huge splenomegaly and pancytopenia. Bone marrow aspiration revealed numerous amastigotes within macrophages. Isolation of Leishmania LSCM1 into culture and DNA sequence analysis (ribosomal RNA ITS-1 and large subunit of RNA polymerase II) revealed the parasites to be members of the Leishmania enriettii complex, and apparently identical to L. martiniquensis previously reported from the Caribbean island of Martinique. This is the first report of visceral leishmaniasis caused by L. martiniquensis from the region. Moreover, the majority of parasites previously identified as “L. siamensis” also appear to be L. martiniquensis.
Light micrograph of Leishmania amastigotes in bone marrow aspirate.Two infected macrophages are stained (large arrows), each with a nucleus (N) and numerous amastigotes (examples with small arrows) within the cytoplasm. The specimen was stained using Wright’s stain. The bar represents 20 µm.doi:10.1371/journal.pntd.0003339.g001

Author Summary

Visceral leishmaniasis is a potentially life threatening parasitic disease that is found in many tropical and subtropical regions of the world. We report a case of visceral leishmaniasis in northern Thailand caused by a recently described new species of Leishmania parasite, Leishmania martiniquensis. By comparing DNA sequences from this parasite with those of other isolates, we show that this parasite is more widely spread than previously thought, with several other examples in Thailand, and possibly from Europe and the USA, as well as the original location in the Caribbean island of Martinique. This parasite appears to be an emerging pathogen, which, because it causes a potentially fatal disease, needs to be investigated in detail so that its transmission can be understood and control measures can be developed.

Giemsa-stained promastigote forms from culture.A–H, examples showing morphological variation of forms observed, all at the same magnification, bar in F represents 5 µm. Procyclic-like promastigotes can be observed in A (arrows);, leptomonad-like promastigotes in B and C (arrows); nectomonad-like promastigotes in D, E and F; and rosettes and aggregates in G and H.doi:10.1371/journal.pntd.0003339.g003

Pothirat T, Tantiworawit A, Chaiwarith R, Jariyapan N, Wannasan A, et al. (2014) First Isolation of Leishmania from Northern Thailand: Case Report, Identification as Leishmania martiniquensis and Phylogenetic Position within the Leishmania enriettii Complex. PLoS Negl Trop Dis 8(12): e3339. doi:10.1371/journal.pntd.0003339 Available from: LINK.

HPAI H5N2 Strikes Two More Counties in Wisconsin

Two more counties in Wisconsin have fallen prey to the Highly Pathogenic Avian Influenza H5N2 strain which continues its exponential race across the Mississippi flyway, along which this infection has been gaining momentum. According to the report in Madison, this new outbreak, affecting the Barron and Juneau counties, have put almost 126,000 heads of poultry at risk.

Although this disease seems to be highly infectious and has a very high case fatality rate, it has not yet made the species jump at similar proportions and is believed to be of little infectivity and virulence to man.