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2009-10-28 Science & Technology

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Posted by Anonymoose 2009-10-28 10:16|| || Front Page|| [2 views ] Top

#1 Doc, correct me if I am wrong, but is this related to the cytokine storm caused by overreaction of the Beta activated immune response? Meaning we should see antibodies and interferons against a virus.

If it were cell mediated, the Tc would lyse the crap out of things, and the Ts would eventually shut down that feedback loop, which is more purely destructive, not stimulative of tissue deposits.

This almost sounds like what I remember as opsonization, except that its happening to the simple squamous tissue in the epithelial linings of the alveoli instead of a pathogen. That and the hyaline tissue is being deposited instead of antibodies.

FYI for those not having had physiology, hyaline tissue is what cartilage is frequently built from in the upper portions of the brachia all the way to the bronchioles. Its not supposed to be in the respiratory bronchioles nor in the lung lobules or alveolar area at all.

This sounds more like a bacteria, maybe an opportunistic one, instead of a virus unless it has some sort of retroviral styel activating pathway that kicks on an autoimmune response on the proteins in respiratory membrane epithelials, causing the body to treat them like upper respiratory tract tissue instead of lung tissue.

Whatever the case is, this sure is a damned odd turn at this stage.

Posted by OldSpook 2009-10-28 12:31|| 2009-10-28 12:31|| Front Page Top

#2 Hmm, in simpler terms: Whats happening is the very flexible and thin (less than one micro meter, only one cell thick) lining of the air sacs in the lungs is becoming layered with a cartilage-like tissue, which makes it less flexible, and worse, it makes it thicker and less permable to gases like O2 and CO2. This interferes with the ability of the lungs to efficiently accomplish gas exchange. Meaning the body cannot dump CO2 all that well, and cannot absorb O2, because the tissue is simply too thick for the blood to get oxygen through and dump carbon dioxide out.

Posted by OldSpook 2009-10-28 12:36|| 2009-10-28 12:36|| Front Page Top

#3 Our household has the svine flu, hell, our entire city has it, and as usual, my wife zipped through it like a minor cold and it hit me like a freight train. The hallucinations got pretty interesting until they finally took me to the ER and old sawbones give me a coupe of bags of fluid and the full court press of TamiFlu.
Now all that remains is lethargy,the occasional chill and a much worse chest cough than I had with this flu in its first stages. And wouldn't ya know it, it's the first week of rifle season, and now to boot the History channel is showing nothing good this week.

Posted by Senor Svine 2009-10-28 12:55|| 2009-10-28 12:55|| Front Page Top

#4 OldSpook: This one just beats all. A cytokine storm response causes inflammation so profound you can see it on an X-Ray. And the common opportunistic bacteria all cause necrosis. This leads me to suspect an opportunistic virus, like herpes (but likely not herpes), which can cause protein accumulation. But this is stabbing in the dark.

Posted by Anonymoose 2009-10-28 13:51|| 2009-10-28 13:51|| Front Page Top

#5 Cytokine storm is indeed the issue here.

Generally influenza doesn't kill directly, it instead alters the immunity of the lung so as to allow bacterial infection (pneumococcus, staphylococcus) and pneumonia.

'Cytokine storm' is the situation in which the virus provokes an over-exuberant response from the innate immunity cells in the lung; these release cytokines and chemokines which in turn facilitate an overwhelming inflammatory response.

Understand that cytokine release, properly controlled, is a good part of the inflammatory response: we get more immune cells to the right place and have them activated to sequester and quell the viral infection. When it goes haywire and is far more than needed, one gets damage to the lung cells and structures.

Now cytokine storm isn't completely understood and so I wouldn't use the terms 'opsonization', etc. But part of the damage that may occur is a fibrotic response to inflammation. We see this, for example, in 'adult respiratory distress syndrome', a response to infection, trauma, etc in which there is first flooding (edema) of the lung followed by (if not treated) fibrosis. That can be fatal. Without knowing what happened in the H1N1 cases I can't say, but I could imagine a similar response with thickening of the alveolar membranes (and their eventual fibrosis and destruction).

It's certainly possible for such a reaction to occur in the absence of a superimposed bacterial infection.

I need to hear more about this, and I'm sure our critical care group will be looking into it. As OS notes, it's ominous.

Posted by Steve White 2009-10-28 14:10|| 2009-10-28 14:10|| Front Page Top

#6 I still have my notes from the Avian flu and other flu discussions here at Rantburg. Do the recommendations still hold, or should we be doing something more/different to control the cytokine storm response?

My notes then were:
o Cold-eeze brand zinc gluconate lozenges at least 3x/day, refraining from food or drink for an hour afterward
o Large quantities of ordinary cranberry juice
o Vitamin D-3 (Cholecalciferol) not vitamin D-2
o Wash hands with soap or use alcohol sanitizer 6x/day
o GSE grapefruit extract, sold in health food stores as a calcium supplement, as a surface decontaminant: add a tablespoon to the water of a room vaporizer/humidifier to disinfect the air and room surfaces.
o the sick person to wear a dust mask to prevent the spread of infected droplets from sneezing/coughing

The things I know to use against inflammation are aspirin, Co Q-10, resveratol (red wine extract).

When I took the trailing daughters to get their seasonal flu shots, it was recommended that those eighteen years and older also get a pneumonia vaccine, which trailing daughter #1 dutifully did. While a good thing overall, will that help in this particular situation?

Posted by trailing wife">trailing wife 2009-10-28 15:06|| 2009-10-28 15:06|| Front Page Top

#7 two-thirds of the influenza H1N1 patients who died actually tested negative for the virus.

As I recall that is consistent with a cytokine storm. The immune system does knock out the virus, but doesn't recognize that it has for some reason and goes into 'overdrive' trying to kill the virus causing the c storm.

Posted by phil_b 2009-10-28 15:26|| 2009-10-28 15:26|| Front Page Top

#8 Poorly phrased, try again,

and goes into 'overdrive' trying to kill the virus which is no longer present causing the c storm.

Posted by phil_b 2009-10-28 15:28|| 2009-10-28 15:28|| Front Page Top

#9 tw, Steve's the Doc, I'm just a kibitzing nurse wannabe. But all-in-all the pneumonia vaccine is probably a good thing (that's what's causing the deaths - flu just opens the door).

Whats alarming is that the virus isn't showing up in a large enough number of the fatalities, so the morbidity mechanism is different from other known issues.

This means its something other than the flu virus, and its also not like the usual bacterial or known viral pathogens that destroy the lung capacity in this sort of illness scenario. And *that* is what caught my attention - and it's raising the hackles on people far more educated than I (like Doc Steve).

Posted by OldSpook 2009-10-28 15:47|| 2009-10-28 15:47|| Front Page Top

#10 TW and SW: The latest recommendation against secondary infections is Avelox (Rx) (tablets):

http://www.rxlist.com/avelox-drug.htm

Other bits: long term arsenic exposure can be deadly in this case, because it has been observed to inhibit pathogen recognition, followed by an immune overreaction. Not much of a problem due to tight EPA standards in drinking water in the US, fortunately.

There is an effort to develop an OTC cocktail of cytokine inhibitors enough to prevent the onset of ARDS, with the most promising being inhibitors for H-1, H-2, ACE and Prostaglandin in combination.

Considerable success has been found using external blood oxygenation to substantially reduce mortality. No mention of oxygen therapeutics augmentation, however.

Odd statistical observations are first that some Hispanics seem to be more prone to severe infections, and high mortality among the very young, those with other medical conditions, and strangely, older, healthy children who had a day or so before their disease went acute, been strenuously exercising.

Posted by Anonymoose 2009-10-28 17:00|| 2009-10-28 17:00|| Front Page Top

#11 A question from one who did not do well in high school biology: What caused the death if H1N1 is not shown to be present?

Posted by tipover 2009-10-28 17:45|| 2009-10-28 17:45|| Front Page Top

#12 Sorry folks, I only read the first few replies before asking the question, it may have been answered by Steve White and Phil_b in replies 5,7,8. Still sounds like there a ton of unknowns.

Posted by tipover 2009-10-28 18:03|| 2009-10-28 18:03|| Front Page Top

#13 tipover: often it is oxygen deprivation. The lungs have been so damaged that the internal organs can't get enough oxygen. Otherwise, fluid buildup in the lungs, secondary bacterial infection from one of several bacteria, and the exacerbation of other medical conditions, such as diabetes and heart disease.

Posted by Anonymoose 2009-10-28 18:25|| 2009-10-28 18:25|| Front Page Top

#14 TW
zinc is good but should be consumed in less than 50mg a day (FedReg) I'd use no more than 20 - throughout the day in small doses -(it can cause stomach distress)

cranberry juice is a wonderful source of vit C and anti oxidants

be careful with vit D it is a oil sourced vit and is not washed out of your system easily if you take too much..

always wash your hands../.

grapefruit extract is sold this way because of its acidic qualities (and pricey ones) white vinegar will work the same - albeit more smelly..

dust masks have negligible effects .. there are medical grade masks available with more price and imo little value..

!!asprin -"the miricle drug"!!!

Posted by linker 2009-10-28 21:06|| 2009-10-28 21:06|| Front Page Top

#15 dust masks have negligible effects .. there are medical grade masks available with more price and imo little value..

Largely a myth. Flu is spread primarily by contact (touch) with the mucous membranes. Anything over the nose, mouth and eyes will work to prevent this contact (hospital workers excepted).

Posted by phil_b 2009-10-28 21:22|| 2009-10-28 21:22|| Front Page Top

#16 And for those of you not familiar with Dengue shock syndrome (DSS), also referred to as dengue hemorrhagic fever (DHF), which looks remarkably like cytokine storm.

The dengue virus serotypes are named dengue type 1,2,3, and 4. The four serotypes are extraordinarily similar, but have different strains of dengue virus. If an individual is infected with one serotype, then s/he has immunity to that virus. However the immunity applies to only that virus not to the others. Exposure to one serotype, in fact causes the individual to be more susceptible to dengue shock syndrome. The immunity produces specific antibodies to prevent the virus from attaching to the macrophage cells, which is the target cell that dengue viruses infect. If an individual is infected with a second serotype of dengue virus the bodys immune system will trigger, thinking that it is the serotype of the first infection. The antibodies attach to the serotype, assuming they are doing their job, however the virus still exist and continues to infect the person. This condition is known as antibody dependent enhancement. The person persists to be infected resulting in dengue hemorrhagic fever and dengue shock syndrome.

Posted by phil_b 2009-10-28 21:30|| 2009-10-28 21:30|| Front Page Top

#17 re: phil_b
'Largely a myth.'
yeah i've read studies going either way on that one .. but i'll still stick firmly to
'always wash your hands../.'

Posted by linker 2009-10-28 21:43|| 2009-10-28 21:43|| Front Page Top

#18 regardless, IMA quitn licking keyboards and doorknobs and sech

Posted by Frank G">Frank G 2009-10-28 21:44|| 2009-10-28 21:44|| Front Page Top

#19 linker: Several important notes. Zinc gluconate, patented by Cold-Eeze, is readily uptaken by the mucous membranes where it is needed. Other forms of zinc are not. Zinc inhibits viral reproduction inside cells.

Cranberry juice is specifically because it has been shown to inhibit virus adhesion to cells in some other viruses, and may do so in influenza.

Vitamin D3 has toxicity at 30-50,000 IU daily for a few weeks. Some people are sensitive to as little as 3,000 IU, but most people aren't. Vitamin D has several mechanisms shown to interfere with viruses, including a breakdown product that erodes viral coats.

Grapefruit extract is specifically for its ionic calcium, not its acidic properties. Unlike zinc, it oxidizes viruses like bleach.

Dust masks will stop the drops of moisture on which viruses travel, so are quite effective for most people. N95 masks are for those who must work around infected people a great deal. In which case they also need protective glasses to prevent optic viral uptake.

Viruses travel by air optimally at 40F and low humidity. At higher temperatures and humidity, they become increasingly dependent on surface contact contamination.

Posted by Anonymoose 2009-10-28 22:02|| 2009-10-28 22:02|| Front Page Top

#20 # 6, TW, I have to use very potent cocktail of anti-oxidant/free radical scavengers to keep me alive.Almost daily I use the following:
1. Natural Astaxanthin, 10 mg softgel (from vitacost.com, item number 844197013258, cost 17.99 for 60 softgels)
2. CN Pine Bark extract 90%, 100 mg (from americannutrition.com. cost 15.99 for 120 vcaps)
3. Alka-Seltzer, twice a week ( contains aspirin and bicarbonate that scavenges nitric oxide free radicals) or daily low dose (80 mg) aspirin and sparkling water.
4 A regular multivitamin plus mineral with zinc.
5. A small dash of turmeric powder (curcumin, the yellow spice in Indian curry)
All of the above are safe and available over the counter.

Posted by Annon 2009-10-28 22:10|| 2009-10-28 22:10|| Front Page Top

23:58 trailing wife
23:43 S.
23:39 trailing wife
23:23 Skunky Glins****
23:11 ed
23:02 Skunky Glins****
23:00 Redneck Jim
22:55 Skunky Glins****
22:55 Lumpy Elmoluck5091
22:51 Skunky Glins****
22:49 VietVet68
22:46 Redneck Jim
22:44 Sgt. Mom
22:35 Redneck Jim
22:24 Redneck Jim
22:19 S.
22:18 ed
22:17 whitecollar redneck
22:15 phil_b
22:15 Anguper Hupomosing9418
22:11 JosephMendiola
22:11 Scooter McGruder
22:10 Anguper Hupomosing9418
22:10 Annon