Sunday, February 17, 2008

letters vs. words

We have become increasingly comfortable in recent years in the area of assigning acronyms to diseases and disorders or viruses and bacteria. This makes them easier to refer to and maybe less scary. Or are they less scary? Is something we can't pronounce or understand more or less scary than the letters that represent it? Is the IRS more or less scary because we have relegated it to the status of acronym? I should actually change the word from acronym to initialism. Acronyms are supposed to actually spell a word that can be pronounced, like NOW for the National Organization of Women, etc., whereas initialisms are things like IRS which take some or all of the initials of something and make it a common phrase or almost a word. I looked that up, are you impressed?
What's funny is now that I know that, the whole MRSA thing has really got me going! What do you call an initialism (MRSA) that people, usually on the news, have begun to pronounce as a word, like MeRSA, or MaRSA, when the 'e' or 'a' is nonexistent, not just silent? You call it an attention-getter, a catch phrase, a buzz word, a lead-in, a hype...One would conclude from watching the news (another acronym, by the by) that if you don't die from the flu this year you're bound to succumb to MeRSA or RSV or AIDS. The FDA is making a new PI for the old AD's and NSAID's because of AE's noted in RS's of UD. I made most of that up, but it's jargon for the fact that the FDA is "re-looking" at old drugs based on retrospective studies of usage data. The news talking head doesn't know that, he or she just knows the initials and leaves the rest to you to decipher.
So, is methicillin resistant staphylococcus aureus more or less scary than MRSA? Would Kelly Ogle be able to repeatedly say the "non-initialism" and therefore it would be the problem that it is vs. the BREAKING NEWS STORY it has become?
The lay (nonmedical) public's understanding of microbiology is pretty minimal, and if I wasn't a doctor, mine would be, too, I'm sure. But THE FLU is a virus (not, "I hope it's just a virus and not THE FLU."). RSV, initialized from respiratory syncytial virus, is also a virus, obviously, hence the name and the 'v' on the end of the initialism. Viruses are myriad - there's a gazillion of them, more or less. From the common cold (rhinovirus most often) to the stomach "flu" (another misconception - "I thought he had the flu, but he wasn't throwing up", the real live influenza virus isn't known for causing vomiting as much as high fever, body aches, sore throat, cough, so stomach "flu" is a misnomer, but the most famous in kids is rotavirus, another, famous on cruise ships, is the Norwalk virus), some are petty and to be endured until they go away, while others, like herpes simplex, to quote Eddie Murphy, you keep "like luggage". Then there are the scary viruses, like HIV, an initialism for human immunodeficiency virus, which causes AIDS, an acronym for acquired immunodeficiency syndrome. It can kill you. Some are more in the middle, like hepatitis A, which you get and get over, not to be confused with hepatitis B, which again is like luggage, and even like HIV, can kill. 
One must not only differentiate between viruses and bacteria, but between diseases and their causes. AIDS is the disease caused by HIV. Hepatitis is a liver disease caused by a few different viruses, typically, but can be caused by drugs and other toxins that are not infectious agents. Pneumonia is a lung infection and can be caused by viruses or bacteria. We typically think of it as a bacterial infection and in this case the public lack of knowledge is fed by the medical community's consistent use of antibiotics for pneumonia and bronchitis while studies continue to show that most cases are caused by viruses and no antibiotic treatment is needed. I'm guilty here, too, but hey, how do we know? To find out specific causes takes a lot of time and a decent amount of money, and the public hears pneumonia and has an expectation of at least an antibiotic, hopefully a shot, and if grandma hears about it, she thinks it means hospitals and possible death.
So, pneumonia isn't one thing, nor is hepatitis. RSV is one thing, a virus, but it causes several other things, like bronchiolitis, bronchitis, pneumonia, pneumonitis, ear infections, etc. MRSA is technically one thing, or a group of similar things. 
To further clarify (?), viruses are viruses, and bacteria are bacteria. There don't seem to be as many famous bacteria as viruses lately, but MRSA is an exception. Maybe E. coli is another. There are bunches of bacteria, too, but some of them are good and play a part in our health, whereas viruses are pretty much always a nuisance if not a problem, though most of us have had exposure to way more viruses than we know. Point: there aren't any "good" viruses, only ones that don't cause problems, where there are some "good" bacteria, like probiotics, which actually help us. I may get corrected for saying there are no good viruses, maybe I just can't think of any.
Bacteria are things like streptococcus, which causes strep throat, but others with that first name can cause pneumonia, meningitis, flesh-eating diseases, etc. Staphylococcus is a bacterial first name, and here's a place for another clarification. Germs, viruses and bacteria, often have a first and last name, and some even have some letters and numbers after that. The strep of strep throat is different from the strep of meningitis and pneumonia, the first names are the same but the last name is different. Sort of the opposite of the way we are named here in the US and elsewhere. Strep is more like Smith or Jones, and the word after it tells which Smith or Jones you're talking about. 
Bacteria are killed by antibiotics, or antimicrobials, to be exact, because guns could be said to be antibiotics, since it means to be against living things. When we use antibiotics for a while, the bacteria get smart and some get resistant to that antibiotic. When a bacteria gets resistant, we switch to a different antibiotic, and on and on, until something like MRSA shows up, or some strains of tuberculosis, which are "multiple drug resistant", meaning they are not killed by the usual antibiotics, and we have to pick specific ones, and then...nothing works. Or so it seems, but God didn't create us to be wiped out by a bacteria so He made our immune systems so that we can kill most bacteria on our own given time and a decent immune system, but boy oh boy, having antibiotics to help sure has made things better for the most part, or so it seems. 
Viruses are not killed by antibiotics, in fact, they laugh at them. By using antibiotics in a viral infection, we have selected resistant bacteria to cause secondary infections, so that's why the first antibiotic your kid took for his "cold" didn't work and now you're on to the $100 one. 
Secondary bacterial infections, ones that occur on the tail end of a viral infection, are the problem which we, as physicians, face daily. "Yes, today my child has a "cold", but I know that tomorrow it will be an ear infection, can't we just put him on something now to keep that from happening?" I'd love to be able to do that, but the timing is of the essence. If I put him on an antibiotic before a bacteria has decided it wants to cause a secondary infection, then the antibiotic will kill all the bacteria it can, leaving perhaps, and increasingly commonly, one or more that aren't killed by that antibiotic. So, I've guaranteed that the first drug won't work. How do we know when to treat with an antibiotic? We don't, always. However, a good rule of thumb is that it is better to be a little late than a little early with an antibiotic. Let one settle in a bit, and let it get rid of its rival bacteria, then go in and kill it with an antibiotic.  It seems to be increasingly less common for a child to actually have a bacterial infection in the office. Moms are acutely aware of the early warning signs and perceive themselves as bad mothers if they are unable to anticipate an ear infection or strep throat and the child actually gets sick. This is a challenge daily. 
Viruses, at least some of them, can be treated, but they aren't really killed like some bacteria are killed by antibiotics, they are just kept from replicating or reproducing. So you've got whatever symptoms you've got for however long that particular viral generation lasts, then you get over it. Tamiflu, for instance, works that way with influenza A and B. If you've already got the flu virus, you can start it but you won't get well in a day, it will take a couple or more to let the virus die off and since it can't replicate, it's over at that point. You can also take tamiflu to keep from getting the flu if you've been exposed. Viral resistance to drugs happens, too, and they shift pretty quickly, making the little boogers hard to hit sometimes, hence the flu shot only working on 40% of the flu virus present in the US this year. 
To finish, don't be scared of bugs with initials. They are no more scary than when they had long names that were hard to pronounce. Conversely, they aren't tamed when they've been initialized either. Learn the difference between a virus and a bacteria, an initial infection and a secondary infection, and then you can make better choices as to when to take your child or yourself to the doctor and when and if an antibiotic is indicated. Antibiotics aren't all bad or all good, they are tools, and when used properly, work pretty well. When they become overused, whether by the physician or based on the demands of a patient (sometimes it's hard to separate the two, but healthcare is a consumer driven business to a great extent, and the customer has to leave satisfied...), bad things can happen. Remember, better to wait an extra day or so on an antibiotic than to start too early. There are few bacterial infections out there that are exceptions, like meningococcal meningitis, but 99.9% of the time, this caveat holds true.
Wow, I started off on acronyms and ended up with a microbiology lesson. Sorry. LOL (I don't even know for sure what that initialism means!) but it's a pretty common one in the text business. Have you seen the commercial where the mom, grandma, and daughter are playing Scrabble and they're using initialisms from texting for words? PFF (pretty fricking funny).

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