Fatal brain infection was thought to be from profound immune suppression. Not anymore.
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You’re likely already infected with a brain-eating virus you’ve never heard of
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sigmasirrus
Ars Scholae Palatinae
As the other commentator mentioned, there are resources available if you would like to talk to someone and I hope they are helpful for you. I’m sorry that life feels so bad right now.
But on this one account at least some perspective is that the virus seems very rare and still requires the immune system to be severely compromised. The man in the article was already at kidney failure which had the side effect of taking out his immune system. So it’s unlikely to affect many people.
As regards the other things going on in the news, sometimes things are bigger than us and we can only do so much one way or the other. But we can love our family and friends, get out in nature, find little things that mean something to us, even if it doesn’t mean much to others. We don’t have to carry the weight of the news on our shoulders. I hope that’s helpful.
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It's not the zombie apocalypse we fear, it's the zombie apocalypse we deserve!
Or something. I probably have to work on the slogan a bit more.
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Yes, there's a test - I mean if there wasn't how would we have any idea of its prevalence ...
But more seriously, I mentioned earlier in this thread that PML is a real and recognised risk for MS patients treated with the monoclonal antibody Tysabri - once that became apparent then screening potential patients for the JC virus became the norm.
Treatment ? I don't think so, and anyway, do you really want to be trying to get a treatment through the blood-brain barrier just to prod a virus that in the vast majority of cases is dormant, but which if you do wake it up it'll make sure you have a really bad day ...
Let sleeping viruses lie, says I.
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Nora Lenderbee
Ars Tribunus Militum
The fact that shingles vaccines have been shown to reduce the chances of developing dementia lends some credence.
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I would temper this case report with the fact that there are an insanely large number of people with CKD stage 5, and they not infrequently get the MRI brain imaging that would find the classical lesions of PML (because kidney disease goes along with vascular disease and strokes are not uncommon in these patients), and finding lesions suggestive of PML is pretty much unheard of. I'm not saying that this gentleman didn't have PML, but it's very possible they also had other, likely more difficult to diagnose, reasons for immunosuppression than just CKD that would lead to loss of control over JC virus. Such as congenital immunodeficiencies, or an acquired immunodeficiency such as aplastic anemia, multiple myeloma, or immunoglobulin deficiency. Given how rapidly it seemed he declined, it's possible this other immunosuppressive condition wasn't able to be identified by that point.
In infectious diseases, we sometimes see "normal" people who come down with conditions that typically only affect the severely immunocompromised (such as PML but also certain fungal infections). It can take a pretty exhaustive immunological workup to find subtle immunodeficiencies that would have never been identified had the patient not gotten the wrong type of infection.
In infectious diseases, we sometimes see "normal" people who come down with conditions that typically only affect the severely immunocompromised (such as PML but also certain fungal infections). It can take a pretty exhaustive immunological workup to find subtle immunodeficiencies that would have never been identified had the patient not gotten the wrong type of infection.
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I'm glad there are people studying and working on this, but I did not need to know about it. Thanks.
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Yet another reason that I'm happy that I didn't study biology. 
Besides all of that frog/rat/cadaver dissection stuff, of course.
Besides all of that frog/rat/cadaver dissection stuff, of course.
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Anybody know more about the "awaken, rearrange its genetic material, and morph into a brain-demolishing nightmare" aspect? That seems...unusual. Maybe unique. If I were a writer I would have some dark agency working with this to try to create a weapon and...of course... have it go horribly wrong and the percent morphing to deathly version be really high...and our intrepid research team has to create a cure pronto or ITS THE END OF THE WORLD. But if I were a writer I would write Greek tragedies so...there's that...
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Hell, last year I spent ~6 weeks with a debilitating headache that never went away and insane loss/mutation of taste (which made all protein taste like sh*t) because a doctor misdiagnosed a sinus infection as strep throat. Gave me some antibiotics that didn’t help.
So, I saw another internal medicine doctor, also clueless, and as I wasn’t getting better, the first two decided the best thing to do was to give up and told me to go to the ER. The doctor before him, and the one in the ER kept insisting I had suddenly developed migraines even though I kept pointing out that I and no one in my entire family had ever had a migraine and that makes it extremely unlikely, especially a migraine that literally hadn’t stopped for weeks at that point. I even had my ex boyfriend confirm to them that I don’t really even get headaches like ever, even when I have a cold or something. They shrugged and I was told to keep taking the ineffective migraine pills and that I could see a neurologist in a couple months.
After I finally got through to some regional head of medicine or whatever for my area practice, he ordered an MRI (which was an emergency, given my ceaseless debilitating pain, and ofc my insurance decided to deny it after I already had it, another story) but the doctor got the results was literally like “WTF this is just a sinus infection!” Put me on the correct antibiotics and I was better in like 2 days, with tastebuds sorting itself out after a few more weeks.
So I guess it doesn’t have to be an unheard-of brain destroying virus for the ER to shrug, give you tylenol, and send you packing (or to the morgue), it can just be like literally anything.
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I read these articles and start to stress. I then mentally queue Oingo Boingo Nothing Bad Ever Happens to Me
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"archetype JC virus" that is fatal without HAART therapy sounds like a Deus Ex subplot; and here 90% of the population goes just having it mostly without incident.
On the plus side; maybe it will fight for dominance with the brain-eating amoebas, should I inadvertently inhale any.
On the plus side; maybe it will fight for dominance with the brain-eating amoebas, should I inadvertently inhale any.
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I'd be curious to know how much of the not-as-seen-on-TV effect comes down to diseases also not generally being as seen on TV (when House and friends go poking it's basically always something interesting, unless they ever did an episode where it was actually lupus just to mess with people after all the ones where that was proposed and shot down, and almost but not quite always something relevant to treatment rather than a neat footnote on a tale of medical futility) vs. other factors (whether overtly non-telegenic like cost control pressures and hubris or not really plot friendly but wholly reasonable issues like patient reluctance or concern over risks of certain procedures to confirm or rule out low probability causes; or reluctance to push too hard in a case where there's a paragraph of comorbidities jostling in line to kill the guy and your options will be limited if it's not what you first suspected it to be).
I don't doubt that there are people who are quite content to bury their mistakes; and it's obvious that you simply won't discover novel mechanisms if you don't do a certain amount of not-necessary-as-far-as-we-know looking into cases; but I assume that you also don't start a fragile patient with both anemia and clotting issues on regular dialysis entirely casually(above and beyond how inconvenient that is for the patient) and once you've confirmed that they've got a viral neurological issue you can't treat cueing up the repeated CT scans and MRIs doesn't seem like the cheap and incurious option.
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Could you please add some more acronyms to explain your acronyms?
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Yes, there is absolutely a blood test for JC virus (JCV). Most if not all people on Tysabri have to take it periodically to see if they are positive for JCV antibodies and if so at what level as studies have shown that this is very correlated with your risk of PML.
If you are JCV negative, that means the test found no antibodies and there is no indication you have ever been exposed to JCV. This equates to about 1/10,000 risk of PML. Once you test as JCV positive, the risk goes up. The higher the amount of antibodies and the longer the time you've taken the drug and if you've taken any other immunosuppressants all make the risk go up more. To 1/1,000 or even 1/120 maybe (this is older data and may have changed somewhat but gives a picture).
As far as I know, Biogen-Idec are still constantly compiling data for everyone on Tysabri of their JCV index rates and then if they end up getting PML, that is another data point they add to better understand risks.
It should be noted that treatment for Tysabri-caused PML is just to get the Tysabri out of your system as fast as possible with plasma exchange or similar so your immune system can hopefully get in there and put the JCV back in check the way it normally does.
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reads through all the comments about Dr. Mole and medical horror stories and chuckles
I don't know if it's a prerequisite for the medical profession or anything, but my partner who's a retired RN also used to watch a lot of those shows where they take you into real ERs, ORs, and such. I could imagine Dr Mole and my partner sharing the popcorn with rapt attention over those shows. After one episode with a person with a 2 day long priapus (don't drink unknown herbal tea that makes claims to cure impotence!!) ... which I STILL can't get out of my head years later, um... I just figured I'd share the wealth. Yes, true story. And it was the LAST time I watched the shows... or that cable channel which I have at least managed to forget the name of.
I don't know if it's a prerequisite for the medical profession or anything, but my partner who's a retired RN also used to watch a lot of those shows where they take you into real ERs, ORs, and such. I could imagine Dr Mole and my partner sharing the popcorn with rapt attention over those shows. After one episode with a person with a 2 day long priapus (don't drink unknown herbal tea that makes claims to cure impotence!!) ... which I STILL can't get out of my head years later, um... I just figured I'd share the wealth. Yes, true story. And it was the LAST time I watched the shows... or that cable channel which I have at least managed to forget the name of.
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Now, it seems to me the herbal tea did in fact fulfill the claims. Just be careful what you wish for
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It's not entirely clear from the article, but the anti-retroviral treatment works against PML because it suppresses HIV, a retro-virus (made from RNA, that needs to be reverse-trancribed into DNA for the virus to multiply). Less HIV, less immune-suppression, less PML. In the case of CDK, an anti retroviral treatment would not do anything, since the immune suppression is not caused by a retrovirus in this case, and polyoma viruses themselves are not susceptible to anti-retrovirals since they are DNA viruses.
These types of slumbering viruses have a small, stochastic chance of waking up. Nothing sinister, just random activation in a small percentage of infected cells. Most likely, in this case, the activation of the virus is accompanied by an increase in immunogenicity (the virus starts to make virus proteins that are recognized as foreign), and the unlucky cell who is host to this event is cleared by the immune system. Unless there is no active immune system and the viral cascade can continue...
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I wonder if this short story was the genesis idea for Apple TV’s Pluribus?
Reminds me of Adrian Tchaikovsky’s “We’re going on an adventure!”
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Kaliithiel
Smack-Fu Master, in training
While the term 'brain-eating' makes sense for the famous amoeba, I don't feel like it makes much sense for a virus since viruses can't eat. I do understand why it was used though; 'brain-eating' does sound cooler than 'neural cell death inducing through injection of viral DNA and forced production of viral particles'.
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Maybe we succumb to viruses that don't even need to infect us anymore - we carry them around in our genomes. One of the weirder hypotheses about aging is that cells start expressing genes from viruses that integrated into our ancestors' genomes ages ago. We still carry them as "Human Endogenous Retroviruses" (HERV genes) and normally cells do a good job of repressing the expression of those genes. This repression slackens with age, and although the genes are mutated enough that they can't make complete viruses anymore, they can still get the cells to produce snippets of viral proteins, e.g. capsid proteins. Those can trigger all kinds of receptors in the cells, notably immune cells.
See e.g. here: https://doi.org/10.1016/j.cell.2022.12.017
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Albino_Boo
Ars Tribunus Angusticlavius
My solution, drink whiskey. Raasay cask strength at 60%. It might not change anything but you just won't care anymore
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I am a doctor and no. A) because scans such as a CT and MRI both are dangerous in CKD patients if using contrast dye (in MRI the dye is dangerous in itself in CKD patients, in CT dye it can worsen CKD although if someone is ESRD (end-stage renal disease) like this patient you can't make dead kidneys worse (zombie kidneys?) B) anyway also common things being common, before jumping to a $1500 test which can harm the patient, going with the much more common thing of uremic encephalopathy (very, very common) which is solved by doing the normal thing we do in failed kidneys - dialysis) is far simpler.
Now that all being said in the CT dye case, if a patient is hemodialysis depended then CT is easier since their kidney is a machine, and doesn't care, but we then need to coordinate urgent dialysis since the volume of the liquid of the dye needs to be removed (MRI dye is less volume but can be directly dangerous in CKD patients - causing a nasty fibrosing disease). And yes we often need to do both since CT and MRI see different things and depending what we are looking for we often would need both (CT is far superior at spotting a bleed, MRI is better at looking for changes in tissues)
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Given the prevalence mentioned above there is little reason for screening tests in average patients. If you are going to immunosuppress someone (say, chemotherapy, MS treatment, etc) then it might make sense (it's really only going to be helpful if negative) and the treatment is restoration of the immune system. As someone who trained during the AIDS era (luckily at the end) we saw this periodically, even amongst AIDS patients it wasn't super common, and we'd get a lumbar puncture and send cerebrospinal fluid for testing. I think of the hundreds of AIDS patients I treated I saw 1 case, versus hundreds of cases of cryptococcal meningitis and toxoplasmosis.
But like many of the dormant infections unless you have cause don't go messing around looking for trouble, like sure you are likely CMV infected, but as far as we know, shrug. But lose your immune system and then we might care. In this specific case we didn't know that the virus could reactivate in severe CKD so wouldn't have instinctively tested for it. Different immunosuppressive drugs can reactivate different things commonly so we automatically test for those, like with any of the TNF-A blockers (like Enbrel) we know to test for TB to look for latent TB. But given the millions of people on those and the incredibly rare case of JC probably not worth testing for as a screen (different as a diagnostic test if someone presents altered - even so I'd still think of normal viral encephalitis like West Nile long before JC)
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You go to the apocalypse with the zombies you have, not the zombies you wish you had?
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Well, poop. I guess we should do the things we always wanted to do and not put it up to later when the kids have grown up and moved out, while we have a brain to enjoy it with!
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At least you haven't prefaced it with "Good news, everybody!" – now that would have gotten me really worried...
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Sorry, it's been cancelled by the guy who brakes for roadkill.
I'd like to thank Dr. Mole for bringing me another fun way to die this Saturday morning.
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