Amore dormiente (Love Sleeping) by Caravaggio (1608)
 

In Michelangelo da Caravaggio’s dream of becoming a Knight of Malta, he painted Amore dormiente which was commissioned for Fra Francesco dell'Antella, Florentine Secretary for Italy to Alof de Wignacourt, Grand Master of the Knights of Malta.

 

The cupid who is a slave to the senses, or is now freed from the senses, is abandoned in sleep as one hand holds the broken bow and arrow.  The state of the body has always aroused thoughts that Caravaggio had used a body of a sickly or dying child to depict Fra Francesco dell'Antella.  It has been suggested that the broken bowstring and arrow signifies the abandonment of worldly pleasures, and Antella may have commissioned it as a reminder of his vow of chastity.  Pizzorusso, based on pieces of poetic compositions on the theme of Sleeping Love, deduced an interpretation of the painting as the "peaceful understanding as a state of mind reached through the control and the overcoming  of passions.

 

"Caravaggio took his vows at Mass in the Oratory on 14 July 1608, between the Epistle and the Gospel, in front of his own painting of St. John.  Having confessed his sins, wearing a red silk surcoat embroidered with a great white cross, he stood before Fra’ Alof. First, he was made a knight. At the Giving of the Sword, he was reminded that normally membership of the Religion was “by custom granted only to those who, by virtue of their ancient lineage and personal virtue, are accounted worthy.  He promised to defend the Church, together with “those who are poor, dispossessed, orphaned, sick and suffering.” (1)

 

The "Sleeping" Virus ~ Epstein-Barr virus (EBV) - Infectious Mononucleosis

Viral infection is considered as an environmental factor to trigger autoimmune disease (Munz et al., 2009). Examples of human viruses include Epstein-Barr virus (EBV) and Parvovirus B19 (Takahashi et al., 1998) which have both been linked to rheumatoid arthritis.

A study conducted by scientists at Cincinnati Children’s reports that the Epstein-Barr virus (EBV)—best known for causing mononucleosis and increases the risks for some people of developing seven other major diseases.(2)  Combined, these seven diseases affect nearly 8 million people in the U.S.  Watch Video
Those diseases are:

  • rheumatoid arthritis (RA)
  • juvenile idiopathic arthritis (JIA)
  • inflammatory bowel disease (IBD)
  • celiac disease
  • type 1 diabetes
  • systemic lupus erythematosus (SLE)
  • multiple sclerosis (MS)

Epstein-Barr virus (EBV) Highlighlights

  • is a double stranded DNA virus
  • 90% of the world's population is seropositive for EBV
  • Human herpesvirus 4 (HHV4)
  • EBV cause Heterophile positive infectious mononucleosis (mono - The kissing disease because it is primarily transmitted saliva)
  • 35-50% of EBV infections during adolescence or young adulthood
  • Replication in epithelial and B-cells
  • biomarker - Heterophile antibodies

EBA viruses infect the circulatory, reticuloendothelial, and lymphatic systems.  The virus can remain silent, cause hyperproliferation, or cellular dysfunction in these organ systems.

Progression Symptoms

  • fever (sweating) + malaise (feeling of weakness) + fatigue + virus shedding
  • lymphadenopathy (typically occur in the posterior triangle of the neck inflammation of the tonsils)
  • hepatospenomegaly (enlargement of both the liver and the spleen)
  • pharangitis (inflammation of the back of the throat, typically results in a sore throat and fever Streptococcal pharyngitis, also known as strep throat)
  • tender lymphadenitis (swollen or enlarged lymph nodes)
  • disease progresses without major complications, only in a few exceptional cases splenomegaly ( enlargement of the spleen) and rupture can occur

The viral life cycle is completed in 5 steps

1. infect B cell
2. cause B cell to proliferate and produce antibodies to EBV virus and other random antigens= heterophiles antibodies
3. T cells rec. infection and being fighting off infection
4. few B cells escape forming memory B cells -have EBV virus in genome in laten phase
5. stim--> moment from latency to productive phase--> asymptomatic shedding in saliva

Progression of Antigen & Antibodies

1. Anti-EBV EA antibody
2. Viral capsid antigen (VCA) Anti-VCA
3. IgM appears early in EBV infection and usually disappears within four to six weeks
4. IgG + anti edna.  IgG appears in the acute phase of EBV infection, peaks at two to four weeks after onset, declines slightly then persists for the rest of a person's life.

Treatment

1. Rest and Hydration
2. Anti-virals (acyclovir)
- inhibit the viral polymerase
- not used because cause is not virus but immune response to infected B cells
3. Avoid strenuous activity to avoid splenic rupture

Other Diseases EBV Associated with Besides Mono:

  • Cancer (Hodgkin lymphoma, non-Hodgkin lymphoma, nasopharyngeal carcinoma)
  • Birth Defects
  • Immunosuppression
  • Cardiac dysfunction
  • Epstein-Barr Virus

    Factors contributing to cancer:
    -Immunosuppression ex. malaria
    -Genetic predisposition
    -Environmental factors

    Most common EBV-positive cancers in the US:
    Hodgkin lymphoma, non-Hodgkin lymphoma, nasopharyngeal carcinoma

    Most common EBV-positive cancer in Southern China:
    Nasopharyngeal cancer. 50/100,000 men over the age of 50 (3)

    Childhood tumor is seen in high incidence in equatorial Africa:
    EBV-positive Burkitt lymphoma

    Most common EBV-associated malignancy worldwide:
    Gastric cancer

    Highest risk of developing EBV-associated lymphomas:
    Organ and bone marrow transplant recipients. 1-20% will develop lymphoma due to immunosuppression that allows the EBV to come out of latency.

    EBV infection in children is usually asymptomatic:
    Because their immune system is still developing, so it doesn't fight back as hard against the virus. It is the immune response to the virus that causes the symptoms of EBV infection.

    Clinical trials of an experimental EBV vaccine target:
    gp350, the most abundant glycoprotein on EBV and EBV infected cells.

 

No More EBV: How to Fight the Epstein-Barr Virus and chronic fatigue syndrome

Although the virus remains in the infected person's body for a lifetime, even after decades, the "sleeping" virus can be reactivated. Frequent triggers are stress, overload, other secondary diseases or even addictive drugs such as alcohol. If the virus is reactivated in the body of the affected patient, this can lead to major and serious problems and health restrictions.

The body often reacts to reactivation with an overreaction of the immune system. This promotes the development of autoimmune diseases and can also trigger Chronic Fatigue Syndrome (CFS).  It can also be triggered by many other viral diseases. Unfortunately, this disease is often misdiagnosed because the accompanying symptoms are very similar to those of other diseases.  It is only since 2016 that serious efforts have been made in Germany to better understand chronic fatigue syndrome (CFS) and develop effective treatment methods. The Charité Berlin and the Helmholtz Institute of the Munich University Hospital are leaders in this field.

The above book was written by Lea Julia.  Through their long suffering Lea-Julia and her husband have created a unique self-therapy and perfected it over the years, which helps you to alleviate your diagnosed and not scientifically treatable suffering directly. 

Book Source:   https://www.amazon.com/Lea-Julia/e/B07VMGDPMG/ref=dp_byline_cont_pop_book_1

 

 

ANTI-Epstein-Barr Virus (EBV)

Plant

Food Source & Dose

Ref.

(-)-EPICATECHIN

--

1

(1'S)-1'-ACETOXYCHAVICOL-ACETATE

IC50=1.5 uM

2

1,4-NAPHTHOQUINONE

Black Walnut

2

2-AMINO-1,4-NAPTHOQUINONE

--

2

4-AMINO-1,2-NAPTHOQUINONE

--

2

ARJUNOLIC-ACID

Arjuna Tea (Terminalia arjuna -Wood)

2

ASPIDIN

Male Fern (Rhizome), celery

2

BETA-EUDESMOL

 

2

BILOBETIN

Ginkgo biloba

2

BOROPINIC-ACID

--

2

CHLOROGENIC-ACID

Peanut

1

CURCUMIN

Turmeric; Indian Saffron     IC50=5.4 uM

2

DESASPIDIN

Male Fern(Rhizome)

2

EPICATECHIN

Tea

1

GENIPIN

Okra

2

GERANIAL

IC50=16 uM

2

GLYCYRRHETINIC-ACID

Smooth Licorice; Licorice; Licorice-Root; Commom Licorice

3

HINOKIFLAVONE

--

2

LUPEOL

Hedge Apple; Osage-Orange

2

URSOLIC-ACID

Bearberry; Uva Ursi

3

References

1. Economic & Medicinal Plant Research, 6: 189.

2. Duke, James A. 1992. Handbook of phytochemical constituents of GRAS herbs and other economic plants. Boca Raton, FL. CRC Press.

3. Newall, C. A., Anderson, L. A. and Phillipson, J. D. 1996. Herbal Medicine - A Guide for Health-care Professionals. The Pharmaceutical Press, London. 296pp.



 

Human parvovirus B19 as a causative agent for rheumatoid arthritis

Soderlund et al. (21) demonstrated the detection of B19 DNA not only in the synovial tissues of chronic arthritis, but also in those of nonarthropathy controls, as confirmed in this paper. It is, however, noteworthy that the detection of B19 RNA and B19 antigen VP-1 in synovium is specific in RA, but not in other disease categories. Subsequently, data including previous case reports (11) provide important information toward the etiopathology of RA.

Source:  Human parvovirus B19 as a causative agent for rheumatoid arthritis
Yuichi  Takahashi et al. PNAS July 7, 1998 95 https://www.pnas.org/content/95/14/8227


Human Parvovirus B19
HP is a single-stranded DNA virus that causes the infection, erythema infectiosum (Fifth Disease)

  • A major HUMAN pathogen
  • Family of Parvovirus B19 (Parvoviridae)
  • Nonenveloped, ssDNA genome
  • 30-60% are seropositive
  • Common in the USA and worldwide
  • Phase 1 of Biphasic disease
    Febrile infectious stage---> viral replication & shedding
    1. Initial mild illness with fever, malaise, headache myalgia, sore throat, and itching.
    2. Accompanied by lymphadenopathy and splenomegaly
    3. Mild decrease in WBC and RBC (leukemia and anemia)
    4. Arthalgias and arthritis may develop (particularly symmetrical polyarthritis in female adults) that may be short lived or long-lasting

    Phase 2 of Biphasic disease
    Manifestations on skin occur in STAGES:
    1. Slapped cheek syndrome---> bright red, confluent, indurated rash appears on the face
    2. Gloves & socks syndrome---> Papular-purpuric erythema spreads to proximal extremeties (acral distribution), fades to a LACY PINK-red exanthem, with the palms and soles spared.
    3. Rash resolves in 5-7 days
    4. IgG is on the rise when rash appears

How is it spread

  • Enters the respiratory tract, replicates in nasopharynx/upper respiratory tract
  • Respiratory droplets
  • Hand-to-mouth contamination
  • Blood products - mother to fetus via placenta

How does the host become infected

  • Virus replicates in hematopoietic stem cells in bone marrow
  • Hemolysis and RBC aplasia occurs - causes undetectable drop in Hb levels in healthy children/adults
  • Effect more severe if host has hemoglobinopathy, hemolytic anemia, sickle cell anemia
  • Anemia most significant on fetus, due to the shorter half life of the fetal RBC

Who is most at risk

  • Children ages 4-11 most effected
  • Mothers of school-aged children
  • Daycare workers
  • School teachers
  • most common in the springtime

Incidence

  • 50-75% of women are already immune but do not know because many infections are asymptomatic
  • 1-3% of all pregnant women will become infected over the course of their pregnancy, rising to over 10% during epidemic periods
  • 20-30% of susceptible women with occupational exposure become infected
  • 50% of susceptible women with household exposure become infected

Adverse effects on the fetus

  • Most significant concern with Parvovirus B19 Infection
  • Of mothers that become infected, only 17-33% will pass it on to the fetus
  • Most infected fetuses will experience a spontaneous resolution of the infection, with no adverse outcomes
  • Critical period of increased risk to fetus is 10-25 weeks gestation

When adverse outcomes occur, the most common are

  • miscarriage (13%)
  • stillbirth (0.5%)
  • non-immune fetal hydrops caused by anemia (2.9%)
  • No known risk of congenital anomalies or long term effects on infant

Clinical presentation

  • 4-14 days incubation period

Initial Symptoms:

  • flu or cold-like symptoms, infectious at this point
  • 1-4 days later:
    Children: Characteristic "slapped-cheek" appearance, can later spread to the torso
    Adults: rash manifests as papular-pruritic "gloves and socks" syndrome
  • 2-3 weeks after exposure: arthropathy (pain in the joints of knees, hands, wrists, ankles), affecting up to 50% of pregnant women
  • Rare: anemia, acute myocarditis

Complications:

  • Patients with hemoglobinopathy: profound anemia, aplastic crisis
  • Immunocompromised patients: persistent with persistent anemia
  • Infection of fetus: Hydrops fetalis and death
  • Fetal Hydrops
  • Abnormal collection of fluid in two or more fetal compartments, due to an imbalance in interstitial fluid production and lymphatic return
    Hydrops can occur due to:
    1. severe anemia/hypoxia --> high output cardiac failure
    2. viral myocarditis --> cardiac failure
    3. hepatocyte damage --> liver dysfunction --> decreased oncotic pressure
  • 60-90% mortality rate - dependent on etiology and time of infection. Prognosis is better with increasing GA.
  • Maternal complications due to fetal hydrops:
    1. polyhydramnios
    2. preeclampsia

Screening

  • IgM antibodies appear 10-12 days after exposure, may persist up to 6 months
  • IgG antibodies appear after IgM and usually remains for life to provide permanent immunity
  • IgG-.IgM-: no previous exposure, no immunity
  • IgG-/IgM+: very recent infection or false positive
  • IgG+/IgM-: client immune. If exposure >8 weeks prior, IgM may have been present and has rapidly cleared.
  • IgG+/IgM+: acute infection confirmed
  • IgG increasing = recent infection
  • IgG stable = infection less than or equal to 6 months prior

Treatments for Parvovirus B19

  • No specific treatment. Self-limiting. Supportive care
  • IV Ig for immunocompromised
  • Is there na vaccine available for Parvovirus B19
  • Hand-washing is recommended for Parvovirus B19 prevention
  • Parvovirus B19 diagnosis can only be made through viral DNA testing via amniotic fluid, or serum testing for IgM through cordocentesis
  • If Parvovirus B19 is likely due to ultrasound findings, SOGC recommends consultation with MFM specialist in a tertiary care centre

 

Childhood Exanthems

There are 6 classical classifications of the childhood exanthems.  An exanthem is a widespread rash occurring on the outside of the body and usually occurring in children. An exanthem can be caused by toxins, drugs, or microorganisms, or can result from autoimmune disease. (1)
1. Rubella
2. Measles
3. Scarlet Fever
4. Filatov-Duke (atypical scarlet fever)
5. Parvovirus B19 (hence: FIFTH disease)
6. Roseola (HHV6)