|
|
Conference Summary
Women and Infectious Disease—Chronic
Disease Interactions1
Siobhán O'Connor,*
Sheila K. West,† Breyette Lorntz,‡ Frank Vinicor,* and Cynthia Jorgensen*
*Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Johns
Hopkins University, Baltimore, Maryland, USA; and ‡University of Virginia,
Charlottesville, Virginia, USA
Suggested
citation for this article
Relationships between infectious and chronic diseases are complex and
diverse. Chronic infection, inflammation and immunity, malignant transformation,
and other processes can cause progression to chronic disease. Sudden permanent
deficits or secondary sequelae of events precipitated by infection can
occur. Each point in time from acute infection to chronic outcome represents
an opportunity to minimize infectious and chronic diseases. Women are
disproportionately affected by recognized preventable chronic outcomes
such as trachoma. Women are needed to help prevent childhood infections
with long-term developmental sequelae. Chronic diseases can alter risk
for infection, and infection may determine chronic disease complications
or death.
Chronic
Ocular Chlamydia trachomatis (Trachoma)
Trachoma from ocular C. trachomatis infection accounts for one
fourth of the >80% preventable or curable blindness in many countries.
The blinding complications of trachoma disproportionately affect women,
and its prevalence in disease-endemic regions is high. The cycle is vicious,
from facile transmission with repeated infections, often involving severe
inflammation, which promotes scarring and can lead to disabling trichiasis
and blindness. Severe scarring and trichiasis increase with age, the result
of repeated infections in childhood and young adulthood.
Trachoma is a community disease, clustered within families and neighborhoods.
Caring for children, who are the reservoir of infection within these communities,
increases women's risk for trachoma. The World Health Organization has
endorsed a multipronged trachoma control strategy as part of the resolution
for the Global Elimination of Blinding Trachoma by 2020. The strategy
consists of surgery for trichiasis to decrease avoidable blindness, administration
of antimicrobial drugs to reduce the community pool of infection, face
washing to interrupt transmission, and environmental change to reduce
transmission. Mass treatment alone, with single dose azithromycin or topical
antimicrobial drugs for several weeks, can result in infection and trachoma
reemergence from untreated and inadequately treated community members.
The full intervention strategy is recommended, including hygiene activities
and environmental improvement, to sustain reduction of trachoma in affected
communities.
Early Childhood
Enteric and Parasitic Infections: the Role of Women
Worldwide, ≈2.5 million children die each year from enteric infections.
We have shown long-term effects from nonfatal early childhood diarrhea
that include growth shortfalls, fitness impairment, cognitive impairment,
and poor school functioning in a longitudinal cohort of poor children
with complete diarrhea surveillance from 0 to 2 years of age and quarterly
evaluations from age 2. The detailed survey included enteric parasitic
and bacterial infections. Five years later, early childhood diarrhea from
0 to 2 years of age correlated with impaired physical fitness and cognition;
diarrhea negatively correlated with height-for-age Z-scores taken at 2
to 7 years old. The number of diarrhea episodes at 0 to 2 years negatively
correlated with impaired cognitive function and decreased semantic and
phonetic fluency, even when adjusted for maternal education, income, and
birth size; significantly poorer school functioning was independent of
maternal education, socioeconomic status, other illnesses, and stunting.
Possible biologic explanations include a cycle of malnutrition and diarrhea
and adverse effects on brain development. Early childhood diarrhea might
double the disability-adjusted life-year for global diarrhea. Engagement
of mothers and women is crucial to early childhood diarrhea prevention.
Worldwide
Impact of Infection on Type 2 Diabetes
The relationships between women, infections, and type 2 diabetes mellitus
create a complex triangle. Insulin resistance followed by relative insulin
deficiency typifies type 2 diabetes mellitus. Type 2 diabetes prevalence
is increasing worldwide, affecting millions of women. Rates in the United
States approach 8%–10% of adults, with lifetime risk 1/3, but this risk
is 1/2 for Hispanic females and 2/5 for African-Americans. Obesity is
the major contributor, but the aging population also contributes. Primary
prevention focuses on improved screening and diagnosis and access to and
utilization of quality health care. Risk for serious infections increases
with poor diabetes control, but more complex relationships between infection
and type 2 diabetes are now appreciated. For example, in U.S. NHANES III
national surveillance, type 2 diabetes increases among people with hepatitis
C virus infection. Insulin resistance and beta-cell failure occur; the
HCV genotype may be important. Neuropathic and vascular foot ulcers with
skin breakdown, predisposed to infection and osteomyelitis, remain a problem.
The importance of asymptomatic bacteruria (infection vs. non-pathogen)
in diabetic women is poorly understood, and alone, probably should not
be treated with antibiotics. Viruses may also affect diabetics. Influenza
is always a concern. Less clear, several severe acute respiratory syndrome
reports noted diabetes among 1%–37% of critically ill (1–3).
These examples exemplify dynamic diabetes-infection interactions. Obesity
prevention, diabetes control, and good infection prevention measures may
affect women and men at risk for and with type 2 diabetes.
References
- Booth CM, Matukas LM, Tomlinson GA, Rachlis AR, Rose
DB, Dwosh HA, et al. Clinical
features and short-term outcomes of 144 patients with SARS in the greater
Toronto area. JAMA. 2003;289:2801–9.
- Fowler RA, Lapinsky SE, Hallett D, Detsky AS, Sibbald WJ, Slutsky
AS, et al. Critically
ill patients with severe acute respiratory syndrome. JAMA. 2003;290:367–73.
- Tsang KW, Ho PL, Ooi GC, Yee WK, Wang T, Chan-Yeung M, et al. A
cluster of cases of severe acute respiratory syndrome in Hong Kong.
N Engl J Med. 2003;348:1977–85.
1The following comments were made in presentations
by the above authors at the International Conference on Women and Infectious
Disease.
Suggested citation
for this article:
O'Connor S, West SK,
Lorntz B, Vinicor F, Jorgensen C. Women and infectious disease—chronic
disease interactions [conference summary]. Emerg Infect Dis [serial on
the Internet]. 2004 Nov [date cited]. Available from http://www.cdc.gov/ncidod/EID/vol10no11/04-0623_14.htm
|
