Dancing plague of 1518, event in which hundreds of citizens of Strasbourg (then a free city within the Holy Roman Empire, now in France) danced uncontrollably and apparently unwillingly for days on end; the mania lasted for about two months before ending as mysteriously as it began.
In July 1518, a woman whose name was given as Frau (Mrs.) Troffea (or Trauffea) stepped into the street and began dancing. She seemed unable to stop, and she kept dancing until she collapsed from exhaustion. After resting, she resumed the compulsive frenzied activity. She continued this way for days, and within a week more than 30 other people were similarly afflicted. They kept going long past the point of injury. City authorities were alarmed by the ever-increasing number of dancers. The civic and religious leaders theorized that more dancing was the solution, and so they arranged for guildhalls for the dancers to gather in, musicians to accompany the dancing, and professional dancers to help the afflicted to continue dancing. This only exacerbated the contagion, and as many as 400 people were eventually consumed by the dancing compulsion. A number of them died from their exertions. In early September the mania began to abate.
The 1518 event was the most thoroughly documented and probably the last of several such outbreaks in Europe, which took place largely between the 10th and 16th centuries. The otherwise best known of these took place in 1374; that eruption spread to several towns along the Rhine River.
Contemporary explanations for the dancing plague included demonic possession and overheated blood. Investigators in the 20th century suggested that the afflicted might have consumed bread made from rye flour contaminated with the fungal disease ergot, which is known to produce convulsions. American sociologist Robert Bartholomew posited that the dancers were adherents of heretical sects, dancing to attract divine favour. The most widely accepted theory was that of American medical historian John Waller, who laid out in several papers his reasons for believing that the dancing plague was a form of mass psychogenic disorder. Such outbreaks take place under circumstances of extreme stress and generally take form based on local fears. In the case of the dancing plague of 1518, Waller cited a series of famines and the presence of such diseases as smallpox and syphilis as the overwhelming stressors affecting residents of Strasbourg. He further maintained that there was a local belief that those who failed to propitiate St. Vitus, patron saint of epileptics and of dancers, would be cursed by being forced to dance.
This article explores issues concerning the growing problem with resistance to antibiotics & antimicrobials worldwide. From overuse of antibiotics in the general populations to lack of understanding of the proper use of antibiotic medication to ease of purchase of over the counter antibiotics in certain jurisdictions, to the over-prescription of antibiotics by physicians. I reference numerous authoritative sources explaining antibiotic resistance, its causes, effects & possible solutions to the problem.
Antibiotic Resistance (AR or ABR) & Antimicrobial Resistance (AMR or AR): are generally defined as the capability of bacteria and other microorganisms to prevent the effects of an antibiotic or biocides to which they were once receptive. Antibiotic resistance is a major concern & is caused by many complex factors including the overuse & over-prescription of antibiotics. Also known as drug resistance. (The term antibiotic resistance is a subset of AMR, as it applies only to bacteria becoming resistant to antibiotics).
Antimicrobial resistance is the ability of a microbe to eliminate the effects of medication that in the past successfully treated the microbe. Resistant microbes are more challenging to treat, requiring alternative medications or higher doses of antimicrobials until the treatment is no longer productive. This treatment can be more expensive, more toxic or both. Microbes resistant to multiple antimicrobials are called multidrug-resistant (MDR). Those considered extensively drug-resistant (XDR) or totally drug-resistant (TDR) are sometimes termed “superbugs“.
Cross-species. Where species acquire resistance from another.
All classes of microbes can develop resistance. Fungi develop antifungal resistance. Viruses develop antiviral resistance. Protozoa develop antiprotozoal resistance, and bacteria develop antibiotic resistance. Resistance can appear spontaneously because of random mutations. However, extended use of antimicrobials appears to encourage selection for mutations which can render antimicrobials ineffective.
Preventative measures –
Prevention can be effective when only using antibiotics when required, thereby halting the misuse of antibiotics or antimicrobials. Narrow-spectrum antibiotics are preferred over broad-spectrum antibiotics when feasible, as effectively and accurately targeting specific organisms is less likely to cause resistance, as well as side effects. When home-medicating without supervision, education about proper use is essential. Both public & Health care providers can minimize the spread of resistant infections by the employment of correct sanitation and hygiene, including handwashing and disinfecting between patients, and should encourage the same of the patient, visitors, and family members.
The growing problem of drug resistance is caused mainly by the use of antimicrobials in humans and other animals, and the exchange of resistant strains between both. Expanding resistance has also been connected to the disposal of inadequately treated effluents from the pharmaceutical industry, especially in developing countries where bulk drugs are produced. Antibiotics increase selective pressure in bacterial populations, causing vulnerable bacteria to die; this increases the percentage of resistant bacteria which continue growing. Even at very low levels of antibiotic, resistant bacteria can have a growth advantage and grow faster than vulnerable bacteria. With resistance to antibiotics becoming more common there is a greater need for alternative treatments. Calls for new antibiotic therapies have been issued, but new drug development is becoming less & less viable due to high costs.
Antibiotic & Antimicrobial resistance is increasing worldwide because of the greater availability of antibiotic drugs in developing countries. Statistics estimate there are 700,000 to several million deaths resulting per year. Each year in North America, at least 2.8 million people become infected with bacteria that are resistant to antibiotics and at least 35,000 people die as a result. There are public calls for worldwide collective action to address the threat that includes proposals for international treaties on antimicrobial resistance. Worldwide antibiotic resistance is not completely identified, but poorer countries with weaker healthcare systems are more affected.
Antibiotic resistance results in longer hospital treatment, increased medical costs and an increase in mortality.
A survey conducted by PEW Research in 2014 on The Threat of Antibiotic Resistance & its effects on the US Healthcare sector found the following-
63% of infectious disease doctors have treated patients with infections that did not respond to any antibiotics.
Antibiotic resistance costs the US Healthcare system up to $20 Billion per year.
Every antibiotic in use today is based on a discovery made more than 30 years ago.
2 Million Americans acquire serious infections caused by antibiotic-resistant bacteria each year. 23,000 people die as a direct result of these infections.
3 – Causes of Antibiotic Resistance
Antibiotic resistance is now a global threat & if left unchallenged may well become an existential threat. It is important to examine the complex background that has led Global medicine to this situation. As if by magic, discoveries in antibiotics, originally over 30 years ago, were once hailed as miracle cures, but overuse has led to a sharp decline in their effectiveness
The importance of correct treatment.
The deployment of antibiotics has saved countless lives, but its habitual use to treat any & all infections, whether serious, minor, or even viral will logically lead to an increase in antibiotic resistance & mutation. Antibiotics strictly target bacteria, but it is challenging to differentiate between viral and bacterial infections without costly tests. It is often less time-consuming and more cost-effective to proactively prescribe antibiotics, rather than take precautions and prescribe only the correct treatment.
Another issue with antibiotics is the inability to monitor patient intake. Antibiotic dosages are devised to combat entire populations of the pathogens. When antibiotics are not taken for the entire prescribed course, pathogenic bacteria can adapt to the presence of low dose antibiotics, and eventually create a population that is totally resistant to the antibiotic regardless of the dosage.
Antibiotic usage is also not exclusive to humans. Every day, antibiotics are used to treat livestock and fish to prevent infections. Similar to overuse in humans, uncontrolled use of antibiotics creates a reservoir of bacteria that could become resistant, thus rendering the antibiotic impotent.
City living can be lethal. As a result of cities becoming more densely populated, its inhabitants are exposed to more pathogens all the time. Hospitals and clinics are experiencing more and more patients with infections, and it is extremely difficult to inhibit the spread of a pathogen in a population. Identification, isolation or treatment of all infectious diseases are not always feasible, resulting in the addition of more pathogens to the immediate environment. Along with a lack of hygiene and poor sanitation, large urban conurbations become an ideal breeding ground for bacteria.
Antibiotic development has declined significantly in the past few decades.
Additionally, a major issue in antibiotic resistance is the decline of new & more adaptive antibiotics being developed by the pharmaceutical industry. Following an unparalleled number of antibiotic discoveries in the past 4 decades, the number of new antibiotics being identified has almost completely ceased. Without new drugs to combat the ever-increasing number of antibiotic resistance, society is running out of options in the treatment of infections.
In summary, the 6 main causes of antibiotic resistance have been linked to:
Over-prescription of antibiotics
Patients not finishing the entire antibiotic course
Overuse of antibiotics in livestock and fish farming
According to ‘Dose of Reality’, an examination of the Global use of Antibiotics by The Economist in 2015 the following chart displays usage by country.
As examined above, Antibiotic resistance happens when bacteria adapt in a way that renders antibiotic drugs used to kill them impotent. Antimicrobial resistance concerns resistance not just to antibiotics, but also to other antimicrobials used to treat other microbes, such as viruses, fungi, and parasites. But what is the scale & scope of the problem?
The global medical establishment has been passive in recognizing the scale of the problem and to act, even though the first record of resistance to quinine as an antimalarial was noted in the 19th century and the first case of penicillin resistance in a patient was recorded in 1947, just five years after the antibiotic went into worldwide use.
Eventually, all medications encounter resistance and too few alternative treatments are coming forward. For example, the gonorrhea bacterium has become very challenging to treat. Much modern surgery would be too risky if infections cannot be treated. Cancer chemotherapy and organ transplantation would no longer be viable. This is now a real danger, as bacteria continue to develop resistance while the flow of new antibiotics has diminished.
There is a requirement for a deeper understanding of the factors causing antimicrobial resistance, as well as an assessment of its economic impact and security implications. There are many challenges facing all sectors of public health.
What actions do governments need to take regarding stewardship and infection control?
What needs to be done to stimulate new drug development?
What cross-sectoral actions, particularly in the food and agricultural sector, need to be taken?
What should governments do together to combat this global threat?
6 – Infections & Illnesses affected by Antibiotic Resistance
In 2013, CDC published the first AR Threats Report, which sounded the alarm to the danger of antibiotic & antimicrobial resistance. The report stated that each year in the U.S. at least 2 million people get an antibiotic-resistant infection, and at least 23,000 people die. The 2013 AR Threats Report helped inform the National Action Plan for Combating Antibiotic-Resistant Bacteria. The 2013 and 2019 reports do not include viruses (e.g., HIV, influenza) or parasites.
The report was published listing 4 main categories of antibiotic & antimicrobial resistance.
7 – Antibiotic & Antimicrobial Resistance in the Food Chain
The CDC has produced an educational infographic concerning the spread of Antibiotic & Antimicrobial Resistance in the Food Chain, from farm to Table.
8 – Medical & Technological Solutions to Antibiotic Resistance
In a 2018 article titled ‘Medical technologies in the fight against antimicrobial resistance’, healtheuropa.eu reports that –
Diagnostic tests and other medical technologies have an essential role to play in preventing the spread of antimicrobial resistance (AMR), which has been widely recognised as one of the most significant public health challenges of the 21st Century. Drug-resistant bacteria threaten to undo decades of hard-won progress in the fight against ill health and disease and return medicine to a pre-antibiotic era in which common, everyday infections become untreatable superbugs.
Antibiotic & Antimicrobial Resistance is, (literally,) deadly serious & for this reason, controversy rages continually around this subject. While it is impossible to apportion blame to any one of many possible causes it may be instructive to watch the following video entitled – “Antibiotic Resistance is Real. We Need to Take it Seriously”, a lecture given by Dame Sally Davies, Chief Medical Officer of England, Dept. of Health. Hosted by WIRED UK.
Topics covered in this video –
Welcome Trust & calls for government action from Ghanian, Indian & Thai governments.
Post Apocalyptic scenario of ‘Flemings Bugs’ ‘getting their way’.
Problems caused by lack of data.
Comparison of Antibiotic Resistance to Climate Change.
Babies in India dying of Drug Resistant Sepsis.
Antibiotic & Antimicrobial Resistance currently impacting on the ‘YOPI’s’. The Young. The Old. The Pregnant & The Immune Compromised.
5000 Deaths in England per year.
1 in 4 Prescriptions of antibiotics don’t work.
1 in 3 take Antibiotics once a year.
Problem of casualization of use of Antibiotics.
Projection of 10 Million deaths per year by 2050.
Impact on Global economic growth.
Impact on Sustainable Development Growth.
The ‘Discovery Void’. New classes of Antibiotics ceased in late 1980’s. Leading to ‘Market failure’ & disinvestment in new research.
Requirement for new ‘Market Pull Mechanisms’.
Problems in Aqua Culture, fish vaccinations in Asia. Discharge of excess Antibiotics into the environment, water table.
Problems in Agriculture & Food Chain. Use of Antibiotics for growth promotion which stimulates resistance. Example of resistant salmonella.
Problem of Antibiotic both treating a bacterial infection but also giving patient Antibiotic resistant bugs which can sit in gut for 6 – 12 months.
Problem of Globalization. ‘Bugs know no Borders’.
Challenge of Surveillance of Antibiotic Resistance spread internationally.
Challenge of building new partnerships in fight against Antibiotic Resistance. Public, private, pharmaceutical, governmental & with NGO’s.
Interesting new innovations in Big Tech. ie. Drones for delivery, mobile diagnostics. etc.
Better use of social media for public education & awareness.
An in-depth documentary which examines the 1918 Spanish Flu epidemic. It’s causes, origin, transmission & treatment
Spanish Flu pandemic. Historical pandemics. World War 1. Army living conditions. Civilian living conditions. Troop movements, War machine. Disease contagion. Epidemiology. Civilian population. Civilization. Southeast Asia origin of flu pandemics. Incubation. Public health issues. Food shortages. Viral mutation. Viral species transfer. Flu symptoms. Secondary infections. Pneumonia. Controversy. Political mismanagement. American Medical Association. Dengue. Vertigo. Headaches. Blindness. Double vision. Mucus excretions. Poison gas. Hemorrhagic fever. Oxygen starvation. Delirium. The ‘Blue Death’. Speed of death. High death rate. Hospital overcrowding. Quarantine. Philadelphia. San Francisco. Avian flu. H1N1. John Hopkins Center. Immunization. 2009 Swine flu.
“I had a little bird. Its name was Enza. I opened the window & in-flu-Enza” Children’s rope jumping song. 1918