September 12th, 2022

The enterovirus, Polio, is now heading into a transmission state of significance in New York according to new sewage viral tracking reports. The first known case occurred in July in an unvaccinated man in southern New York where polio vaccination rates are only in the 60% range. He developed paralysis, a rare but serious complication of infection. Sewage reports show that there is infection occurring in higher numbers than previously thought. It will only be a matter of time before more paralytic cases are seen in those without viral vaccination protection.

It has been over 10 years since a case of paralytic polio was seen stateside.

This is potentially the beginning of more preventable disease issues in the US. With the increasing anti vaccine stance being adopted in the wake of the Covid vaccine messaging debacle, we have to be vigilant for these previously unseen illnesses in our clinic.

The inactivated polio vaccine is very effective at preventing these issues.

Dr. M


PACS/IBS - summary of physiology

"The pathophysiology of PACS including that of the GI manifestations is incompletely understood; however, it is likely multifactorial. Epithelial invasion by SARS-CoV-2 is substantiated by the high expression levels of angiotensin-converting enzyme-2 on the enterocytes and colonocytes. The angiotensin-converting enzyme-2 is a negative regulator of the renin-angiotensin system and has a protective cellular role, including in the intestinal tract. Following the entry of SARS-CoV-2 in the cell, angiotensin-converting enzyme-2 protein is downregulated, resulting in an increase in angiotensin-II, the likely molecular mechanism of severe acute respiratory syndrome and systemic inflammatory response development with this coronavirus. Intestinal microbial dysbiosis has also been associated with acute SARS-CoV-2 infection and PACS. Long-term respiratory dysfunction after COVID-19 is associated with altered gut microbiota and persistently elevated lipopolysaccharide-binding protein levels. One study showed that dysbiosis in COVID-19 patients continued throughout their hospitalizations and up to 21 days from disease onset, with a decrease in health-promoting, short-chain fatty acid–forming bacteria. Gut microbiome of patients with PACS was characterized by higher levels of Ruminococcus gnavus and Bacteroides vulgatus, and lower levels of Faecalibacterium prausnitzii. Interestingly, presence of butyrate-producing bacteria showed an inverse correlation with development of PACS at 6 months. A recent study also suggested that salivary microbiome during acute infection may predict the development of GI PACS. Other etiologies that may underlie development of GI PACS include the worsening or development of diabetes after SARS-CoV-2 infection. Diabetes can predispose to development of DGBI, such as functional dyspepsia, gastroparesis, and diarrhea. Weight gain experienced by a subset of individuals post-COVID-19 can also aggravate gastroesophageal reflux disease or other DGBI symptoms. More recently, a T-cell-based immune dysregulation was reported to play a role in the development of PACS, particularly chronic GI symptoms. In this study, 9% of individuals developed PACS but 18% had anosmia/dysgeusia. GI PACS was associated with multiple positive antibodies during the acute and chronic phases. T-cell receptor and single-cell sequencing also showed that GI PACS is associated with specific T-cell clonal dynamics where there is an expansion of cytotoxic pool. Additionally, SARS-CoV-2-specific CD8 T cells exhibited undifferentiated phenotypes during acute disease and elevated cytotoxic characteristics at chronic stage. Bystander activation of cytomegalovirus-specific T cells has also been observed in GI PACS. Increased intestinal permeability, which has been implicated in PI-IBS, has also been reported in patients with severe COVID-19. Lastly, autonomic dysfunction associated with PACS and chronic anosmia/dysgeusia can also play into the pathophysiology of chronic GI symptoms.
In established DGBI patients recovering from COVID-19 infection, an overall increase in symptoms, medication use, and health care use has been observed. Multiple studies have highlighted the profound psychological impact of the pandemic on patients with DGBI, with worsening of GI symptoms significantly correlating with increased depression and anxiety. Moreover, alterations in dietary habits and behaviors with likely effects on GI symptoms have been reported during the pandemic and confinement, such as increased simple sugar or carbohydrates consumptions, decreased water intake, and reduced physical activity. Psychological stress can also exacerbate underlying eating disorders that may be associated with symptoms of DGBI. These observations may foreshadow a continued rise in patients presenting to gastroenterologist offices with IBS or DGBI symptoms, both from de novo diagnosis and from increase/flare-up of existing symptoms." (Chan et. al. 2022)

Dr. M

 Chan Clin Gastro Hepatology