10 dreaded diseases back from the brink

Once effective treatment or prevention exists for a disease, the hope is that the disease will fade from public health. But illnesses don’t always go away and can lurk in the shadows only to later re-emerge. Some of these diseases reappear because people fail to get vaccinated while others evolve to become more virulent and resistant to current treatments.

Let’s take a closer look at 10 diseases that have been making a comeback in developed nations in recent years.

Syphilis

Syphilis used to be a lot less prevalent, but this sexually-transmitted infection (caused by Treponema pallidum) has been on the rise in the 21^st century. In the United States, the national rate of syphilis cases in 2000-2001 was 2.1 per 100,000 population—the lowest rate since reporting began in 1941. But in 2017, the rate had escalated to 9.5 cases per 100,000 population, according to the Centers for Disease Control and Prevention (CDC).

Syphilis manifests as ulcers or sores, as well as a whole-body rash that can appear on palms of the hand and soles of the feet. Fortunately, syphilis is susceptible to treatment with penicillin, which is first-line treatment.

Measles

We once thought that measles had been defeated in the United States. Unfortunately, with more parents foregoing vaccination for their children, measles has again reared its ugly head. Just in 2019 so far, 79 cases have already been reported—compared with 63 cases in the entire year of 2010, according to the CDC. Measles outbreaks are currently ongoing in New York City, New York State, and Washington State.

Measles presents as a constellation of symptoms including cough, conjunctivitis, rhinitis, high fever, and an erythematous maculopapular rash in a head-to-toe distribution. Complications include otitis media, pneumonia, encephalitis, and sometimes death. Although there is no cure for an established measles infection, over-the-counter medications such as acetaminophen, ibuprofen, or naproxen may help to alleviate the fever that accompanies measles. In addition, increased vitamin A supplementation may reduce the severity of measles, and antibiotics can help to treat any bacterial infections (eg, pneumonia or ear infection) that may develop because of the disease.

Plague

Plague—or the “Black Death” as it was referred to in the Middle Ages—is making a comeback in the developing world and in parts of the United States, including Idaho, California, Arizona, Colorado, and New Mexico. Plague is usually spread by infected rat fleas and can manifest in one of three forms: bubonic (lymph node infection), pneumonic (lung infection), or septicemic (blood infection). People with pneumonic plague can spread the disease through respiratory droplets. Plague can be deadly and requires treatment with antibiotics, such as streptomycin, gentamicin, doxycycline, or ciprofloxacin, as well as oxygen, intravenous fluids, and respiratory support.

Scarlet fever

Scarlet fever is a bacterial infection that usually develops in children aged 10 years or younger. It results in a pathognomonic pink-red rash. Although usually uncommon, scarlet fever has re-emerged in the United Kingdom in the past few years, and experts worry that the disease could jump the pond to the United States.

Scarlet fever takes hold after symptoms of sore throat or impetigo, and is caused by Streptococcus pyogenes bacteria. These bacteria are found on the skin and in the throat. Initial symptoms include sore throat, headache, and fever. After a couple of days, the patient develops a pinkish rash on the chest and stomach, which then spreads. This rash feels like sandpaper to the touch and may be itchy. Scarlet fever is contagious but is easily treated with antibiotics.

Scarlet fever infection can spread to the other organ systems if left untreated, resulting in pneumonia, ear infection, or sinusitis.

Mumps

Cases of mumps are on the rise because fewer people are getting vaccinated. Mumps cases reached a recent high of 6,366 cases nationwide in 2016, compared with only 229 cases in 2012, according to the CDC.

Mumps causes characteristic puffy cheeks and swollen jaw. Other symptoms include fever, headache, tender parotid (salivary glands), muscle aches, fatigue, and loss of appetite. Most people who get mumps clear the illness after a few weeks, with many patients displaying no symptoms at all. But mumps can result in nasty complications, including encephalitis, meningitis, orchitis, and oophoritis.

Gonorrhea

This sexually transmitted infection affects the epithelium and manifests as cervicitis, urethritis, proctitis, and conjunctivitis. The infection can spread and lead to more serious complications, such as endometritis, salpingitis, and tubo-ovarian abscess, if untreated with antibiotics.

Gonorrhea was once a decreasing health concern but has now proven to be a nimble adversary, with strains having become resistant to every medication specifically designated for treatment. In 2018, super gonorrhea that is resistant to azithromycin and ceftriaxone—the last effective dual antibiotic therapy routinely available—cropped up in the United Kingdom, and experts expect that it will make its way to the States. Super gonorrhea is only susceptible to big-gun antibiotics typically found in hospitals, like intravenous ertapenem.

Although there may no longer be a go-to silver bullet for gonorrhea, there is a silver lining: Gonorrhea infection and transmission can be prevented with condoms.

Chlamydia

Chlamydia is gonorrhea’s partner in crime and, oftentimes, these two bacterial diseases will co-infect. In fact, chlamydia is more common than gonorrhea, and is making a comeback just like gonorrhea. From 2000 to 2017, the rate of chlamydial infections reported in the United States increased from 251.4 to 528.8 cases per 100,000 population, according to the CDC.

Together, chlamydia and gonorrhea infections affect the genitals, rectum, and throat in men and women if untreated with azithromycin and ceftriaxone.

Whooping cough

Pertussis, or whooping cough, is making a comeback—much like other illnesses caused by viruses that are preventable with vaccines. Whooping cough typically starts as a cold-like illness in children. Early symptoms of the infection usually manifest within 5-10 days and include runny nose, low-grade fever, occasional cough, and apnea. Of these symptoms, apnea is particularly concerning in babies who develop the illness. According to the CDC, “about 50% of babies less than one year old who get whooping cough have to be hospitalized. In rare cases, death may occur.”

After 1-2 weeks, whooping cough symptoms can evolve into fits of rapid coughs followed by a “whooping” sound, vomiting, and exhaustion from the coughing fits. It can take months for whooping cough to clear.

Tuberculosis

The number of tuberculosis cases rebounded after two decades of decline. The CDC reported 9,547 cases in 2015 compared with 9,398 cases in 2014. The reason for the reversal is unclear, and the CDC is investigating. Meanwhile, the numbers of reported cases since 2015 have resumed a slow decline.

Tuberculosis results in serious lung infection, which is spread by respiratory droplets in the air. Symptoms of tuberculosis include cough, chest pain, fatigue, fever, night chills, and loss of appetite. Tuberculosis can also affect other parts of the body including the spine and kidneys. Unfortunately, many strains of tuberculosis are resistant to antibiotics.

Gout

The incidence of gout has more than doubled in the United States during the past 20 years. Gout is an inflammatory arthritis mediated by crystallization of uric acid in joints, which results in severe pain and swelling. The increasing incidence of gout is likely due to the obesity epidemic, as well as rising levels of hypertension and metabolic syndrome in Americans. Controlling for obesity and hypertension can prevent gout and hyperuricemia.