Dear Doctor Bortolussi,
Please forgive the impertinence of an amateur like myself, in taking the liberty of commenting on your excellent article. However, having devoted more than thirty years of my life to the well-being of families with Hemochromatosis, I do believe the omission of ‘persons with iron overload’ among your list of those most at risk, to have been an oversight.
If, as the experts tell us, iron is an essential growth factor for the multiplication of most bacteria, viruses, and even some cancers, it explains why the people I personally know of ,who were afflicted with Listeriosis from eating unpasteurized soft cheeses, were hemochromatotic; as was one who nearly lost his hand because of Pasteurella from a cat bite.
In a 1986 issue of “Among Ourselves”, the newsletter of the Canadian Hemochromatosis Society, we printed the following:
“ Warnings have been issued in a number of medical journal articles, including one in the April 1985 FDA Drug Bulletin, to patients with chronic liver diseases (including hemochromatosis) not to eat raw clams or oysters, and undercooked seafood, and — in the event of open wounds—to avoid bathing in salt water because of the danger of a virulent Vibrio bacteria (Vibrio Vulnificus). Treatment with tetracycline is specific.
In a letter to the editor of JAMA, June 19, 1987-Vol 257, no 23, the writers, Claudio Chiesa MD, Lucia Pacifico MD, Francesco Renzulli MD, and Mario Midulla, MD, of La Sapienza University of Rome, and Laura Garlaschi MD, of the University of Milan, reported: “From 1978 to 1986, in Italy, almost all cases of severe clinical disease due to Yersinia enterocolitica septicemia, developed in subjects with iron overload.” with hemochromatosis. Therefore, when confronted with this unusual problem, the diagnosis of hemochromatosis should be entertained.”
It is my personal contention that, in situations like the Walkerton E-coli outbreak, and the developing salmonella problem, hemochromatotics should always be considered to be at great risk. In fact, iron stores - particularly the Transferrin Saturation Percentage - should be monitored in all afflicted indivuduals. Not only would this be good for the patient (as in the case of patients treated with Interferon), but it would provide researchers with an invaluable opportunity for research.
Sincerely,
Marie Warder, CVMH CVCH
Founder and President Emeritus: Canadian Hemochromatosis Society
November 4, 2008
You are quite right. It is sometimes forgotten that host factors like iron may play a role in host defense to Listeria and other bacteria. Many articles discuss the immune mechanisms and leave it at that. In fact, however, I do discuss iron overload in a chapter that I write on Listeriosis in a textbook (Remington and Klein). The chapter editors give far more space to discuss additional material than I had available in the brief CMA article. The article was labeled as “Primer” since I intended only to touch the major points. Standard recommendations were taken from CDC etc. I just could not duplicate in the short article, the information that may be included in a textbook.
November 16, 2008
This is not related to anything but I am wondering if surgery is safe for people with hemochromatosis particularly elderly people.
My father passed away and 1 month later we were told he had hemochromatosis. I guess iron levels are not tested prior to surgery.
November 18, 2008
As a person with hemochromatosis I am interested ion whether high iron counts are the criteria for these risks. If i have phebotomies or donate blood to get to “normal” levels is my risk still high?
Is there a “card” that lists these various not insubstantial risks
I do not remember my physician mentioning all of these and I would like to pass the info on to my 5 out of 5 affected family members.
Thanks
December 2, 2008
Hello Don,
At what age did you get diagnosed for HHC?
Bob Rogers
Executive Director
Canadian Hemochromatosis Society
February 15, 2009
I have been recently diagnozed with Hemochromatosis.My Rheumatologist has told me my iron level is normal however a recent study has shown that iron does not need to be a factor in diagnosing Hemochromatosis.I have Lupus and the Rheumatologist feels the arthritis in my hands is not caused by Lupus.My fingers have st arted to fuse together.Please Help. Many Thanks Thanks Diane MacIntosh