Viral Illness and Aromatherapy

What is a virus?  What is a viral illness?  How is a viral illness treated?  How are essential oils in the treatment of viral conditions?

These four questions set the agenda for this brief paper.  To the lay person it can appear as if anything that cannot be treated by surgery or that has an obvious cause is dismissed as ‘viral.'  However, it is essential that we have an accurate and specific definition of what is meant by a virus.

What is a Virus?

The Dutch microbiologist Martinus Beijerinck (1851-1931) was the first person to use the term "virus" for the invisible disease-causing material that he showed to be self-replicating.

A virus is a microorganism smaller than a bacterium, which cannot grow or reproduce apart from a living cell. A virus invades living cells and uses their chemical machinery to keep itself alive and to replicate itself. It may reproduce identically or with mutations - this ability to mutate is responsible for the ability of some viruses to change slightly in each infected person, making treatment more difficult. While it is possible to filter out bacterium, it is not normally possible to do so with a virus.

Viruses cause many common human infections, and are also responsible for a variety of rare diseases. Examples of viral illnesses range from the common cold, which is usually caused by one of the rhinoviruses, to acquired immunodeficiency syndrome (AIDS), which is caused by the human immunodeficiency virus (HIV).

Viruses may contain either DNA or RNA as their genetic material. Herpes simplex virus and the hepatitis- B virus are DNA viruses. RNA viruses have an enzyme called reverse transcriptase that permits the usual sequence of DNA-to-RNA to be reversed so the virus can make a DNA version of itself. RNA viruses include HIV and the hepatitis C virus.

Researchers have grouped viruses together into several major families, based on their shape, behavior, and other characteristics. These include the herpesviruses, adenoviruses, papovaviruses (papilloma viruses), hepadnaviruses, poxviruses, and parvoviruses among the DNA viruses. On the RNA virus side, major families include the picornaviruses (including the rhinoviruses), calciviruses, paramyxoviruses, orthomyxoviruses, rhabdoviruses, filoviruses, bornaviruses, and retroviruses. There are dozens of smaller virus families within these major classifications. Many viruses are host-specific, causing disease in humans or specific animals only.

Myalgic Encephalomyelitis (ME) or Chronic Fatigue Syndrome (CFS) can be triggered by certain viral infections, although people with CFS/ME have no continuing infection with the virus. So, there may be factors other than the virus which keep CFS/ME going and delay recovery.

What is a Viral Illness?

The influenza or flu virus is an RNA virus that comes in three genera - A, B, and C. Influenza A is the most common type. It can infect mammals and birds, with aquatic birds being its natural endemic host. Each year there is a seasonal epidemic of Influenza A, infecting millions of people and killing 100-200,000 - mostly the very old, the very young, and the sick.

Influenza B is less common than A and infects only humans, seals and ferrets. Influenza B mutates slower than A, and so has less genetic diversity and is less virulent as a result. Influenza C infects humans, dogs, and pigs and is the least common type, but can be virulent when outbreaks occur.

All of the pandemics over the last century have been of Influenza A. Its primary weapon is its ability to rapidly mutate, avoiding the immune systems of its hosts. This is why each year new strains of Influenza A are causing that season's epidemic.

The flu starts out like a common cold, but lasts longer and becomes more severe. It is characerized by high fevers, muscle aches, fatigue, headache, and severe cough.

Influenza A strains are designated by the two main proteins that determine their infectivity and virulencs -haemaglutanin and neuraminidase, H and N. There are 16 Hs but only H 1-3 infect humans, and there are 9 Ns but only 1 and 2 infect humans. Haemaglutanin is a protein that allows the virus to latch onto and infect host cells, while neuraminidase allows expelled viruses to reinfect other cells.

The most recent mutation, the swine flu virus, is Influenza A H1N1. This strain came about probably by four different strains of Influenza A infecting the same host (probably a pig, hence the name swine flu). Viruses can exchange genetic material, so one strain can combine bits from other strains, creating a new strain. The current swine flu likely combines bits from a human virus, a bird virus, and two swine viruses, although this is still being confirmed.

Influenza is potentially a fatal illness, killing about 1% of those infected. Death results from one of three types of causes - the flu infection itself can cause a serious pneumonia that can impair breathing to the point of death. A serious infection can also leave someone open to a superinfection (another organism causing a second infection while the host's immune system is occupied with the flu). And those who have a chronic underlying illness may succumb from the added physiological stress added by the flu.

How is a Viral Illness Transmitted?

In 1918 the Spanish Flu (named after the country of origin of the first identified case) swept the globe, killing 20-40 million people - more than the First World War (which killed 15 million) which was just ending. When an epidemic spreads to multiple regions, especially multiple countries or continents, it becomes a pandemic. Flu pandemics happen every 40 years or so.

A single sneeze propels 100,000 droplets into the air at around 90 mph.

According to Wendy Barclay - professor of influenza virology at the UK-based Imperial College London - swine flu, now known as A(H1N1), is a 'triple reassortment' virus. It is made up of segments from human, swine and avian viruses.

Kennedy Shortridge - a virologist at the University of Hong Kong - warned that as the virus spreads further this mixture is likely to increase: "... the farther the virus spreads, the more chance it will mix, or reassort, with other flu viruses in circulation and turn into something more lethal".  He also stated that there are human strains of the virus in areas that are resistant to the current treatment Tamiflu and urged the sequencing of as many viral samples as possible to help predict changes in the virus.

How is a Viral Illness Treated?

Prevention is always better than attempting a cure.  There are three simple steps recommended as a means off prevention:

1. Wash Your Hands Frequently. It may sound obvious, but hand-washing with soap (especially if it contains essential oils) and water for around 20 seconds is the single best thing you can do (if you're going to go out into the world and interact with other human beings). It is estimated that 80 percent of all infections are spread by hands. If you can't wash your hands regularly, try hand-sanitizers with 60 percent alcohol content.

2. Avoid.  Reduce unnecessary social contact, staying away from crowds, and avoiding people if you're sick or if you're concerned that they may be infected. It may not be especially practical when you have to go to, say, work, but experts believe it's worth repeating: Isolation and avoidance reduce your chances of getting infected or infecting others.

(Researchers in the UK have found that 99 percent of commuters suffer at least one cold per winter. By contrast, 58 percent of people who work from home and 88 per cent of those who walk to work caught a cold last winter).

3. Recognize the Symptoms and Get Help. Fever, body aches, sore throat, cough, runny nose, vomiting, diarrhea, and lethargy. If you don't feel well, seek medical attention.

Medical advice is clear: there is no cure for the common cold; antibiotics have no effect on viruses.

Antiviral drugs called Zanamivir and Oseltamivir are sometimes used for flu. They do not kill the virus but interfere with the way the virus multiplies. Therefore, they do not cure flu, but may reduce the severity and duration of symptoms, and may prevent complications. If you develop flu, an antiviral drug may be prescribed if you are at increased risk of developing complications. Antiviral drugs need to be given soon after symptoms begin to be of any benefit. Also, an antiviral drug may be prescribed to certain people to prevent flu. For example, if you live in a residential home and there is an outbreak of flu in the home. Or, if you are at increased risk of complications and have been in close contact with a person with flu.

Blood donations - treated with heat to kill viruses.

Vaccination - prevention being better than treatment.

How are Essential Oils Used in the Treatment of Viral Conditions

Within holistic medicine, we should be clear that there are times when disease can work with the body to achieve a better homeostasis.  For instance, those diseases that have a viral cause (measles, mumps, rubella and chickenpox) stimulate the development of the immune system.  While it is appropriate to treat the symptoms (rashes or irritation), the introduce something as negative as antibiotics could in fact delay, not assist, recovery. 

During the recent threat of bird flu, it was a delight to read in the Independent the following article (Jeremy Laurance, Health Editor, Saturday, 15 October 2005):

Star anise, the unusual fruit of a small oriental tree, is sold in supermarkets in the UK to consumers seeking its pungent, liquorice-like flavour.

But the herb has a vital function as the source of shikimic acid from which the drug Tamiflu is made, the only defence the world currently has against the threatened flu pandemic.

Tamiflu cannot prevent infection with avian flu but it can reduce its severity. In the absence of an effective vaccine - which has not yet been developed - it is all that stands between the world and what could become a modern plague.

Yesterday it emerged that a shortage of star anise is one of the key reasons why countries including Britain cannot obtain enough Tamiflu to protect their populations. European Union ministers met yesterday to discuss measures to reduce contact between wild birds and poultry to curb its spread.

The deadly H5N1 strain of the virus, which has infected more than 100 humans, killing more than 60, in the Far East, was identified this week in poultry in Turkey. Results of tests on infected birds in Romania are expected to be revealed on Monday. EU scientistsagreed measures that could lead to millions of chickens and turkeys being kept indoors to prevent contact with migrating birds.

As moves to halt the growing threat of avian flu intensified, governments sought to stockpile the only drug currently available to offer any sort of defence for humans. The herb from which Tamiflu is made is grown in four provinces in China and "huge quantities" of its seeds are needed, according to the Swiss pharmaceutical manufacturer Roche.

It is harvested by local farmers between March and May, purified and the shikimic acid extracted at the start of a 10-stage manufacturing process which takes a year.

Only star anise grown in the four provinces of China is suitable for manufacture into Tamiflu and 90 per cent of the harvest is already used by Roche.

The Common Cold:

Herpes Simplex:

Type 1 herpes simplex affects the area around the lips and is commonly referred to as a cold sore.  Type 2 herpes simplex affects the genital area and is a sexually transmitted infection (STI). 

Cold sores are caused by the herpes simplex virus. A first cold sore usually occurs in childhood. The virus infects through the moist 'inner' skin that lines the mouth. It is commonly passed on by skin contact such as kisses from a family member who has a cold sore.

After the first infection, the virus settles in a nearby nerve sheath and remains there for the rest of your life. For most of the time, the virus lies dormant (inactive) and causes no symptoms. However, in some people the virus becomes 'active' from time to time. When activated, the virus multiplies and travels down the nerve sheath to cause cold sore blisters around the mouth. Some people have cold sores often, others only now and then. It is not clear what causes the dormant virus to become active. Some things that may 'trigger' the virus to activate and cause a cold sore include:

•·                     Illness. Cold sores may occur during feverish illnesses such as colds, coughs, and 'flu.

•·                     Menstruation. Cold sores are common around the time of monthly periods.

•·                     Stress or just being 'run down' for one of many reasons.

•·                     Sunshine. Strong, direct sunlight may trigger cold sores in some people.

HIV/AIDS:

HIV stands for human immunodeficiency virus. This is a virus in the group of viruses called retroviruses. HIV destroys cells in the body called CD4 T-cells. CD4 T-cells are a type of lymphocyte (a white blood cell). These are important cells that protect the body against various bacteria, viruses and other 'germs'. HIV actually multiplies within CD4 cells. HIV cannot be destroyed by white blood cells as it keeps on changing its outer coat so protecting it.

AIDS stands for acquired immunodeficiency syndrome. This is a term which covers the range of infections and illnesses which can result from a 'weakened' immune system caused by HIV.

When you are first infected with HIV you do not have AIDS. There is usually a time lag of several years between first being infected with HIV and subsequently developing infections and other AIDS-related problems. This is because it usually takes several years for the number of CD4 T-cells to reduce to a level where your immune system is weakened.

HIV is transmitted by one of the following:

• Sexual transmission. This is the most common way the virus is passed on. You can become infected if you have sex with an infected person (vaginal, anal or oral sex). Semen, vaginal secretions and blood from an infected person contains HIV. The virus can enter the body through the lining of the vagina, vulva, penis, rectum or mouth during sex.
• Needle sharing. HIV (and other viruses such as hepatitis B and C) can be transmitted by drug users who share needles, syringes and other injecting equipment which is contaminated with infected blood.
• Infected blood. In the past quite a number of cases occurred from infected blood transfusions and other blood products. This is now rare in the UK as since 1985 all blood products are checked for HIV before being used. It is still a significant problem in developing countries.
• Accidental needlestick injuries. The risk is extremely low; health care workers who have been injured accidentally by contaminated needles only have a risk of 3 in 1000.
• From mother to child. Pregnant women with HIV can pass the infection on to their babies during pregnancy or childbirth. Studies suggest that about 1 in 7 babies born to HIV-infected mothers are likely to be infected, although this is higher in Africa. However, treatment with anti-HIV drugs during pregnancy greatly reduces the risk of passing on the virus. Having a caesarean section to deliver the baby reduces the risk even further. HIV can occasionally be passed to babies through breast milk during breastfeeding. If formula milk is available, mothers with HIV are encouraged not to breastfeed.

To become infected with HIV, some infected blood, semen or vaginal secretions has to get into your body. You can not catch HIV from ordinary contact with someone with HIV such as hugging, shaking hands or touching, or from sharing food, towels, utensils, swimming pools or telephones.

  Once HIV is in your body the virus attaches to and gets into the CD4 T-cells. The virus then uses the DNA (the genetic code inside the cell) to replicate (make copies of itself). As new virus particles break out of a CD4 T-cell, the cell dies. The new virus particles then attach and enter new CD4 T-cells and so the process continues. Millions of new virus particles are made in CD4 T-cells each day and millions of CD4 T-cells die each day.

To counter the virus destruction the body continues to make new CD4 T-cells each day. However, over time, the virus usually 'wins' and the the number of CD4 T-cells gradually falls (usually over several years). Once the level of CD4 T-cells goes below a certain level, your immune system is weakened. If your immune system is severely weakened by HIV infection then you are likely to develop various 'opportunistic' infections. These are infections caused by germs which are commonly around us. You would not normally develop infections from these germs if you have a healthy immune system. A low level of CD4 T-cells also increases the risk of developing other conditions which the immune system helps to prevent such as certain cancers.

When you first become infected with HIV it is known as the 'primary infection'. You may not have any symptoms at this time. However, some people develop symptoms similar to flu or glandular fever. This commonly happens 6-8 weeks after becoming infected. This is sometimes called 'seroconversion illness' as it is the time when antibodies first appear in the bloodstream. Symptoms may include: fever, sore throat, blotchy red rash, feeling sick, diarrhoea, swollen glands, headache, tiredness and general aches and pains. These symptoms can last up to three weeks and are often just thought of as 'flu' or a 'viral illness'. This is not AIDS but just an initial reaction to being infected with HIV. A test for HIV may well be negative during this early infection.

After any primary infection settles, without any treatment you can remain without any symptoms for several years. On average this is for ten years. As there are often no symptoms during this time, many people do not realise that they are even infected with HIV. However, the virus continues to multiply, the number of CD4 T-cells tends to gradually fall, and you can pass on the virus to others. During this time some people with HIV who are otherwise well may develop persistent swollen lymph glands (persistent generalised lymphadenopathy) or night sweats.

In time you may start to develop problems such as recurring mouth ulcers, recurring herpes or shingles infections or seborrhoeic dermatitis (a skin condition caused by a yeast). Old TB (tuberculosis) infection may 'reactivate' in some cases even before AIDS develops, especially in people in the developing world. Other symptoms of HIV that may occur before AIDS develops include diarrhoea, skin rashes, tiredness and loss of weight.

The term AIDS is used to describe the most advanced stages of HIV infection. AIDS is a general term which includes various diseases which can result from a very weakened immune system. Typically, a person with AIDS has:

• A very low level of CD4 T-cells (around 200 cells per cubic millimeter of blood or below), and/or...
• One or more opportunistic infections such as pneumocystic jiroveci pneumonia (PcP), severe thrush in the vagina or mouth, fungal infections, tuberculosis (TB), mycobacterium avium complex, toxoplasmosis, cytomegalovirus, etc. These infections can cause a range of symptoms including sweats, fever, cough, diarrhoea, weight loss and generally feeling unwell.

In addition, people with AIDS have an increased risk of developing other conditions such as:

• Certain cancers. Kaposi's sarcoma is a cancer which is usually only seen in people with AIDS. There is also an increased risk of developing cancer of the cervix and lymphoma.
• An AIDS-related brain illness such as HIV encephalopathy (AIDS dementia)
• A severe body wasting syndrome.

Many different symptoms can develop from the above conditions. Children with AIDS can develop the same opportunistic infections and problems as adults. In addition, they may also develop severe common infections of childhood such as severe ear infections or severe tonsillitis.

HIV is now a treatable medical condition and most people with the virus remain fit and well on treatment. Since the 1990s a number of drugs have been developed called antiretroviral drugs. Antiretroviral drugs work against HIV infection by slowing down the replication of the virus in the body. Newer drugs are more effective than drugs used in the past. There are several classes of these drugs which include: nucleoside reverse transcriptase inhibitors (NRTIs), nucleotide reverse transcriptase inhibitors (NtRTIs), protease inhibitors (PI) and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Newer classes of drugs have recently been introduced which are integrase inhibitors, fusion inhibitors and CCR5 antagonists. The drugs in each class work in different ways but all work to stop the HIV from replicating itself.

Taking three or more antiretroviral drugs at the same time, each attacking HIV at different points in its cycle of replication, is more effective than one or two drugs alone. This is called HAART (highly active antiretroviral therapy). Taking a combination of different drugs also reduces the risk that the virus will become resistant to any individual drug. In 2008 the first one pill a day treatment was launched. Each pill contains three different drugs. This is popular as it is convenient to take and has few side-effects.

The choice of drugs are considered and chosen for each individual patient. The treatment for HIV can be complicated as it involves taking many different medications. A team of healthcare professionals are usually involved in looking after you and giving your treatment.

The aim of treatment is to reduce the 'viral load' to low levels. In most people who are treated with HAART, the viral load reduces to very low levels and the number of CD4 T-cells rises. This means your immune system is no longer as weakened and you are not likely to develop opportunistic infections. However, it is vital to take the medication regularly and as exactly as prescribed to maintain success, and to help prevent the virus from becoming resistant to the drugs.

As with other powerful drugs, antiretroviral drugs can cause side-effects in some cases. In addition, some of these drugs can react with other commonly used medications. It may be necessary to change an initial combination of drugs to a different combination because of problems with side-effects, reactions or resistance of the virus to an initial drug. Therefore, different people with HIV can often take different combinations of drugs. Common side-effects include nausea, vomiting and headaches.

As a general rule, antiretroviral drugs are usually started if:

• Opportunistic infections or other AIDS-related problems develop, or
• Your CD4 T-cells fall below a certain level (around 350 cells per cubic millimeter of blood or less) - even without symptoms. The exact level when treatment is started depends on many different factors which your doctor will discuss with you. These include any symptoms present and the rate of decline of the CD4 T-cells.

However, the treatment of HIV is a rapidly changing area of medicine. Trials are underway to assess whether antiretroviral drugs should be started earlier in people who have no symptoms, even as early as when first infected with HIV. The trials aim to show whether there are benefits from treatment before symptoms develop which outweigh the risk of side-effects from the drugs. You are likely to have regular blood tests to monitor for side effects whilst taking treatment.

Having protected sexual intercourse is very important to protect against other sexually transmitted infections including herpes and hepatitis. People with HIV are usually vaccinated against Hepatitis A and B, influenza and the pneumococcus (a common cause of pneumonia).

Opportunistic infections are usually treated with antibiotics, antifungals or anti-TB drugs, obviously depending on which infection develops. Even if you have not developed an infection, once the CD4 T-cells falls to a low level you will normally be advised to take a regular dose of one or more antibiotics or other drugs to prevent certain opportunistic infections from developing.