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Harvard Commentaries
35320
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


What Your Doctor Is Saying What Your Doctor Is Saying
 

Diseases Named After Geographical Locations


July 11, 2014

By Robert H. Shmerling M.D.

Beth Israel Deaconess Medical Center

Not long ago, I was traveling through upstate New York and saw signs for Coxsackie. The name sounded familiar, but I didn’t expect to see it on a freeway sign.

In medical circles, Coxsackie refers to a virus that commonly causes mouth sores and a skin rash. It can also cause conjunctivitis, pleurisy, hepatitis and heart inflammation. It turns out that the virus was named for the town where the first recognized outbreak of this viral illness occurred in 1948.

There are many examples of conditions, diseases or infectious agents that are named after a particular location. Here are just a few.

West Nile Virus

Most of us first heard about West Nile virus in 1999 when an outbreak in New York shocked doctors and public health officials. This was the first reporting of this illness in the United States. But soon doctors had diagnosed nearly 29,000 cases. And nearly half of the people had the severe form that affects the brain and nervous system. By 2010, nearly every U.S. state had reported cases. These were unexpected developments for a virus that had been discovered more than 60 years earlier.  

The name comes from the place where it was first identified: the West Nile District of Uganda in Africa. 

The virus is spread to humans through mosquito bites, but it can cause illness in a number of other animal species, especially birds. Most people who are infected do not get sick. But about 20% develop mild fever, headache, nausea and fatigue. And 1 in 150 infected persons develops neurologic disease, including changes in mental function. Severe, and sometimes fatal, infections may cause meningitis, brain inflammation or a polio-like syndrome with paralysis. 

Flu Outbreaks

Widespread outbreaks (pandemics) of the flu have been named after the site where we suspect they began.  Notable examples include the Spanish Flu of 1918, the Asian flu of 1957 and the Hong Kong flu of 1967.

Ebola (or Ebola hemorrhagic fever)

This deadly virus was first described in the mid-1970s. Since then, outbreaks have killed 60% to 90% of those infected. Still, it was an obscure virus until an outbreak developed in Reston, Virginia, among imported monkeys in 1989. This was the subject of a bestselling book, The Hot Zone, by Richard Preston.  

Ebola gets its name from a region of the Democratic Republic of the Congo called the Ebola River Valley. This is where the first outbreak was recognized. 

There are actually several species of Ebola that  get their names from the place each was first identified. They include:

  • Zaire
  • Sudan
  • Ivory Coast
  • Bundibugyo (a town and district in Uganda)
  • Reston

Symptoms include fever, fatigue and chills. Muscle aches, nausea, vomiting, abdominal pain and diarrhea are also common. Rash, bleeding, sore throat and cough may accompany this infection. Eventually, blood pressure drops and the infected person may slip into a coma. 

The current outbreak in West Africa is among the worst ever; it’s already killed more than 300 people.

Lyme Disease 

The illness, caused by tick bites, was first described in a 1977 report about residents (particularly children) in Lyme, Connecticut, who developed attacks of arthritis. Initially, their doctors thought the cases of juvenile rheumatoid arthritis were just coincidence. But the cluster of cases occurred in one neighborhood. And the unusual rash appeared in the spring and summer. These factors inspired investigators to look into possible infectious causes. Soon, experts discovered the cause was a bacterium related to syphilis.

Common symptoms include a "bull’s eye" rash followed by knee arthritis that could take months to years to develop. However, an irregular heart rhythm and neurologic problems (such as facial weakness or shooting pains) may develop weeks to months after the rash. 

Nantucket Fever 

This name refers to babesiosis, a tick-borne parasitic infection of the red blood cells (somewhat similar to malaria). Mild cases may cause flu-like symptoms. Severe infections may cause breathing problems, heart and kidney failure. The disease is occasionally fatal. As you might guess from the name, the disease is particularly common in Nantucket, but it can be found in much of the Northeast United States as well as the Midwest. 

Rocky Mountain Spotted Fever 

The name of this disease is actually misleading. Rocky Mountain spotted fever was first identified in the Rocky Mountain area of the United States, but the disease is found throughout most of the country. It only occasionally occurs in the Rocky Mountain states of Colorado, Idaho, Montana and Wyoming.

This bacterial infection is spread by tick bites. Symptoms start within a few days to two weeks of the bite. Symptoms include fever, headache, rash, abdominal pain, nausea and muscle pain. Though it can be fatal if untreated, prompt antibiotic therapy usually cures it. 

Philadelphia Chromosome 

Geographic locations aren’t only used to designate diseases where they were first reported. Genetic mutations and variations are often named for the place where researchers first made the discovery. Perhaps the most famous is the Philadelphia chromosome. Researchers in Philadelphia discovered it in 1960.

In this mutation, 2 chromosomes exchange genetic material. This mutation is present in 95% of people with a particular type of leukemia (called chronic myelogenous leukemia or CML). So it’s a useful diagnostic test when CML is a consideration. Other types of blood disorders may have this genetic mutation as well.

The Bottom Line 

Some people may be offended that an illness bears the name where they live.  Perhaps they're afraid people will hold it against their hometowns. I'm guessing that most locations included in disease names are none the worse for it. 

And once a location is attached to a disease, it's unlikely the location will be tagged again with an ailment. For example, Legionnaires' disease and its bacterial cause (Legionella pneumophila) were named after the conventioneers who contracted the illness rather than their location. The name Philadelphia had already been taken. 

Sometimes, to understand what your doctor is saying, it helps to know your geography. But don’t put too much stock in the geographic names of these conditions. Most of these illnesses also occur in places far from where they got their names.

Robert H. Shmerling, M.D., is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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