Tularemia--What's the Risk?--And School's Out!

School's Out!

I just forgot to remind you.  ;)

Just like last year, I've decided to take the summer off from writing new posts.  I need time in the garden and for selling my books at farmers markets here and in Utah.  But last summer, I couldn't keep from writing and simply built up a nice reserve of articles to carry me through the year.  These past couple of weeks, I've been trying to compose new articles--there is still so much to learn--but without much success.  Perhaps because the garden calls.  Perhaps because I feel the need to compile the medical articles into a 2nd edition of Bring Your Own Bandages.  

Of course, I will continue to re-post previous articles.  We all need to be reminded.  I'll continue to check the comments and try to respond within a day.  Or so.  It is summer, after all.

Enjoy time outdoors and with family, and keep on preparing.

 

Since at least fifth or sixth grade, maybe even earlier, I've been fascinated with infectious disease.  Yes, my family finds it creepy.  I don't know.  Am I the only one who thinks discussing smallpox or the Spanish flu or yellow fever makes for great dinnertime conversation?

But even with my interest in these dread diseases, I couldn't remember much about tularemia or even whether it was all that serious, only that it was associated with rabbits.  Ha!  At least I remembered that correctly.  Tularemia is indeed a bacterial disease associated with rodents, rabbits, and hares.  It is usually a rural disease and occurs throughout the United States, except Hawaii, though most cases occur in the south central and western states.  The mortality rate without treatment is 33%; with treatment it is less than 2%.

As with any disease, prevention is always the best way to go.  To prevent tularemia, take the following measures, only one of which is unique to this disease:

• Use insect repellent.  Most cases of tularemia are transmitted by tick and deer fly bites.  Use DEET or something similar on the skin and permethrin on clothes.
• Wash hands often when handling sick animals or carcasses, especially rabbits and hares.
• Cook food thoroughly and make sure your water is pure.  
• Note any changes in pet rabbits, rodents, and hares.  

Tularemia is unique in that the bacteria responsible for the disease can be transmitted in numerous ways.  Diagnosis is made much more difficult because the signs and symptoms vary depending on how the person was infected and where the bacteria choose to set up housekeeping.  As noted earlier, the signs and symptoms of tularemia will depend on how the person was infected.  The incubation period is generally 3 to 5 days, but may range from 1 to 14 days. Tularemia manifests in the following forms:

• Ulceroglandular:  75% of tularemia cases are ulceroglandular and result from a tick or deer fly bite or the handling of infected animals or carcasses.  There is a single lesion at the bite site with a central eschar.  The lesion looks like other bug bites--swollen and raised, and the eschar is the actual site of the bite with the dead tissue and scab spreading out.  There is prominent lymphadenopathy (swollen glands).  The first cases identified in the United States were in Utah, and the disease, Francisella tularensis, is named for the Utah man who first researched it, Edward Francis.
• Glandular:  This is the most common form in children.  There is regional lymphadenopathy.  The glands are swollen and painful and may need draining.  The bite may have healed over or may have been overlooked.
• Oropharyngeal:  This form presents with a fever, severe sore throat, mouth ulcers, exudative pharyngitis, and tonsillitis.  It arises from ingesting contaminated food or water.  There is prominent lymphadenopathy around the neck, ears, and jaws.
• Oculoglandular:  This form is marked by eye pain, including photophobia, excessive tearing, conjunctivitis, and small ulcers of the cornea.  It may result from airborne bacteria, a splash of contaminated water, or rubbing the eyes with contaminated hands.  There is prominent lymphadenopathy around the neck, ears, and jaws.
• Intestinal:  A rare form of tularemia marked by intestinal pain, vomiting, and diarrhea.  It arises due to eating undercooked, contaminated food or drinking contaminated water.
• Pneumonic, or pulmonary:  This form occurs due to inhalation or spread from ulceroglandular or typhoidal forms.  Farmers, sheep shearers, landscapers, and lab workers are at greater risk for this form of the disease.  Symptoms are very similar to pneumonic plague and influenza, including chest pain, dry cough, and shortness of breath.  Untreated, this form has a 30-60% mortality rate.
• Typhoidal:  This form is difficult to diagnose.  There is little if any lymphadenopathy.  Symptoms are not specific and may include a high fever, nausea, vomiting, diarrhea, abdominal pain, cough, pneumonia.

Tularemia is unique in that there are so many ways it can be transmitted and so many forms it can take.  Fortunately, there is no documented transmission from person to person, so the patient does not need to be isolated.  However, and this may be significant to those with dogs, our pets can transmit it to us.  In a collapse scenario, our dogs may decide to start supplementing their diets with rabbits and hares.  And sick rabbits are easier to catch.  The dogs may contract tularemia and pass it to us.

What's interesting about tularemia is that it is classified as a Category A bioweapon by the CDC.  It's right up there with anthrax, smallpox, plague, and botulism.  It is easily disseminated, and very few bacteria are needed to cause illness. 

Fortunately, tularemia can be treated.  The drugs of choice are gentamicin or streptomycin, which are both intramuscularly or intravenously administered, and neither of which is commonly available to or stocked by preppers.   The other options are doxycycline or ciprofloxacin.  Physicians generally prescribe doxycycline 100 mg or ciprofloxacin 500 mg, both every 12 hours for 10-14 days.  Unfortunately, there's a good chance for relapse with both of these drugs.

Links to related posts:
TEOTWAWKI Tick Prevention  

For further reading:
https://emergency.cdc.gov/agent/tularemia/facts.asp
https://texashelp.tamu.edu/wp-content/uploads/2016/02/Tularemia-and-Bioterrorism.pdf
https://www.wikem.org/wiki/Tularemia--different clinical features of tularemia
https://azdhs.gov/documents/preparedness/emergency-preparedness/zebra-manual/zm-s4-tularemia.pdf
https://texasprepares.org/factsheets/factsheet_tularemia_and_bioterror_eng.pdf
https://www.ok.gov/health2/documents/Tularemia.pdf
http://outbreaknewstoday.com/isis-and-bioterrorism-tularemia-planned-use-in-turkeys-water-67823/
https://www.acsh.org/news/2017/08/24/dog-gives-woman-fatal-tularemia-potential-bioterrorism-agent-11741
https://academic.oup.com/cid/article/47/1/e4/378987
https://www.oregon.gov/oha/ph/DiseasesConditions/CommunicableDisease/ReportingCommunicableDisease/ReportingGuidelines/Documents/tularemia.pdf
https://www.merckmanuals.com/professional/infectious-diseases/gram-negative-bacilli/tularemia

© 2019, PrepSchoolDaily.blogspot.com    

23 june 2021

Tick-Borne Bacterial Illnesses: Rocky Mountain Spotted Fever, Lyme Disease, Etc.

Disclaimer.  I am not a licensed health practitioner.  This is just another post on an item you might wish to have available if needed so that a physician can treat you and your family as best as possible.  No medication, including those available over the counter, should be taken without consulting a physician.  Information shared here is for educational and entertainment purposes only.  It is not medical advice nor a substitute for licensed medical care.  A qualified, licensed physician or other medical provider should be consulted before beginning any herbal or conventional treatment.

Unlike the other creepy-crawlies covered recently who are only able to transmit one kind of disease, ticks are more evolved.  They spread pain and suffering in a much wider variety of ways (wow, makes them sound like politicians, doesn't it?).  Their bites can transmit bacteria, viruses, and other parasites.  Some species of ticks may carry more than one kind of disease.  It's enough to make you want to bathe in DEET and never go outside if you think about it long enough.

But that approach isn't necessarily healthy, or practical.  So let's be a little more realistic.

In an effort to be a bit more logical in the approach to addressing the various tick-borne diseases, today's post will focus on the bacterial diseases transmitted by tick bites.  Other tick-borne diseases will be addressed later.


Please refer to the post on ticks for methods of preventing tick bites and removing ticks.


All tick-borne illnesses:

• If you have the resources, every patient presenting with a tick bite in a high risk area may be given doxycycline in a 200 mg single dose.  
• If I had an immediate family member with a tick that had possibly been attached more than twelve hours, I wouldn't hesitate to use doxycycline in this manner, and assuming I still had an adequate supply.
• Others can use their own supplies or hope for the best. I wouldn't use my supplies prophylactically on someone outside my family. 
• Even today, if a patient indicates he has been bitten by a tick, and he displays signs and symptoms consistent with a tick-borne disease (and which are common to many illnesses), a physician will start him on a course of antibiotics immediately.  Blood test results take time, and at least one of these tick-borne illnesses can quickly become fatal. If a patient reports flu-like symptoms after a tick bite, antibiotics are automatically administered.
• Regardless of whether a tick-borne disease is identified sooner or later, antibiotics are still used.  Those identified later may need a longer course of therapy, up to four weeks, and there is the possibility of suffering the consequences for life.  
• The treatment for most tick-borne diseases that are bacterial in origin is the same--doxycycline.  Physicians typically prescribe doxycycline at 100 mg/2x per day/10-14 days.  Amoxicillin is another option, 500 mg/3x per day/14 days.
• The common signs and symptoms:  headache, rash, muscle and joint pain, altered mental status.

There is very little information in the off-grid medicine books I consulted on the treatment of tick-borne diseases.  The best resource I could find is the CDC.  Links are posted below.

Lyme disease.  Lyme disease mimics many other illnesses, with rashes, headaches, and muscle and joint aches, and has a very long incubation period--up to 30 days.  If a patient recalls being bitten by a tick, that helps with diagnosis, but most patients--over 60%--do not recall being bitten.  Remember, a tick doesn't latch on and stay on.  It attaches for a very long feeding, and then falls off.  (Sounds like some of my babies.)  Early signs include a characteristic bullseye rash around the site of the attack bite.  There may be meningitis or inflammation of heart muscle, neither of which is going to be easily diagnosed in an austere environment.  Later symptoms include severe arthritis involving many joints or chronic meningitis--headaches, problems in thinking clearly, and sleepiness.

The ticks that carry Lyme disease are found all over the US, but most infections occur in the Northeast and North Central US.


Rocky Mountain spotted fever.  The ticks carrying this disease are found throughout the US, but most frequently identified in Arizona, Oklahoma, Missouri, Arkansas, Tennessee, and North Carolina.  The incubation period is 3-12 days.  Early signs (1-4 days) include a high fever, severe headache, gastrointestinal symptoms (nausea, vomiting, anorexia), and edema around the eyes and on the back of the hands.  Later signs include altered mental status, cerebral edema, pulmonary edema and respiratory distress, necrosis (tissue death requiring amputation), and kidney failure.  If there is any suspicion of RMSF, begin treatment immediately.  Delay may be fatal.

The rash associated with RMSF begins 2-5 days after the onset of symptoms.  The small, flat, pink, non-itchy spots first appear on the wrists, forearms, and ankles and sometimes spread to the trunk, palms and soles.  About 10% of patients never develop a rash and the decision to begin treatment should not be based on the presence of a rash.  Later, the rash turns red to purple.  This is a sign of severe progression of the disease and treatment should have already begun.

Rickettsiosis.  The ticks that carry this disease are found in the Southeast and Mid-Atlantic US, as well as southern Arizona.   The incubation period is 2-10 days.  The disease is less severe than RMSF; the treatment is the same.

Ehrlichiosis.  The ticks that carry this disease are found in the Southeast and South Central US.  Additional symptoms include fever, chills, and gastrointestinal complaints--vomiting, diarrhea, anorexia, and nausea.  The incubation period is 5-14 days.

Anaplasmosis.  The ticks that carry this disease are found in the Upper Midwest and Northeastern US.  Additional symptoms and incubation period are the same as for ehrlichiosis.  There is the possibility of co-infection with Lyme disease.

Tick-borne relapsing fever.  The ticks that carry this disease are found primarily in the Western US, and most cases occur when people sleep in rustic cabins, whether in the summer when ticks are most active, or in the winter when fires are heating cabins and ticks nesting in walls and woodwork are activated.  The incubation period is about 7 days.  The febrile periods last 3 days, followed by a 7 day break, then another 3-day fever, and so on.  The usual antibiotics are tetracycline or erythromycin, both in the same dosages:  500 mg/4x day/10 days. 

Links to related posts:
Ticks--Preventing Bites and Removing Ticks 

For further information:
https://www.cdc.gov/ticks/tickbornediseases/rmsf.html
https://www.cdc.gov/ticks/tickbornediseases/tbrf.html
https://www.cdc.gov/ticks/tickbornediseases/lyme.html
https://www.cdc.gov/ticks/tickbornediseases/rickettsiosis.html
https://www.cdc.gov/ticks/tickbornediseases/anaplasmosis.html
https://www.cdc.gov/ticks/tickbornediseases/ehrlichiosis.html

© 2019, PrepSchoolDaily.blogspot.com  

30 april 2023