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

The Problem with Zebras

"When you hear hoof beats, think horses, not zebras."

That was one of the gems that Dr. Steve shared in his off-grid medicine course.  It's something taught to all students in medical school.  And what is means is this:  Common things happen commonly.  The child in the waiting room is more likely to have an ear infection than appendicitis.  The young adult is more likely to have type-2 diabetes than a gunshot. 

We naturally gravitate toward the sensationalized rather the common.  If we decide to learn something new, it has to be something cool, different, unique.  Quick and easy would be really good, too.  Macho survivalists want to learn how to DIY an appendectomy on themselves, sans anesthesia.  But learning to satisfy the essentials of good nutrition to stay healthy in the first place?  Leave that to the grannies. They want to be able to stitch up that GSW or finish off an amputation or place a tourniquet (and argue about which tourniquet is best).  They want to be able to treat the rare injuries, the zebras, that likely aren't even once in a lifetime or once in a family's lifetime, but can't manage the common problems (the horses).  They don't know which OTC meds are best for which conditions or when to suture and which wounds must be left open.

Spending money on stuff is easier than learning a new skill. The acquisition of that box of ammo, bottle of fish antibiotics, or solar rechargeable penlight provides an immediate reward of having accomplished something.  And with online shopping, you receive that reward twice--once when you purchase, and again when it arrives.

Learning a new skill takes time. It's not glamorous or sensational.  On top of that, the macho guys are even ridiculing your choices, which makes it harder.  They're sure the hoof beats coming are zebras, and it's silly to waste time preparing for horses, mules, or donkeys.  So you just have to put your head down and plow on.

Which brings us back to the problem with zebras.  For a very long time the US, figuratively, has been a nation of horses treated by horse doctors, horse doctors that have been trained to treat only horses.  Not zebras.  Even though zebras bear some physical resemblance, there are significant differences.  Because the zebras carry some vastly different diseases.  And those diseases have symptoms and presentations that are quite similar to those for horses, but the treatments may be totally different.  The horse doctors might have read about these zebra diseases, but they have never seen them.  Most American doctors have never seen even one case of the following:

• diphtheria
• tetanus
• rabies
• scabies
• mumps
• German measles
• cholera
• yellow fever
• typhus
• tularemia
• plague
• anthrax
• botulism
• measles (though this is changing with increasing numbers of people who are not immunized)

When American doctors hear hoof beats, they think horses. Scabies gets diagnosed as psoriasis.  Improperly diagnosed rabies patients are given steroids for pain and sent home.  Is it influenza, or anthrax?  The symptoms are very similar. What about plague or tularemia?  Even with experience, these can be hard to differentiate.  Without experience? You probably don't want to go there.

Unfortunately, many of those hoof beats in the distance are in fact coming from zebras.  Most physicians in US have never seen the actual zebras making a comeback and crossing our borders.  Measles is only the beginning.  Lots of other communicable diseases are on their way.   We currently have the problem of physicians unable to identify more exotic diseases now, while the technology is available to help them.  What happens when our society collapses?  They will not have their technology to help them diagnose anything.

Now, there are a few horse doctors who hear the hoof beats of zebras in the distance.  Some of them teach off-grid medicine to preppers.  Some write books or blogs.  No one physician covers everything, so it's best to acquire at least two or three different sources--hard copies.  Make sure you're prepared to deal with the ailments common to horses.  That's what you'll see the most of.  But it would also be wise to have the means of dealing with communicable diseases, parasites, and infectious diseases of third world countries, as well as bioweapons.  Zebras can be heard in the distance.

Links to related posts:
Cholera
Rabies
Scabies
Tularemia 
Typhus
Armageddon Medicine  
Survival and Austere Medicine, 3rd Edition  
The Survival Medicine Handbook 

For further reading:
https://www.deseretnews.com/article/900041016/utahn-dies-from-rabies-a-first-since-1944.html
https://www.healthline.com/health/psoriasis/psoriasis-vs-scabies

 © 2019, PrepSchoolDaily.blogspot.com  04.23.24