Category Archives: ___b) Disease

Tuberculosis

(Survival Manual/ 6. Medical/ b) Disease/ Tuberculosis)

Important points to remember from this article:
•  More than two billion people, equal to one-third of the world’s total population, are infected with TB bacilli.
•  TB remains a disease of poverty and poor health services.
• [Should there occur a SHTF/ TEOTWAWKI event drastically lowering global living standards, expect Tuberculosis rates & overall numbers to increase. At present, Tuberculosis is a fringe disease for we who live in the affluent West, that could change. Just remember, if the global economy goes south and stays down for an extended length of time, people with “a cough that just won’t go away” may have contracted Tuberculosis. See “Signs and Symptoms”, below. Mr Larry]


A.  World Tuberculosis Day 2011
19 August 2011, Doctor NDTV, Aman subeditor
Pasted from: <http://doctor.ndtv.com/storypage/ndtv/id/5055/type/feature/World_Tuberculosis_Day_2011.html?cp>

World Tuberculosis (TB) Day, which falls on March 24 every year, aims to raise public awareness about tuberculosis, a preventable disease. Tuberculosis is still an epidemic in many regions of the world, annihilating the lives of many millions of people each year. Each year, over nine million people around the world get infected with TB and almost two million TB related deaths are recorded worldwide. The actual figures must be far larger than this.

For World TB Day 2011, we enter the second year of a two-year campaign – “On the move against tuberculosis”. The campaign aims to inspire innovation in TB research and care. The 2011 World TB Day campaign is focused on individuals around the world who have found new ways to stop TB and can serve as an inspiration to others. The basic idea is to recognise people who have introduced a variety of innovations in a variety of settings. The objectives of TB day are listed below:

  • Research aimed at developing new diagnostics, drugs or vaccines
  • Operational research, aimed at making TB care more effective and efficient
  • New approaches to helping people gain access to TB diagnosis and treatment
  • Novel partnerships between actors in the fight against TB
  • Advances in integrating TB care into health systems
  • New approaches to providing support from members of the community to people affected by TB
  • Innovative ways of raising awareness about TB.

According to World Health Organization (WHO), here are some interesting facts about tuberculosis:
Fact 1 – Tuberculosis is contagious and spreads through air. If not treated, each person with active TB can infect on average 10 to 15 people a year.
Fact 2 – More than two billion people, equal to one third of the world’s total population, are infected with TB bacilli, the microbes that cause TB. One in every 10 of those people will become sick with active TB in his or her lifetime. People living with HIV are at a much higher risk.
Fact 3 – A total of 1.7 million people died from TB in 2009 (including 3, 80,000 people with HIV), equal to about 4,700 deaths a day. TB is a disease of poverty, affecting mostly young adults in their most productive years. The vast majority of TB deaths are in the developing world, with more than half occurring in Asia.
Fact 4 – TB is a leading killer among people living with HIV, who have weakened immune systems.
Fact 5 – There were 9.4 million new TB cases in 2009, of which 80% were in just 22 countries. Per capita, the global TB incidence rate is falling, but the rate of decline is very slow – less than 1%.
Fact 6 – TB is a worldwide pandemic. Among the 15 countries with the highest estimated TB incidence rates, 13 are in Africa, while a third of all new cases are in India and China.
Fact 7 – Multidrug-resistant TB (MDR-TB) is a form of TB that does not respond to the standard treatments using first-line drugs. MDR-TB is present in virtually all countries surveyed by WHO and its partners.
Fact 8 – There were an estimated 4, 40,000 new MDR-TB cases in 2008 [drug resistant] with three countries accounting for over 50% of all cases globally – China, India and the Russian Federation. Extensively drug-resistant TB (XDR-TB) occurs when resistance to second-line drugs develops. It is extremely difficult to treat and cases have been confirmed in more than 58 countries.
Fact 9 – The world is on track to achieve two TB targets set for 2015:
•  Millennium Development Goal, which aims to halt and reverse global incidence (in comparison with 1990); and
•  Stop TB Partnership target of halving deaths from TB (also in comparison with 1990).
Fact 10 – Forty one million TB patients have been successfully treated in DOTS programmes and up to 6 million lives saved since 1995, 5 million more lives could be saved between now and 2015 by fully funding and implementing The Global Plan to Stop TB 2011-2015

The global epidemic of tuberculosis (TB) 
It is estimated that 1.7 million people died of tuberculosis in 2009. There were an estimated 9.4 million new cases of tuberculosis in 2009 of which the majority were in Asia and Africa. It is thought that the rates of new tuberculosis infections and deaths per capita have probably been falling globally for several years now. However, the total number of new tuberculosis cases is still slowly rising due to population growth.

.

B.  Control of Tuberculosis (TB)
October 24, 2005- February 11, 2006, About.com, by Jerry Kennard and the MEDICAL Review Board
Pasted from: <http://menshealth.about.com/od/diseases/a/tb.htm&gt;
and <http://menshealth.about.com/od/diseases/a/treatment_tb.htm&gt;

In the 1959s the US and many European countries introduced immunization programs. As a result the incidence of TB fell dramatically. In the late 1980s there was a resurgence of TB cases in the large cities of the US and in Europe. This has been for a number of reasons, among them;

Homelessness; overcrowding in shelters, prisons and in homes for the poor; increased immigration from countries with a high incidence of TB; drug abuse; HIV/AIDS.

Facts About Tuberculosis (TB)
According to the World Health Organization (WHO) each year around eight million people develop TB. Every year about 2 million people die from TB, a curable disease. Every second somewhere in the world someone gets infected with TB bacilli. The World Health Organization estimates that about one-third of the world’s population is currently infected with the TB bacillus.

In the USA the tuberculosis (TB) infection rate in the United States fell to a record low in 2004. A total of 14,511 active TB infections, or 4.9 cases per 100,000 people, were reported to the Centers for Disease Control and Prevention.

Tuberculosis (TB) is a contagious disease caused by the bacillus Mycobacterium tuberculosis. TB spreads through the air. The usual form is pulmonary TB, which affects the lungs. Only people who are sick with TB in their lungs are infectious.
It is important to know that not everyone infected with TB germs develops active TB. About 5-10% of people who are infected with TB bacilli become sick or infectious at some time during their life.

Although TB most commonly affects the lungs, TB germs can also spread to other organs in the body (extra-pulmonary TB). This air borne infection is spread through coughs, sneezes and spitting of infected material. It only takes a few inhaled germs to become infected but In general, you need prolonged exposure to an infected person before becoming infected yourself.
Someone with a compromised or weakened immune system is more likely to become infected with Tuberculosis. TB remains a disease of poverty and poor health services.
TB has been around for many thousands of years. It has been found in bones dating back at least 5,000 years.

Signs and Symptoms of Active Tuberculosis (TB)
Signs and symptoms of active pulmonary TB are usually
  A cough lasting three or more weeks
  Discolored or bloody sputum
  Weight loss
 Fatigue
  Slight fever
  Night sweats
  Chills
  Loss of appetite
  Pain when breathing or coughing (pleurisy)
Tuberculosis can also occur in other parts of your body. These include your joints, bones, bone marrow, muscles, urinary tract, lymphatic system and central nervous system.

.
C.  Treatment and Control of Tuberculosis
October 24, 2005, About.com, Jerry Kennard and reviewed by the Medical Review Board
Pasted from: <http://menshealth.about.com/od/diseases/a/treatment_tb.htm

Treatment for Tuberculosis (TB)
Treatment for TB was only available from about 50 years ago. Active tuberculosis, if not treated, will infect on average between 10 and 15 people every year. If active tuberculosis is not treated it can kill and treatment currently reaches only about a quarter of people with Tuberculosis.

Antibiotics are used in the treatment of Tuberculosis (TB). Antibiotic treatment therapy is lengthy and you have to take them for six to 12 months to completely destroy the bacteria. The length of treatment and the type of drug that is needed is determined by your age, overall health, the results of susceptibility tests, and whether you have TB infection or active TB.

It is the length of drug treatment that causes so many difficulties in developing countries as well as in the West. Poor supervision, incomplete treatment, doctors and health workers prescribing the wrong treatment regimens, or an unreliable drug supply not only fails to treat TB but can lead drug-resistant TB.
Surgery is now very rarely used to treat TB.

Drug-resistant Tuberculosis TB Treatment
Strains that are resistant to a single drug have been documented in every country. A particularly dangerous form of drug-resistant TB is multidrug-resistant TB (MDR-TB) Rates of MDR-TB are high in many countries including the former Soviet Union.
People infected with the drug resistant strain will pass on the same drug-resistant strain when they infect others. While drug-resistant TB is generally treatable, it requires extensive chemotherapy, sometimes up to 2 years of treatment. The medication required for drug resistant TB is extremely expensive, often more than 100 times more expensive than treatment of drug-susceptible tuberculosis. Treatment is often more toxic to patients and not so well tolerated.

 

D.    Risk factors
Anyone can get tuberculosis, but certain factors can increase your risk of the disease. These factors include:
_1) Weakened immune system
A healthy immune system can often successfully fight TB bacteria, but your body can’t mount an effective defense if your resistance is low. A number of diseases and medications can weaken your immune system, including:

  • HIV/AIDS
  • Diabetes
  • End-stage kidney disease
  • Cancer treatment, such as chemotherapy
  • Drugs to prevent rejection of transplanted organs
  • Some drugs used to treat rheumatoid arthritis, Crohn’s disease and psoriasis
  • Malnutrition
  • Advanced age

_2) International connections
TB risk is higher for people who live in or travel to countries that have high rates of tuberculosis, such as:

  • Sub-Saharan Africa
  • India
  • China
  • Mexico
  • The islands of Southeast Asia and Micronesia
  • Parts of the former Soviet Union

_3) Poverty and substance abuse

  • Lack of medical care. If you are on a low or fixed income, live in a remote area, have recently immigrated to the United States or are homeless, you may lack access to the medical care needed to diagnose and treat TB.
  • Substance abuse. Long-term drug or alcohol use weakens your immune system and makes you more vulnerable to tuberculosis.
  • Where you work or live
  • Health care work. Regular contact with people who are ill increases your chances of exposure to TB bacteria. Wearing a mask and frequent hand-washing greatly reduce your risk.
  • Living or working in a residential care facility. People who live or work in prisons, immigration centers or nursing homes are all at risk of tuberculosis. That’s because the risk of the disease is higher anywhere there is overcrowding and poor ventilation.
  • Living in a refugee camp or shelter. Weakened by poor nutrition and ill health and living in crowded, unsanitary conditions, refugees are at especially high risk of tuberculosis infection.

.

E.  TB Medical Advisory Board Statement on the Treatment of Active Tuberculosis in Adults
 Pasted from <http://www.in.gov/isdh/19686.htm>
Recommended Treatment Regimens
Unless there are contraindications, patients with active tuberculosis should be treated initially with four drugs: isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB). Four drugs are recommended because (1) EMB helps to prevent the emergence of RIF-resistant organisms when primary resistance to INH may be present; (2) INH resistance continues to occur in our state, (3) foreign-borne persons from countries with high rates of drug resistance make up a growing number of TB cases in Indiana, and (4) six-month treatment regimens are not possible without the use of PZA.

 Use of Drugs Other Than INH, RIF, PZA, or EMB
There are no substitutes for any of the first-line agents. Before rifampin was available, TB patients had to take medication for 18-24 months. The combination of INH and rifampin allowed completion of therapy within 9 months. Routine addition of PZA during the first two months has shortened duration of therapy to 6 months for most cases. Ethambutol is known as a ‘companion drug,’ and has bacteriostatic activity. Its primary purpose is to suppress the further development of resistance in situations where INH resistance is already present at diagnosis. Ethambutol can be discontinued as soon as the organism is known to be susceptible to both INH and RIF.

The drugs are not interchangeable. Second-line agents must be used when patients cannot take first-line drugs because of resistance or intolerance. These second-line agents are substantially less active, and not without risks of toxicity. Patients taking second-line drugs in lieu of both INH and RIF require treatment durations of up to 2 years with frequent monitoring for side effects.

.

F.  Prevention
Pasted from <http://www.mayoclinic.com/health/tuberculosis/DS00372/DSECTION=coping-and-support>
If you test positive for latent TB infection, your doctor may advise you to take medications to reduce your risk of developing active tuberculosis. The only type of tuberculosis that is contagious is the active variety, when it affects the lungs. So if you can prevent your latent tuberculosis from becoming active, you won’t transmit tuberculosis to anyone else.

Protect your family and friends
If you have active TB, keep your germs to yourself. It generally takes a few weeks of treatment with TB medications before you’re not contagious anymore. Follow these tips to help keep your friends and family from getting sick:

  • Stay home. Don’t go to work or school or sleep in a room with other people during the first few weeks of treatment for active tuberculosis.
  • Ventilate the room. Tuberculosis germs spread more easily in small closed spaces where air doesn’t move. If it’s not too cold outdoors, open the windows and use a fan to blow indoor air outside.
  • Cover your mouth. Use a tissue to cover your mouth anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away.
  • Wear a mask. Wearing a surgical mask when you’re around other people during the first three weeks of treatment may help lessen the risk of transmission.

Finish your entire course of medication
This is the most important step you can take to protect yourself and others from tuberculosis. When you stop treatment early or skip doses, TB bacteria have a chance to develop mutations that allow them to survive the most potent TB drugs. The resulting drug-resistant strains are much more deadly and difficult to treat.

Vaccinations
In countries where tuberculosis is more common, infants are vaccinated with bacillus Calmette-Guerin (BCG) vaccine because it can prevent severe tuberculosis in children. The BCG vaccine isn’t recommended for general use in the United States because it isn’t very effective in adults and it causes a false-positive result on a TB skin test. Researchers are working on developing a more effective TB vaccine.

Coping and support
Undergoing treatment for tuberculosis is a complicated and lengthy process. But the only way to cure the disease is to stick with your treatment. You may find it helpful to have your medication given by a nurse or other health care professional so that you don’t have to remember to take it on your own. In addition, try to maintain your normal activities and hobbies, and stay connected with family and friends.

Keep in mind that your physical health can affect your mental health. Denial, anger and frustration are normal when you must deal with something difficult and unexpected. At times, you may need more tools to deal with these or other emotions. Professionals, such as therapists or behavioral psychologists, can help you develop positive coping strategies.

Leave a comment

Filed under Survival Manual, __6. Medical, ___b) Disease

Malaria

(Survival Manual/ 6. Medical/ b)Disease/ Malaria)

Pasted from <http://www.mayoclinic.com/health/malaria/DS00475/DSECTION=prevention>
Pasted from <http://www.getawayafrica.com/index.php?id=432>

Definition
Malaria produces recurrent attacks of chills and fever. Caused by a parasite that’s transmitted by mosquitoes, malaria kills about 1 million people each year worldwide.

While the disease is uncommon in temperate climates, malaria is still prevalent in tropical and subtropical countries. World health officials are trying to reduce the incidence of malaria by distributing bed nets to help protect people from mosquito bites as they sleep. A vaccine to prevent malaria is currently under development.

If you’re traveling to locations where malaria is common, take preventive medicine before, during and after your trip. Many malaria parasites are now immune to the most common drugs used to treat the disease.

[Map above: Places currently affected by Malaria.]

Symptoms
A malaria infection is generally characterized by recurrent attacks with the following signs and symptoms:
•  Moderate to severe shaking chills
•  High fever
•  Profuse sweating as body temperature falls

Other signs and symptoms may include:
•  Headache
•  Nausea
•  Vomiting
•  Diarrhea

Malaria signs and symptoms typically begin within a few weeks after a bite from an infected mosquito. However, some types of malaria parasites can lie dormant in your body for months, or even years.

 When to see a doctor
Talk to your doctor if you experience a high fever while living in or after traveling to a high-risk malaria region. The parasites that cause malaria can lie dormant in your body for months. If you have severe symptoms, seek emergency medical attention.

Causes
Malaria is caused by a type of microscopic parasite that’s transmitted most commonly by mosquito bites.

Mosquito transmission cycle
•  Uninfected mosquito. A mosquito becomes infected by feeding on a person who has malaria.
•  Transmission of parasite. If you’re the next person this mosquito bites, it can transmit malaria parasites to you.
•  In the liver. The parasites then travel to your liver — where they can lie dormant for as long as a year.
•  Into the bloodstream. When the parasites mature, they leave the liver and infect your red blood cells. This is when people typically develop malaria symptoms.
•  On to the next person. If an uninfected mosquito bites you at this point in the cycle, it will become infected with your malaria parasites and can spread them to the next person it bites.

Other modes of transmission
Because the parasites that cause malaria affect red blood cells, people can also catch malaria from exposures to infected blood, including:
•  From mother to unborn child
•  Through blood transfusions
•  By sharing needles used to inject drugs

Risk factors
The biggest risk factor for developing malaria is to live in or to visit tropical areas where the disease is common. Many different subtypes of malaria parasites exist. The variety that causes the most lethal complications is most commonly found in:
•  African countries south of the Sahara desert
•  The Indian subcontinent
•  Solomon islands, Papua New Guinea and Haiti

Risks of more severe disease
People at increased risk of serious disease include:
•  Young children and infants
•  Travelers coming from areas with no malaria
•  Pregnant women and their unborn children

Poverty, lack of knowledge, and little or no access to health care also contribute to malaria deaths worldwide.

 Immunity can wane
Residents of a malaria region may be exposed to the disease so frequently that they acquire a partial immunity, which can lessen the severity of malaria symptoms. However, this partial immunity can disappear if you move to a country where you’re no longer frequently exposed to the parasite.

Complications
Malaria can be fatal, particularly the variety that’s common in tropical parts of Africa. The Centers for Disease Control and Prevention estimate that 90 percent of all malaria deaths occur in Africa — most commonly in children under the age of 5.

In most cases, malaria deaths are related to one or more of these serious complications:
•  Cerebral malaria. If parasite-filled blood cells block small blood vessels to your brain (cerebral malaria), swelling of your brain or brain damage may occur.
•  Breathing problems. Accumulated fluid in your lungs (pulmonary edema) can make it difficult to breathe.
•  Organ failure. Malaria can cause your kidneys or liver to fail, or your spleen to rupture. Any of these conditions can be life-threatening.
•  Severe anemia. Malaria damages red blood cells, which can result in severe anemia.
•  Low blood sugar. Severe forms of malaria itself can cause low blood sugar, as can quinine — one of the most common medications used to combat malaria. Very low blood sugar can result in coma or death.

Recurrence may occur
Some varieties of the malaria parasite, which typically cause milder forms of the disease, can persist for years and cause relapses.

Tests and diagnosis
Blood tests can help tailor treatment by determining:
•  Whether you have malaria
•  Which type of malaria parasite is causing your symptoms
•  If your infection is caused by a parasite resistant to certain drugs
•  Whether the disease is affecting any of your vital organs
Some blood tests can take several days to complete, while others can produce results in less than 15 minutes.

Treatments and drugs
The types of drugs and the length of treatment will vary, depending on:
•  Which type of malaria parasite you have
•  The severity of your symptoms
•  Your age
•  Whether you’re pregnant

Medications
The most common antimalarial drugs include:
•  Chloroquine (Aralen)
•  Quinine sulfate (Qualaquin)
•  Recommended treatment Quinine can be given by the oral, intravenous or intramuscular routes. Quinine or quinine-containing compounds such as Quinimax ® should not be given alone for the treatment of malaria as short courses, e.g. 3 days, owing to the possibility of recrudescence (200).

When administered to patients with uncomplicated malaria, quinine should be given orally if possible, by one of the following regimens:
*  Areas where parasites are sensitive to quinine: Quinine, 8 mg of base per kg three times daily for 7 days.
*  In Areas with marked decrease in susceptibility of P. falciparum to quinine Quinine 8 mg of base per kg three times daily for 7 days plus Doxycycline 100 mg of salt daily for 7 days (not in children under 8 years of age and not during pregnancy); a pharmacologically superior regimen would include a loading dose of 200 mg of doxycycline followed by 100 mg daily for 6 days. or  Tetracycline 250 mg four times daily for 7 days (not in children under 8 years of age and not in pregnancy).

•  Hydroxychloroquine (Plaquenil)
•  Mefloquine
•  Combination of atovaquone and proguanil (Malarone)

The history of antimalarial medicine has been marked by a constant struggle between evolving drug-resistant parasites and the search for new drug formulations. In many parts of the world, for instance, resistance to chloroquine has rendered the drug ineffective.

Prevention
If you’re going to be traveling to a location where malaria is common, talk to your doctor a few months ahead of time about drugs you can take — before, during and after your trip — that can help protect you from malaria parasites.
In general, the drugs taken to prevent malaria are the same drugs used to treat the disease. Your doctor needs to know where you’ll be traveling so that he or she can prescribe the drug that will work best on the type of malaria parasite most commonly found in that region.

Doxycycline: Travellers who cannot take Mefloquine should take Doxycycline to prevent malaria if they are traveling in a malaria area. This drug is taken every day at an adult dose of 100 mg, to begin on the day before entering the malaria area, while there, and continued for 4 weeks after leaving. If Doxycycline is used, there is no need to take other preventive drugs, such as Chloroquine.

Possible side effects include skin photosensitivity that may result in an exaggerated sunburn reaction. Wearing a hat and using sunblock can minimize this risk. Women who take Doxycycline may develop vaginal yeast infections and should discuss this with their doctor before using Doxycycline.

Doxycycline should not be used by:
•  pregnant women during their entire pregnancy,
•  children under 8 years of age or
•  travellers with a known hypersensitivity to doxycycline

No vaccine yet
Scientists around the world are trying to develop a safe and effective vaccine for malaria. As of yet, however, there is still no malaria vaccine approved for human use.

 Reducing exposure to mosquitoes
In countries where malaria is common, prevention also involves keeping mosquitoes away from humans. Strategies include:
•  Spraying your home. Treating your home’s walls with insecticide can help kill adult mosquitoes that come inside.
•  Sleeping under a net. Bed nets, particularly those treated with insecticide, are especially recommended for pregnant women and young children.
•  Covering your skin. During active mosquito times, usually from dusk to dawn, wear pants and long-sleeved shirts.
•  Spraying clothing and skin. Sprays containing permethrin are safe to use on clothing, while sprays containing DEET can be used on skin.

Leave a comment

Filed under Survival Manual, __6. Medical, ___b) Disease

Tuberculosis

 (Survival Manual/ 6. Medical/b) Disease/Tuberculosis)

 The global epidemic of tuberculosis (TB)
It is estimated that approximately 1.7 million people died of tuberculosis in 2009. There were an estimated 9.4 million new cases of tuberculosis in 2009 of which the majority were in Asia and Africa. It is thought that the rates of new tuberculosis infections and deaths per capita have probably been falling globally for several years now. However, the total number of new tuberculosis cases is still slowly rising due to population growth.

One-third of the world’s population is currently infected with TB or tuberculosis.
<http://www.unmultimedia.org/radio/english/2012/03/world-tb-day-raises-awareness-about-the-global-epidemic/>
24 Mar 2012
The World Health Organization says TB remains a leading cause of death from infectious diseases worldwide, second only to HIV/AIDS. Last year alone, 8.4 million people contracted TB and 1.4 million died from the disease.

Control of Tuberculosis (TB)
In the 1950s the US and many European countries introduced immunization programs. As a result the incidence of TB fell dramatically. In the late 1980s there was a resurgence of TB cases in the large cities of the US and in Europe. There have been for a number of reasons for the increase, among them: Homelessness; overcrowding in shelters, prisons and in homes for the poor; increased immigration from countries with a high incidence of TB; drug abuse; HIV/AIDS.

Definition
Tuberculosis (TB) is a potentially serious infectious disease that primarily affects your lungs. The bacteria that cause tuberculosis are spread from person to person through tiny droplets released into the air via coughs and sneezes.

Tuberculosis was once rare in developed countries, but the number of TB cases began increasing in 1985. Part of the increase was caused by the emergence of HIV, the virus that causes AIDS. HIV weakens a person’s immune system so it can’t fight the TB germs.
Many strains of tuberculosis can resist the effects of the drugs most commonly used to treat the disease. People who have active tuberculosis must take several different types of medications together for many months to eradicate the infection and prevent development of antibiotic resistance.

A.  Symptoms
<http://www.mayoclinic.com/health/tuberculosis/DS00372/DSECTION=coping-and-support>
Although your body may harbor the bacteria that cause tuberculosis, your immune system usually can prevent you from becoming sick. For this reason, doctors make a distinction between:
•  Latent TB. In this condition, you have a TB infection, but the bacteria remain in your body in an inactive state and cause no symptoms. Latent TB, also called inactive TB or TB infection, isn’t contagious.
•  Active TB. This condition makes you sick and can spread to others. It can occur in the first few weeks after infection with the TB bacteria, or it might occur years later. Most people infected with TB germs never develop active TB.

Signs and symptoms of active TB include:
•  Cough
•  Unexplained weight loss
•  Fatigue
•  Fever
•  Night sweats
•  Chills
•  Loss of appetite

What organs are affected?
Tuberculosis usually attacks your lungs. Signs and symptoms of TB of the lungs include:
•  Coughing that lasts three or more weeks
•  Coughing up blood
•  Chest pain, or pain with breathing or coughing

But tuberculosis can also affect other parts of your body, including your kidneys, spine or brain. When TB occurs outside your lungs, symptoms vary according to the organs involved. For example, tuberculosis of the spine may give you back pain, and tuberculosis in your kidneys might cause blood in your urine.

 When to see a doctor
See your doctor if you have a fever, unexplained weight loss, drenching night sweats or a persistent cough. These are often signs of TB, but they can also result from other medical problems. Your doctor can perform tests to help determine the cause.

Causes
Tuberculosis is caused by bacteria that spread from person to person through microscopic droplets released into the air. This can happen when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings.
Although tuberculosis is contagious, it’s not especially easy to catch. You’re much more likely to get tuberculosis from someone you live with or work with than from a stranger. Most people with active TB who’ve had appropriate drug treatment for at least two weeks are no longer contagious.

HIV and TB
Since the 1980s, the number of cases of tuberculosis has increased dramatically because of the spread of HIV, the virus that causes AIDS. Tuberculosis and HIV have a deadly relationship — each drives the progress of the other.
Infection with HIV suppresses the immune system, making it difficult for the body to control TB bacteria. As a result, people with HIV are many times more likely to get TB and to progress from latent to active disease than are people who aren’t HIV-positive.

Drug-resistant TB
Another reason tuberculosis remains a major killer is the increase in drug-resistant strains of the bacterium. Ever since the first antibiotics were used to fight tuberculosis 60 years ago, the germ has developed the ability to survive attack, and that ability gets passed on to its descendants. Drug-resistant strains of tuberculosis emerge when an antibiotic fails to kill all of the bacteria it targets. The surviving bacteria become resistant to that particular drug and frequently other antibiotics as well.

Risk factors
Anyone can get tuberculosis, but certain factors can increase your risk of the disease. These factors include:
Weakened immune system
A healthy immune system can often successfully fight TB bacteria, but your body can’t mount an effective defense if your resistance is low. A number of diseases and medications can weaken your immune system, including:
•  HIV/AIDS
•  Diabetes
•  End-stage kidney disease
•  Cancer treatment, such as chemotherapy
•  Drugs to prevent rejection of transplanted organs
•  Some drugs used to treat rheumatoid arthritis, Crohn’s disease and psoriasis
•  Malnutrition
•  Advanced age
.
International connections
TB risk is higher for people who live in or travel to countries that have high rates of tuberculosis, such as:
•  Sub-Saharan Africa
•  India
•  China
•  Mexico
•  The islands of Southeast Asia and Micronesia
•  Parts of the former Soviet Union

Poverty and substance abuse
_
Lack of medical care:
If you are on a low or fixed income, live in a remote area, have recently immigrated to the United States or are homeless, you may lack access to the medical care needed to diagnose and treat TB.
_ Substance abuse: Long-term drug or alcohol use weakens your immune system and makes you more vulnerable to tuberculosis.

Where you work or live
_
Health care work:
Regular contact with people who are ill increases your chances of exposure to TB bacteria. Wearing a mask and frequent hand-washing greatly reduce your risk.
_ Living or working in a residential care facility. People who live or work in prisons, immigration centers or nursing homes are all at risk of tuberculosis. That’s because the risk of the disease is higher anywhere there is overcrowding and poor ventilation.
_ Living in a refugee camp or shelter: Weakened by poor nutrition and ill health and living in crowded, unsanitary conditions, refugees are at especially high risk of tuberculosis infection.

Complications
Without treatment, tuberculosis can be fatal. Untreated active disease typically affects your lungs, but it can spread to other parts of the body through your bloodstream. Examples include:
•  Bones. Spinal pain and joint destruction may result from TB that infects your bones. In many cases, the ribs are affected.
•  Brain. Tuberculosis in your brain can cause meningitis, a sometimes fatal swelling of the membranes that cover your brain and spinal cord.
•  Liver or kidneys. Your liver and kidneys help filter waste and impurities from your bloodstream. These functions become impaired if the liver or kidneys are affected by tuberculosis.
•  Heart. Tuberculosis can infect the tissues that surround your heart, causing inflammation and fluid collections that may interfere with your heart’s ability to pump effectively. This condition, called cardiac tamponade, can be fatal.

Tests and diagnosis
During the physical exam, your doctor will check your lymph nodes for swelling and use a stethoscope to listen carefully to the sounds your lungs make when you breathe.
The most commonly used diagnostic tool for tuberculosis is a simple skin test. A small amount of a substance called PPD tuberculin is injected just below the skin of your inside forearm. You should feel only a slight needle prick. Within 48 to 72 hours, a health care professional will check your arm for swelling at the injection site. A hard, raised red bump means you’re likely to have TB infection. The size of the bump determines whether the test results are significant.

 Results can be wrong
The TB skin test isn’t perfect. Sometimes, it suggests that people have TB when they really don’t. It can also indicate that people don’t have TB when they really do. A false-positive test may happen if you’ve been vaccinated with the bacillus Calmette-Guerin (BCG) vaccine. This tuberculosis vaccine is seldom used in the United States but is widely used in countries with high TB infection rates. False-negative results may occur in certain populations — including children, older people and people with AIDS — who sometimes don’t respond to the TB skin test. A false-negative result can also occur in people who’ve recently been infected with TB but their immune system hasn’t had time to react to the bacteria yet.

Blood tests
Blood tests may be used to confirm or rule out latent or active tuberculosis. These tests use sophisticated technology to measure your immune system’s reaction to TB bacteria. These tests may be useful if you’re at high risk of TB infection but have a negative response to the skin test, or if you received the BCG vaccine.

Chest X-ray
If you’ve had a positive skin test, your doctor is likely to order a chest X-ray. This may show white spots in your lungs where your immune system has walled off TB bacteria, or it may reveal changes in your lungs caused by active tuberculosis.

Sputum tests
If your chest X-ray shows signs of tuberculosis, your doctor may take a sample of your sputum — the mucus that comes up when you cough. The samples are tested for TB bacteria. These bacteria can also be tested to see if they are resistant to the effects of medications commonly used to treat tuberculosis. This helps your doctor choose the medications that are most likely to work.

Treatments and drugs
Medications are the cornerstone of tuberculosis treatment. But treating TB takes much longer than treating other types of bacterial infections. With tuberculosis, you must take antibiotics for at least six to nine months. The exact drugs and length of treatment depend on your age, overall health, possible drug resistance, the form of TB (latent or active) and its location in the body.

Most common TB drugs
If you have latent tuberculosis, you may need to take just one type of TB drug. Active tuberculosis, particularly if it’s a drug-resistant strain, will require several drugs at once. The most common medications used to treat tuberculosis include:
•  Isoniazid
•  Rifampin (Rifadin, Rimactane)
•  Ethambutol (Myambutol)
•  Pyrazinamide

Medication side effects
Side effects of TB drugs aren’t common but can be serious when they do occur. All tuberculosis medications can be highly toxic to your liver. When taking these medications, call your doctor immediately if you experience any of the following:
•  Nausea or vomiting
•  Loss of appetite
•  A yellow color to your skin (jaundice)
•  Dark urine
•  A fever that lasts three or more days and has no obvious cause

Completing treatment is essential
After a few weeks, you won’t be contagious and you may start to feel better. It might be tempting to stop taking your TB drugs. But it is crucial that you finish the full course of therapy and take the medications exactly as prescribed by your doctor. Stopping treatment too soon or skipping doses can allow the bacteria that are still alive to become resistant to those drugs, leading to TB that is much more dangerous and difficult to treat.
To help people stick with their treatment, a program called directly observed therapy (DOT) is sometimes recommended. In this approach, a health care worker administers your medication so that you don’t have to remember to take it on your own.
.

B.  TB Medical Advisory Board Statement on the Treatment of Active Tuberculosis in Adults
http://www.in.gov/isdh/19686.htm
1. Recommended Treatment Regimens
Unless there are contraindications, patients with active tuberculosis should be treated initially with four drugs: isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB). Four drugs are recommended because (1) EMB helps to prevent the emergence of RIF-resistant organisms when primary resistance to INH may be present; (2) INH resistance continues to occur in our state, (3) foreign-borne persons from countries with high rates of drug resistance make up a growing number of TB cases in Indiana, and (4) six-month treatment regimens are not possible without the use of PZA.

 2. Drug Administration
The preferred regimen in our state is the ‘Denver Regimen.’ In this regimen, the patient is treated with daily medication for the first two weeks, followed by twice-weekly dosing until a total of 26 weeks of therapy are completed. This regimen must be given using directly observed therapy (DOT), meaning that a public health worker delivers medication to the patient and observes the patient ingest the medication. Completion of treatment is defined by the total number of doses ingested as well as the duration of treatment. Note: twice-weekly therapy is contraindicated for HIV-infected patients with CD4+ lymphocyte counts < 100 cells/µl. An overview of the ‘Denver Regimen’ is provided in Table 2 as “Option 1.” Doses for anti-tuberculosis medications are as follows:

Table 1

Table 2

Daily dosing for 5 rather than 7 days per week is an option for the daily portion of treatment options 1 and 2, but should only be used if dosing 7 days per week is not feasible. DOT must be used with this option.

INH, rifampin and pyrazinamide should be continued for the entire first two months. Ethambutol may be discontinued after the drug susceptibility test shows that the patient’s organism is susceptible to both INH and RIF.

3. Major Adverse Effects
All patients should be counseled to watch for symptoms of hepatotoxicity.  If hepatotoxicity develops (ALT or AST greater than five times the upper limit of normal, elevated bilirubin, or symptoms of hepatotoxicity), all drugs should be discontinued, and ISDH should be consulted immediately. The ISDH TB Medical Advisory Board has published guidelines on the management of hepatotoxicity. Other significant adverse reactions are listed in the table below:

Table 3

Drug Major Adverse Effects
Isoniazid Hepatitis, peripheral neuropathy
Rifampin Drug nteractions, hepatitis
Pyrazinamide Hepatitis, GI upset, hyperuricemia
Ethambutol Optic neuritis

.
4. Drug Dosages and Toxicity

The ISDH TB Medical Advisory Board does not recommend prescribing anything other than standard therapeutic doses (Table 1). Prior to treatment, measure CBC with platelets, liver enzymes, uric acid, visual acuity, and perform color vision screening. Then, assess monthly for side effects and order laboratory tests as indicated.

[What is hepatotoxicity? Hepatotoxicity is a general term for liver damage.
The signs and symptoms of hepatotoxicity vary depending on how badly the liver is damaged. Symptoms of liver damage include: nausea, vomiting, abdominal, pain, loss of appetite, diarrhea, feeling tired or weak, jaundice (yellowing of the skin and eyes), hepatomegaly (liver enlargement)
Pasted from< http://www.thebody.com/content/art12772.html>]

5. Use of Drugs Other Than INH, RIF, PZA, or EMB
There are no substitutes for any of the first-line agents. Before rifampin was available, TB patients had to take medication for 18-24 months. The combination of INH and rifampin allowed completion of therapy within 9 months. Routine addition of PZA during the first two months has shortened duration of therapy to 6 months for most cases. Ethambutol is known as a ‘companion drug,’ and has bacteriostatic activity. Its primary purpose is to suppress the further development of resistance in situations where INH resistance is already present at diagnosis. Ethambutol can be discontinued as soon as the organism is known to be susceptible to both INH and RIF.

The drugs are not interchangeable. Second-line agents must be used when patients cannot take first-line drugs because of resistance or intolerance. These second-line agents are substantially less active, and not without risks of toxicity. Patients taking second-line drugs in lieu of both INH and RIF require treatment durations of up to 2 years with frequent monitoring for side effects.

Prevention
http://www.mayoclinic.com/health/tuberculosis/DS00372/DSECTION=coping-and-support
If you test positive for latent TB infection, your doctor may advise you to take medications to reduce your risk of developing active tuberculosis. The only type of tuberculosis that is contagious is the active variety, when it affects the lungs. So if you can prevent your latent tuberculosis from becoming active, you won’t transmit tuberculosis to anyone else.

Protect your family and friends
If you have active TB, keep your germs to yourself. It generally takes a few weeks of treatment with TB medications before you’re not contagious anymore. Follow these tips to help keep your friends and family from getting sick:
Stay home. Don’t go to work or school or sleep in a room with other people during the first few weeks of treatment for active tuberculosis.
Ventilate the room. Tuberculosis germs spread more easily in small closed spaces where air doesn’t move. If it’s not too cold outdoors, open the windows and use a fan to blow indoor air outside.
Cover your mouth. Use a tissue to cover your mouth anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away.
Wear a mask. Wearing a surgical mask when you’re around other people during the first three weeks of treatment may help lessen the risk of transmission.
Finish your entire course of medication. This is the most important step you can take to protect yourself and others from tuberculosis. When you stop treatment early or skip doses, TB bacteria have a chance to develop mutations that allow them to survive the most potent TB drugs. The resulting drug-resistant strains are much more deadly and difficult to treat.
Vaccinations. In countries where tuberculosis is more common, infants are vaccinated with bacillus Calmette-Guerin (BCG) vaccine because it can prevent severe tuberculosis in children. The BCG vaccine isn’t recommended for general use in the United States because it isn’t very effective in adults and it causes a false-positive result on a TB skin test. Researchers are working on developing a more effective TB vaccine.

Coping and support
Undergoing treatment for tuberculosis is a complicated and lengthy process. But the only way to cure the disease is to stick with your treatment. You may find it helpful to have your medication given by a nurse or other health care professional so that you don’t have to remember to take it on your own. In addition, try to maintain your normal activities and hobbies, and stay connected with family and friends.
Keep in mind that your physical health can affect your mental health. Denial, anger and frustration are normal when you must deal with something difficult and unexpected. At times, you may need more tools to deal with these or other emotions. Professionals, such as therapists or behavioral psychologists, can help you develop positive coping strategies.

[End of article]

Leave a comment

Filed under Survival Manual, __6. Medical, ___b) Disease

Syphilis

(Survival Manual/6. Medical/b) Disease /Syphilis)
 Source information pasted from <http://emedicine.medscape.com/article/786191-overview>
<http://menshealth.about.com/od/sexualdiseasesstds/a/syphilis_treat.htm>
<http://www.stdservices.on.net/std/syphilis/management.htm>
<http://www.drugs.com/dosage/tetracycline.html>

History of Syphilis
<http://en.wikipedia.org/wiki/History_of_syphilis>
The first well-recorded European outbreak of what is now known as syphilis occurred in 1495 among French troops besieging Naples, Italy. It may have been transmitted to the French via Spanish mercenaries serving King Charles of France in that siege. From this centre, the disease swept across Europe. As Jared Diamond describes it, ” When syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people’s faces, and led to death within a few months.” The disease then was much more lethal then, than it is today. Diamond concludes,” By 1546, the disease had evolved into the disease with the symptoms so well known to us today.” The epidemiology of this first syphilis epidemic shows that the disease was either new or a mutated form of an earlier disease.
Researchers concluded that syphilis was carried from the New World to Europe after Columbus’ voyages.
Many of the crew members who served on this voyage later joined the army of King Charles VIII in his invasion of Italy in 1495, resulting in the spreading of the disease across Europe and as many as five million deaths.

Syphilis is caused by a bacteria called Treponema pallidum. The bacteria like the warm moist linings of the genital passages, the rectum and mouth, but dies quickly outside the body. Syphilis has an incubation period of between 9 days and 3 months. Syphilis is almost always a result of unprotected sex with an infected person.

 Definition
Syphilis is a bacterial infection usually spread by sexual contact. The disease starts as a painless sore — typically on your genitals, rectum or mouth. Syphilis spreads from person to person via skin or mucous membrane contact with these sores.
After the initial infection, the syphilis bacteria can lie dormant in your body for decades before becoming active again. Early syphilis can be cured, sometimes with a single injection of penicillin. Without treatment, syphilis can severely damage your heart, brain or other organs, and can be life-threatening.
Syphilis rates in the United States have been rising since 2000, particularly among men who have sex with men. The genital sores associated with syphilis can make it easier to become infected with HIV, the virus that causes AIDS.

Symptoms
Syphilis develops in stages, and symptoms vary with each stage. But the stages may overlap, and symptoms don’t always occur in the same order. You may be infected with syphilis and not notice any symptoms for years.
Primary syphilis
 
[Photo at left, Primary Syphilis]
The first sign of syphilis is a small sore, called a chancre (SHANG-kur). The sore appears at the spot where the bacteria entered your body. While most people infected with syphilis develop only one chancre, some people develop several of them. The chancre usually develops about three weeks after exposure. Many people who have syphilis don’t notice the chancre because it’s usually painless and it may be hidden within the vagina or rectum. The chancre will heal on its own within six weeks.

.
Secondary syphilis
[Photo at right, Secondary Syphilis]
Within a few weeks of the original chancre healing, you may experience a rash that begins on your trunk but eventually covers your entire body — even the palms of your hands and the soles of your feet. This rash is usually not itchy and may be accompanied by wart-like sores in the mouth or genital area. Some people also experience muscle aches, fever, sore throat and swollen lymph nodes. These signs and symptoms may disappear within a few weeks or repeatedly come and go for as long as a year.

Latent syphilis
If you aren’t treated for syphilis, the disease moves from the secondary to the latent (hidden) stage, when you have no symptoms. The latent stage can last for years. Signs and symptoms may never return, or the disease may progress to the tertiary (third) stage.
Tertiary or late syphilis
About 15 to 30 percent of people infected with syphilis who don’t get treatment will develop complications known as tertiary, or late, syphilis. In the late stages, the disease may damage your brain, nerves, eyes, heart, blood vessels, liver, bones and joints. These problems may occur many years after the original, untreated infection.
Congenital syphilis
Babies born to women who have syphilis can become infected through the placenta or during birth. Most newborns with congenital syphilis have no symptoms, although some experience a rash on the palms of their hands and the soles of their feet. Later symptoms may include deafness, teeth deformities and saddle nose — where the bridge of the nose collapses. 

When to see a doctor
Call your doctor if you or your child experiences any unusual discharge, sore or rash — particularly if it occurs in the groin area.

Causes
The cause of syphilis is a bacterium called Treponema pallidum. The most common route of transmission is through contact with an infected person’s sore during sexual activity. The bacteria enter your body through minor cuts or abrasions in your skin or mucous membranes. Syphilis is contagious during its primary and secondary stages, and sometimes in the early latent period.
Less commonly, syphilis may spread through direct unprotected close contact with an active lesion (such as during kissing) or through an infected mother to her baby during pregnancy or childbirth (congenital syphilis).
Syphilis can’t be spread by using the same toilet, bathtub, clothing or eating utensils, or from doorknobs, swimming pools or hot tubs.
Even if you’ve been cured of syphilis, you can become re-infected if you have contact with someone’s syphilis sore.

Risk factors
You face an increased risk of acquiring syphilis if you:
•  Engage in unprotected sex
•  Have sex with multiple partners
•  Are a man who has sex with men
•  Are infected with HIV, the virus that causes AIDS

Complications
Without treatment, syphilis can lead to damage throughout your body. Syphilis also increases the risk of HIV infection and, for women, can cause problems during pregnancy. Treatment can help prevent future damage but can’t repair or reverse damage that’s already occurred.
•  Small bumps or tumors
Called gummas, these bumps can develop on your skin, bones, liver or any other organ in the late stage of syphilis. Gummas usually disappear after treatment with antibiotics.
•  Neurological problems
Syphilis can cause a number of problems with your nervous system, including: Stroke, Meningitis, Deafness, Visual problems,,Dementia
•  Cardiovascular problems
These may include bulging (aneurysm) and inflammation of the aorta — your body’s major artery — and of other blood vessels. Syphilis may also damage heart valves.
•  HIV infection
Adults with sexually transmitted syphilis or other genital ulcers have an estimated two- to fivefold increased risk of contracting HIV. A syphilis sore can bleed easily, providing an easy way for HIV to enter your bloodstream during sexual activity.
•  Pregnancy and childbirth complications
If you’re pregnant, you may pass syphilis to your unborn baby. Congenital syphilis greatly increases the risk of miscarriage, stillbirth or your newborn’s death within a few days after birth.

Tests and diagnosis
Syphilis can be diagnosed by testing samples of:
•  Blood. Blood tests can confirm the presence of antibodies that the body produces to fight infection. The antibodies to the bacteria that cause syphilis remain in your body for years, so the test can be used to determine a current or past infection.
•  Fluid from sores. Your doctor may scrape a small sample of cells from a sore to be analyzed by microscope in a lab. This test can be done only during primary or secondary syphilis, when sores are present. The scraping can reveal the presence of bacteria that cause syphilis.
•  Cerebral spinal fluid. If it’s suspected that you have nervous system complications of syphilis, your doctor may also suggest collecting a sample of cerebrospinal fluid through a procedure called a lumbar puncture (spinal tap).

Treatments and drugs
When diagnosed and treated in its early stages, syphilis is easy to cure. The preferred treatment at all stages is penicillin, an antibiotic medication that can kill the organism that causes syphilis. If you’re allergic to penicillin, your doctor will suggest another antibiotic.
A single injection of penicillin can stop the disease from progressing if you’ve been infected for less than a year. If you’ve had syphilis for longer than a year, you may need additional doses.
Penicillin is the only recommended treatment for pregnant women with syphilis. Women who are allergic to penicillin can undergo a desensitization process that may allow them to take penicillin. Even if you’re treated for syphilis during your pregnancy, your newborn child should also receive antibiotic treatment.
* The first day you receive treatment you may experience what’s known as the Jarisch-Herxheimer reaction. Signs and symptoms include fever, chills, nausea, achy pain and headache. This reaction usually doesn’t last more than one day.

Treatment follow-up
•  After you’re treated for syphilis, your doctor will ask you to:
•  Have periodic blood tests and exams to make sure you’re responding to the usual dosage of penicillin.
•  Avoid sexual contact until the treatment is completed and blood tests indicate the infection has been cured.
•  Notify your sex partners so that they can be tested and get treatment if necessary.
•  Be tested for HIV infection.

 * The main of therapy for syphilis is antibiotic treatment, usually penicillin. Doxycycline may be used if you have a penicillin allergy.

Penicillin is given either intramuscularly or intravenously depending on the stage of syphilis. Follow up blood tests (RPR) are usually taken to track the efficacy of the treatment.

If the appropriate antibiotic treatment is given for syphilis in its primary and secondary stages it completely cures this disease. In the latent and tertiary or final stage of syphilis treatment can still eradicate and stop further damage occurring. The damage that has already happen has to be treated but is often difficult or impossible to repair.

Tetracycline dosages for syphilis:
http://www.drugs.com/dosage/tetracycline.html#Usual_Adult_Dose_for_Syphilis___Early
Usual Adult Dose for Syphilis – Early (less than 2 years duration)
Tetracycline should be used only if penicillins are contraindicated.
Doxycycline 200 mg orally daily for 20 days or tetracycline HCl 500 mg orally 6 hourly for 20 days

Usual Adult Dose for Syphilis – Latent
500 mg orally every 6 hours for 28 days; alternatively, 30 to 40 g in divided doses over a period of 10 to 15 days has been recommended.
Tetracycline should be used only if penicillins are contraindicated.

Usual Adult Dose for Tertiary Syphilis
doxycycline 200 mg orally daily for 30 days or tetracycline HCl 500 mg orally 6 hourly for 30 days

Prevention
To help prevent the spread of syphilis, follow these suggestions:
•  Abstain or be monogamous. The only certain way to avoid syphilis is to forgo having sex. The next-best option is to have mutually monogamous sex with one partner who is uninfected.
•  Use a latex condom. Condoms can reduce your risk of contracting syphilis, but only if the condom covers the syphilis sores.
•  Avoid recreational drugs. Excessive use of alcohol or other drugs can cloud your judgment and lead to unsafe sexual practices.

[End of post]

Leave a comment

Filed under Survival Manual, __6. Medical, ___b) Disease

Viral Hemorrhagic Fevers

(Survival Manual/6. Medical/b) Disease/Viral hemorrhagic fevers)

  http://www.mayoclinic.com/health/viral-hemorrhagic-fevers/DS00539

Definition
Viral hemorrhagic (hem-uh-RAJ-ik) fevers are infectious diseases that interfere with the blood’s natural ability to clot. These diseases can also damage the walls of tiny blood vessels, making them leaky. The internal bleeding that results can range from relatively minor to life-threatening.

Some viral hemorrhagic fevers include:
•  Dengue – (see Survival Manual/6. Medical/b) Disease/ Dengue)
•  Ebola – (see Survival Manual/6. Medical/b) Disease/ Ebola)
•  Lassa – (see Survival Manual/6. Medical/b) Diseas/Lassa fever)
•  Marburg
•  Yellow fever – (see Survival Manual/6. Medical/b) Disease/Yellow Fever)

These diseases most commonly occur in tropical areas of the world. When viral hemorrhagic fevers occur in the United States, they’re usually found in people who’ve recently traveled internationally.
Viral hemorrhagic fevers are spread by contact with infected animals, people or insects. No current treatment can cure viral hemorrhagic fevers, and immunizations exist for only a few types. Until additional vaccines are developed, the best approach is prevention.

Symptoms
Signs and symptoms of viral hemorrhagic fevers vary by disease. In general, initial symptoms may include:
•  High fever
•  Fatigue
•  Dizziness
•  Muscle aches
•  Weakness
[Photograph at right: The face of this patient appeared flushed due to dilation of the capillaries. Severe     vomiting could also cause rupture of the blood vessels in the eyes.]

Symptoms can become life-threatening
Severe cases of some types of viral hemorrhagic fevers may cause bleeding:
Under the skin
•  In internal organs
•  From the mouth, eyes or ears
Other signs and symptoms of severe infections can include:
•  Shock
•  Nervous system malfunctions
•  Coma
•  Delirium
•  Seizures
•  Kidney failure

 When to see a doctor
The best time to see a doctor is before you travel to a developing country to ensure you’ve received any available vaccinations and pre-travel advice for staying healthy. If you develop signs and symptoms once you return home, consider consulting a doctor who focuses on international medicine or infectious diseases. A specialist may be able to recognize and treat your illness faster. Be sure to let your doctor know what areas you’ve visited.

Causes
The viruses that cause viral hemorrhagic fevers live naturally in a variety of animal and insect hosts — most commonly mosquitoes, ticks, rodents or bats.
Each of these hosts typically lives in a specific geographic area, so each particular disease usually occurs only where that virus’s host normally lives. Some viral hemorrhagic fevers also can be transmitted from person to person.

 How is it transmitted?
The route of transmission varies by specific virus. Some viral hemorrhagic fevers are spread by mosquito or tick bites. Others are transmitted by contact with infected blood or semen. A few varieties are breathed in if you’re around infected rat feces or urine.
If you travel to an area where a particular hemorrhagic fever is common, you may become infected there and then develop symptoms after you return home.

Risk factors
Simply living in or traveling to an area where a particular viral hemorrhagic fever is common will increase your risk of becoming infected with that particular virus. Several other factors can increase your risk even more, including:
Working with the sick
•  Slaughtering infected animals
• Sharing needles to use intravenous drugs
•  Having unprotected sex
•  Working outdoors or in rat-infested buildings

Complications
Viral hemorrhagic fevers can damage your: Brain, Eyes, Heart, Kidneys, Liver, Lungs and/ or Spleen; in some cases, the damage is severe enough to cause death.

Tests and diagnosis
Diagnosing specific viral hemorrhagic fevers in the first few days of illness can be difficult because the initial signs and symptoms — high fever, muscle aches, headaches and extreme fatigue — are common to many other diseases.
To reach an accurate diagnosis, your doctor is likely to ask about your medical and travel history and any exposure to rodents or mosquitoes. Be sure to describe international trips in detail, including the countries you visited and the dates, as well as any contact you may have had with possible sources of infection.
Laboratory tests, usually using a sample of your blood, are needed to confirm a diagnosis. Because viral hemorrhagic fevers are particularly virulent and contagious, these tests are usually performed in specially designated laboratories using strict precautions.

Treatments and drugs
While no specific treatment exists for most viral hemorrhagic fevers, the antiviral drug ribavirin (Virazole, Rebetol) may help shorten the course of infection and prevent complications in some cases.

 Therapy
Supportive care is essential. To prevent dehydration, you may need fluids to help maintain your balance of electrolytes — minerals that are critical to nerve and muscle function.

Surgical and other procedures
Some people may benefit from kidney dialysis, an artificial way of cleaning wastes from your blood when your kidneys fail.
Patients receive supportive therapy, but generally speaking, there is no other treatment or established cure for VHFs. Ribavirin, an anti-viral drug, has been effective in treating some individuals with Lassa fever or HFRS.

Prevention
 Preventing viral hemorrhagic fevers, especially in developing nations, presents enormous challenges. Many of the social, economic and ecological factors that contribute to the sudden appearance and spread of infectious diseases — war, displacement, destruction of habitat, lack of sanitation and proper medical care — are problems that have no easy or quick solutions.
If you live in or travel to areas where viral hemorrhagic fevers are common, you should take precautions to protect yourself from infection.

 Get vaccinated
The yellow fever vaccine is generally considered safe and effective, although in rare cases, serious side effects can occur. Check with the Centers for Disease Control and Prevention about the status of the countries you’re visiting — some require certificates of vaccination for entry. The yellow fever vaccine isn’t recommended for children under 9 months of age or for pregnant women, especially during the first trimester. Vaccines for several less common types of viral hemorrhagic fevers are currently in development.

 Avoid mosquitoes and ticks
Wear light-colored long pants and long-sleeved shirts or, better yet, permethrin-coated clothing. Don’t apply permethrin directly to the skin. Avoid unnecessary activities at dusk and dawn when mosquitoes are most active and apply mosquito repellent with a 20 to 25 percent concentration of DEET to your skin and clothing. If you’re staying in tented camps or local hotels, use bed nets and mosquito coils.

 Guard against rodents
To prevent rodent infestations in your home:
•  Keep pet food covered and stored in rodent-proof containers.
•  Store trash in rodent-proof containers, and clean the containers often.
•  Dispose of garbage on a regular basis.
•  Make sure doors and windows have tightfitting screens.
•  Place woodpiles and stacks of bricks and other materials at least 100 feet from your house.
•  Mow your grass closely and keep brush trimmed to within 100 feet from your house.

Leave a comment

Filed under __6. Medical, ___b) Disease

Ebola Hemorrhagic Fever

(Survival manual/6. Medical/b) Disease/Ebola Hemorragic Fever)

<http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/ebola/qa.htm>
<http://www.webmd.com/a-to-z-guides/ebola-hemorrhagic>
<http://www.emedicinehealth.com/script/main/art.asp?articlekey=6518>
<http://www.dhpe.org/infect/ebola.html>

Introduction to Ebola hemorrhagic fever
•  Ebola [ee-BO-luh] hemorrhagic fever is a deadly disease that has occurred in outbreaks in Central Africa.
•  Ebola hemorrhagic fever is caused by several Ebola viruses. The source of these viruses in nature is not known.
•  People can get Ebola hemorrhagic fever by direct contact with virus-infected blood, body fluids, organs, or semen.
•  There is no known cure or treatment.
•  Recent outbreaks in humans have occurred in areas where medical supplies and care were inadequate. The outbreaks were controlled by using barrier nursing techniques.
•  Under normal circumstances, travelers are at low risk of getting the disease. To eliminate the risk, travelers should avoid areas where Ebola outbreaks are occurring.

 What is Ebola hemorrhagic fever?
Ebola hemorrhagic fever is one of the deadliest of a group of diseases called viral hemorrhagic fevers. They range in seriousness from relatively mild illnesses to severe and potentially fatal diseases. All forms of viral hemorrhagic fever begin with fever and muscle aches. Depending on the virus, the disease can get worse until the patient becomes very ill with breathing problems, severe bleeding (hemorrhage), kidney problems, and shock. You die, bleeding from every pore as your internal organs are liquefied and turned to mush. Ebola is the 2nd most lethal disease of the 20th Century. Untreated rabies is 100% fatal, treated Ebola is 80-90% fatal.  The virus has a very brief survival period outside its host. When anywhere around Ebola, masks and gloves are minimal requirements.

Viral hemorrhagic fevers are caused by viruses from four families: filoviruses, arenaviruses, flaviviruses, and bunyaviruses. The usual hosts for most of these viruses are rodents or arthropods (such as ticks and mosquitoes). In some cases, the natural host for the virus is not known.

What is the infectious agent that causes Ebola hemorrhagic fever?
Ebola hemorrhagic fever is caused by several Ebola viruses. Ebola viruses are members of the filovirus family; when magnified several thousand times by an electron microscope, these viruses look like threads (filaments). Ebola virus was discovered in 1976 and named for a river in Zaire, Africa, where it was first detected.

Where is Ebola hemorrhagic fever found?
Ebola viruses are found in Central Africa. The source of the viruses in nature remains unknown. Monkeys, like humans, appear to be susceptible to infection and might serve as a source of virus if infected.

How do people get Ebola hemorrhagic fever?
People get the disease by direct contact with virus-infected blood, body fluids, organs, or semen.

The disease is spread mainly by close person-to-person contact with severely ill patients. This happens most often to hospital-care workers and family members who care for an ill person infected with Ebola virus. Close personal contact with persons who are infected but show no signs of active disease is very unlikely to result in infection.

Transmission of the virus has also been linked to the re-use of hypodermic needles in the treatment of patients. Re-using needles is a common practice in developing countries, such as Zaire and Sudan, where the health-care system is underfinanced. Medical facilities in the United States do not re-use needles.

Ebola virus can be spread from person to person through sexual contact. Persons who have recuperated from an illness caused by Ebola virus can still have the virus in their genital secretions for a short time after recovery and can spread the virus through sexual activity.

What are the signs and symptoms of Ebola hemorrhagic fever?
People infected with Ebola virus have sudden fever, weakness, muscle pain, headache, and sore throat, followed by vomiting, diarrhea, rash, limited kidney and liver functions, and both internal and external bleeding. Death rates range from 50% to 90%.

How soon after exposure do symptoms appear?
Symptoms begin 2 to 21 days after infection.

How is Ebola hemorrhagic fever diagnosed?
Diagnosis requires specialized laboratory tests on blood specimens. Handling blood from a persons infected with Ebola virus is an extreme biohazard and can be done only in specially equipped laboratories. Diagnosis in patients who have died can be made by testing tissue samples.

Who is at risk for Ebola hemorrhagic fever?
•  Persons traveling to areas where Ebola hemorrhagic fever is occurring
•  Hospital staff and family members who care for patients with Ebola hemorrhagic fever
•  Central African residents of rural areas and small towns

What is the treatment for Ebola hemorrhagic fever?
There is no known cure or treatment. Severe cases need intensive supportive care.

How common is Ebola hemorrhagic fever?
Until recently, only three outbreaks of Ebola hemorrhagic fever in humans had been reported. The first two, in 1976 in Zaire and in western Sudan, were large outbreaks that resulted in more than 550 cases and 340 deaths. The third outbreak, in 1979 in Sudan, was smaller, with 34 cases and 22 deaths. In each of these outbreaks, most cases occurred in hospitals where medical supplies were inadequate and where needles and syringes were re-used. The outbreaks were quickly controlled by isolating sick patients in a place requiring the wearing of mask, gown, and gloves; sterilizing needles and syringes; and disposing of wastes and corpses in a sanitary way.

In 1995, an outbreak in Kikwit and surrounding areas in Bandundu Province, Zaire, caused 316 deaths. The outbreak was amplified in a hospital by staff who became infected through poor nursing techniques. At the request of health officials in Zaire, medical teams from CDC and the World Health Organization, and from Belgium, France, and South Africa, collaborated to investigate and control the outbreak.

Two isolated cases of Ebola hemorrhagic fever were identified in Cote d’Ivoire in 1994-1995. The most recent outbreaks were in rural Gabon in 1994 and in 1996. A patient from the 1996 Gabon outbreak traveled to Johannesburg, South Africa, and fatally infected a health-worker there as well.

How can Ebola hemorrhagic fever be prevented?
Under normal circumstances, travelers are at low risk of getting the disease. To eliminate the risk, travelers should avoid areas where Ebola outbreaks are occurring.

Ebola virus
      A notoriously deadly virus that causes fearsome symptoms, the most prominent being high fever and massive internal bleeding. Ebola virus kills as many as 90% of the people it infects. It is one of the viruses that is capable of causing hemorrhagic (bloody) fever.

Epidemics of Ebola virus have occurred mainly in African countries including Zaire (now the Democratic Republic of Congo), Gabon, Uganda, the Ivory Coast, and Sudan. Ebola virus is a hazard to laboratory workers and, for that matter, anyone who is exposed to it.

Infection with Ebola virus in humans is incidental — humans do not “carry” the virus. The way in which the virus first appears in a human at the start of an outbreak has not been determined. However, it has been hypothesized that the first patient (the index case) becomes infected through contact with an infected animal.

Ebola virus is transmitted by contact with blood, feces or body fluids from an infected person or by direct contact with the virus, as in a laboratory. People can be exposed to Ebola virus from direct contact with the blood or secretions of an infected person. This is why the virus has often been spread through the families and friends of infected persons: in the course of feeding, holding, or otherwise caring for them, family members and friends would come into close contact with such secretions. People can also be exposed to Ebola virus through contact with objects, such as needles, that have been contaminated with infected secretions.

The incubation period –the period between contact with the virus and the appearance of symptoms — ranges from 2 to 21 days.

The initial symptoms are usually high fever, headache, muscle aches, stomach pain, and diarrhea. There may also be sore throat, hiccups, and red and itchy eyes. The symptoms that tend to follow include vomiting and rash and bleeding problems with bloody nose (epistaxis), spitting up blood from the lungs (hemoptysis) and vomiting it up from the stomach (hematemesis), and bloody eyes (conjunctival hemorrhages). Then finally come chest pain, shock, and death.

A protein on the surface of the virus has been discovered that is responsible for the severe internal bleeding (the death-dealing feature of the disease). The protein attacks and destroys the endothelial cells lining blood vessels, causing the vessels to leak and bleed.

There is no specific treatment for the disease. Currently, patients receive supportive therapy. This consists of balancing the patient’s fluids and electrolytes, maintaining their oxygen level and blood pressure, and treating them for any complicating infections. Death can occur within 10 days of the onset of symptoms.

The prevention of the spread of Ebola fever involves practical viral hemorrhagic fever isolation precautions, or barrier nursing techniques. These techniques include the wearing of protective clothing, such as masks, gloves, gowns, and goggles; the use of infection-control measures, including complete equipment sterilization; and the isolation of Ebola fever patients from contact with unprotected persons. The aim of all of these techniques is to avoid any person’s contact with the blood or secretions of any patient. If a patient with Ebola fever dies, it is equally important that direct contact with the body of the deceased patient be prevented.

Bioterrorism — There has been concern about Ebola virus as a possible weapon for bioterrorism. However, the General Accounting Office, the investigative arm of the US Congress, in a 1999 report considered Ebola virus to be an “unlikely” biologic threat for terrorism, because the virus is very difficult to obtain and process, unsafe to handle, and relatively unstable.

Table: Cases of Ebola Hemorrhagic Fever in Africa, 1976 – 2008
<http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/ebola/ebolamap.htm>

Country Town Cases Deaths Species Year
Dem. Rep. of Congo Yambuku 318 280 Ezaire 1976
Sudan Nzara 151 151 Esudan 1976
Dem. Rep. of Congo Tandala 1 1 Ezaire 1977
Sudan Nzara 34 22 Esudan 1979
Gabon Mekouka 52 31 Ezaire 1994
Ivory Coast Tai Forest 1 0 EIvoryCoast 1994
Dem. Rep. of Congo Kikwit 315 250 Ezaire 1995
Gabon Mayibout 37 21 Ezaire 1996
Gabon Booue 60 45 Ezaire 1996
South Africa Johannesburg 2 1 Ezaire 1996
Uganda Gulu 425 224 Esudan 2000
Gabon Libreville 65 53 Ezaire 2001
Republic of Congo Not specified 57 43 Ezaire 2001
Republic of Congo Mbomo 143 128 Ezaire 2002
Republic of Congo Mbomo 35 29 Ezaire 2003
Sudan Yambio 17 7 Esudan 2004
Dem. Rep. of Congo Luebo 264 187 Ezaire 2007
Uganda Bundibugyo 149 37 Ebundi 2007
Dem. Rep. of Congo Luebo 32 15 Ezaire 2008

Leave a comment

Filed under Survival Manual, __6. Medical, ___b) Disease

Typhus

(Survival manual/6. Medical/ b) Disease/Typhus)
http://www.medicinenet.com/typhus/article.htm
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002339/

History
It has been estimated that epidemic typhus has caused more deaths than all the wars in history.

Epidemic typhus is found most frequently during times of war and deprivation. (also called camp fever, jail fever, hospital fever, ship fever, famine fever, Epidemic louse-borne typhus,and louse-borne typhus) is a form of typhus so named because the disease often causes epidemics following wars and natural disasters.

Typhus was the most common waterborne disease according to Thomas Sydenham, England’s first great physician of the 17th century. A disease caused by contamination from human feces.

Epidemic Typhus is carried by the body louse and is excreted in the feces. The human scratches the bite and rubs the feces into the wound and contracts the disease, which incubates 1-2 weeks. Epidemics occurred throughout Europe from the 17th-19th century. Known as “Gaol Fever” in prisons, it was very common. Widespread epidemics occurred during the Napoleonic Wars and during the Potato Famine 1846-1849.

Throughout the middle ages and into the early part of the 20th century, periodic epidemics of typhus infection killed millions of people. As an example, during the eight-year period from 1917 to 1925, over 25 million cases of epidemic typhus occurred in Russia, causing an estimated three million deaths.

Epidemic typhus is now a rare disease, but two recent developments illustrate that an understanding of it is still important to clinicians:
•  A new cycle of infection involving flying squirrels and their ectoparasites with secondary transmission to humans has been recognized in the United States.
•  More than 45,000 cases of epidemic typhus occurred in Burundi in association with civil war during the 1990s; body louse infestation preceded outbreaks of both epidemic typhus and trench fever.

The outbreaks of typhus in Africa illustrate that the words of Hans Zinsser are still applicable today: “Typhus is not dead. It will live on for centuries and it will continue to break into the open whenever human stupidity and brutality give it a chance as most likely they occasionally will”.

The four main types of typhus are:
•  epidemic typhus (global, in areas with cold weather, poverty, war  and/or disaster)
•  Brill-Zinsser disease (a reinfection of epidemic typhus)
•  endemic or murine typhus (southeast and south USA)
•  scrub typhus (not in North America)
These diseases are all somewhat similar, although they vary in terms of severity. The specific type of Rickettsia that causes the disease also varies, as does the specific insect that can pass the bacteria along.

Epidemic typhus is caused by Rickettsia prowazekii, which is carried by body lice. When the lice feed on a human, they may simultaneously defecate. When the person scratches the bite, the feces (which carries the bacteria) are scratched into the wound. Body lice are common in areas in which people live in overcrowded, dirty conditions, with few opportunities to wash themselves or their clothing. Because of this fact, this form of typhus occurs simultaneously in large numbers of individuals living within the same community; that is, in epidemics. This type of typhus occurs when cold weather, poverty, war, and other disasters result in close living conditions that encourage the maintenance of a population of lice living among humans. Epidemic typhus is now found in the mountainous regions of Africa, South America, and Asia. [Its not enough to plan for food, water storage, personal protection in the eventuality of a long term disaster. Its as vitally important to protect yourself from bacteria, viral and insect infectionss. Maintain heat, warmth, relatively low density living arrangements, personal hygiene, make sure you have clean-sanitary clothing, and maintain sanitary cooking and eating utensils, only drink water that has been sanitized. Mr. Larry]

Epidemic typhus symptoms:
•  fever,
•  headache,
•  weakness, and muscle aches,
•  a rash composed of both spots and bumps. The rash starts on the back, chest, and abdomen, then spreads to the arms and legs.

The worst types of complications involve swelling in the heart muscle or brain (encephalitis). Without treatment, this type of typhus can be fatal.
While children usually recover well from epidemic typhus, older adults may have as much as a 60% death rate without treatment.

Brill-Zinsser disease is a reactivation of an earlier infection with epidemic typhus. It affects people years after they have completely recovered from epidemic typhus. When something causes a weakening of their immune system (like aging, surgery, illness), the bacteria can gain hold again, causing illness. This illness tends to be extremely mild.
•  Brill-Zinsser disease is quite mild, resulting in about a week-long fever, and a light rash similar to that of the original illness.
•  Brill-Zinsser, on the other hand, carries no threat of death.

Murine typhus occurs in the southeastern and southern United States, often during the summer and fall. It is rarely deadly. Risk factors for murine typhus include:
•  Exposure to rat fleas or rat feces
•  Exposure to other animals (such as cats, opossums, raccoons, skunks, and rats)

Symptoms of murine typhus may include:
•  Abdominal pain
•  Backache
•  Dull red rash that begins on the middle of the body and spreads
•  Extremely high fever (105 – 106 degrees Fahrenheit), which may last up to 2 weeks
•  Hacking, dry cough
•  Headache
•  Joint pain
•  Nausea
•  Vomiting
•  The early rash is a light rose color and fades when you press on it. Later, the rash becomes dull and red and does not fade. People with severe typhus may also develop small areas of bleeding into the skin

Treatment
Treatment includes antibiotics such as:
•  Doxycycline
•  Tetracycline
•  Zithromax

Patients with epidemic typhus may need intravenous fluids and oxygen.

Prevention
•  Clean drinking water and personal sanitation are a must.
•  Avoid areas where you might encounter rat fleas or lice.
•  Good sanitation and public health measures reduce the rat population.

Measures to get rid of lice when an infection has been found include:
•  Bathing;
•  boiling clothes or avoiding infested clothing for at least 5 days (lice will die without feeding on blood);
•  using insecticides (10% DDT, 1% malathion, or 1% permethrin)

Leave a comment

Filed under Survival Manual, __6. Medical, ___b) Disease