Category Archives: ___b) Disease

Lassa fever

(Survival manual/6. Medical/b) Disease/Lassa fever)

What is Lassa fever?
Lassa is a Category A disease, according to the U.S., meaning it has the potential, like anthrax and botulism, to be used a biological weapon.
Lassa fever is an acute viral illness that occurs naturally in West Africa. The illness was discovered in 1969 when two missionary nurses died in Nigeria, West Africa. The cause of the illness was found to be Lassa virus, named after the town in Nigeria where the first cases originated. The virus, a member of the virus family Arenaviridae, is a single-stranded RNA virus and is zoonotic, or animal-borne.
In areas of Africa where the disease is endemic (that is, constantly present), Lassa fever is a significant cause of morbidity and mortality. While Lassa fever is mild or has no observable symptoms in about 80% of people infected with the virus, the remaining 20% have a severe multisystem disease. Lassa fever is also associated with occasional epidemics, during which the case-fatality rate can reach 50%.

Where is Lassa fever found?
Lassa fever is an endemic disease in portions of West Africa. It is recognized in Guinea, Liberia, Sierra Leone, as well as Nigeria. However, because the rodent species which carry the virus are found throughout West Africa, the actual geographic range of the disease may extend to other countries in the region.

How many people become infected?
The number of Lassa virus infections per year in West Africa is estimated at 100,000 to 300,000, with approximately 5,000 deaths. Unfortunately, such estimates are crude, because surveillance for cases of the disease is not uniformly performed. In some areas of Sierra Leone and Liberia, it is known that 10%-16% of people admitted to hospitals have Lassa fever, which indicates the serious impact of the disease on the population of this region. [Note: Lassa fever was discovered in 1969, now 40 years later, there have been outbreaks over much of the western side of the African continent]
At least two cases of Lassa fever have occurred in the United States, the first in Chicago, the second in New Jersey. Both individuals who had recently been traveling in endemic areas of Africa, one in Nigeria, the other in Liberia, and succumbed to the fever after returning to the United States. Several incidences of infection in the lab have occurred with Lassa virus, as in the case of well-known virologist Dr. Jordi Casals, who became infected with the virus after studying samples from the original Nigerian case.

In what animal host is Lassa virus maintained?
Mastomys rodent, also known as the “multimammate rat”.  Note the hairless tail.
The reservoir, or host, of Lassa virus is a rodent known as the “multimammate rat” of the genus Mastomys. It is not certain which species of Mastomys are associated with Lassa; however, at least two species carry the virus in Sierra Leone. Mastomys rodents breed very frequently, produce large numbers of offspring, and are numerous in the savannas and forests of West, Central, and East Africa. In addition, Mastomys generally readily colonize human homes. All these factors together contribute to the relatively efficient spread of Lassa virus from infected rodents to humans.

How do humans get Lassa fever?
There are a number of ways in which the virus may be transmitted, or spread, to humans. The Mastomys rodents shed the virus in urine and droppings. Therefore, the virus can be transmitted through direct contact with these materials, through touching objects or eating food contaminated with these materials, or through cuts or sores. Because Mastomys rodents often live in and around homes and scavenge on human food remains or poorly stored food, transmission of this sort is common. Contact with the virus also may occur when a person inhales tiny particles in the air contaminated with rodent excretions. This is called aerosol or airborne transmission. Finally, because Mastomys rodents are sometimes consumed as a food source, infection may occur via direct contact when they are caught and prepared for food.

Lassa fever may also spread through person-to-person contact. This type of transmission occurs when a person comes into contact with virus in the blood, tissue, secretions, or excretions of an individual infected with the Lassa virus. The virus cannot be spread through casual contact (including skin-to-skin contact without exchange of body fluids). Person-to-person transmission is common in both village and health care settings, where, along with the above-mentioned modes of transmission, the virus also may be spread in contaminated medical equipment, such as reused needles (this is called nosocomial transmission).

What are the symptoms of Lassa fever?
Signs and symptoms of Lassa fever typically occur 1-3 weeks after the patient comes into contact with the virus. These include fever, retrosternal pain (pain behind the chest wall), sore throat, back pain, cough, abdominal pain, vomiting, diarrhea, conjunctivitis, facial swelling, proteinuria (protein in the urine), and mucosal bleeding. Neurological problems have also been described, including hearing loss, tremors, and encephalitis. Because the symptoms of Lassa fever are so varied and nonspecific, clinical diagnosis is often difficult.

 How is the disease diagnosed in the laboratory?
Lassa fever is most often diagnosed by using enzyme-linked immunosorbent serologic assays (ELISA), which detect IgM and IgG antibodies as well as Lassa antigen. The virus itself may be cultured in 7 to 10 days. Immunohistochemistry performed on tissue specimens can be used to make a post-mortem diagnosis. The virus can also be detected by reverse transcription-polymerase chain reaction (RT-PCR); however, this method is primarily a research tool.

 Are there complications after recovery?
The most common complication of Lassa fever is deafness. Various degrees of deafness occur in approximately one-third of cases, and in many cases hearing loss is permanent. As far as is known, severity of the disease does not affect this complication: deafness may develop in mild as well as in severe cases.  Spontaneous abortion is another serious complication.

 What proportion of people die from the illness?
Approximately 15%-20% of patients hospitalized for Lassa fever die from the illness. However, overall only about 1% of infections with Lassa virus result in death. The death rates are particularly high for women in the third trimester of pregnancy, and for fetuses, about 95% of which die in the uterus of infected pregnant mothers.

 How is Lassa fever treated?
Ribavirin, an antiviral drug, has been used with success in Lassa fever patients. It has been shown to be most effective when given early in the course of the illness. Patients should also receive supportive care consisting of maintenance of appropriate fluid and electrolyte balance, oxygenation and blood pressure, as well as treatment of any other complicating infections. Ribavirin should be given intravenously for ten days.

What groups are at risk for getting the illness?
Individuals at risk are those who live or visit areas with a high population of Mastomys rodents infected with Lassa virus or are exposed to infected humans. Hospital staff are not at great risk for infection as long as protective measures are taken.

 How is Lassa fever prevented?
Wearing protective clothing — an important part of practicing barrier nursing methods.
Primary transmission of the Lassa virus from its host to humans can be prevented by avoiding contact with Mastomys rodents, especially in the geographic regions where outbreaks occur. Putting food away in rodent-proof containers and keeping the home clean help to discourage rodents from entering homes. Using these rodents as a food source is not recommended. Trapping in and around homes can help reduce rodent populations. However, the wide distribution of Mastomys in Africa makes complete control of this rodent reservoir impractical.

When caring for patients with Lassa fever, further transmission of the disease through person-to-person contact or nosocomial routes can be avoided by taking preventive precautions against contact with patient secretions (together called VHF isolation precautions or barrier nursing methods). Such precautions include wearing protective clothing, such as masks, gloves, gowns, and goggles; using infection control measures, such as complete equipment sterilization; and isolating infected patients from contact with unprotected persons until the disease has run its course.

What needs to be done to address the threat of Lassa fever?
Further educating people in high-risk areas about ways to decrease rodent populations in their homes will aid in the control and prevention of Lassa fever. Other challenges include developing more rapid diagnostic tests and increasing the availability of the only known drug treatment, ribavirin. Research is presently under way to develop a vaccine for Lassa fever.


Is There a Real Biological Warfare Threat?
Current unclassified information reveals that, despite the 1972 Geneva Biological Weapons Convention, at least seventeen countries are known or suspected of having offensive biological weapons programs.
Clearly, BW is a credible threat to our military, as it was during Desert Shield/Storm. Terrorist use of BW agents could kill many people to create an unparalleled medical, political, and social crisis. Despite the fact the biological weapons have never been used against the United States, we must prepare for a new age of terrorism. Civilian health-care workers must know how to recognize a BW attack in the event of terrorist use of BW agents on civilian populations.

Lassa fever may be spread as an aerosol or with dust-powder.

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Yellow Fever

 (Survival manual/6. Medical/b) Disease/Yellow Fever)

  A.  Background
From 1793-1822, yellow fever was one of the most dreaded diseases in US port cities. Yellow fever outbreaks in the United States shaped American history and influenced important national decisions. In the 1780s, yellow fever outbreaks in Philadelphia were responsible for killing one tenth of the city’s population. Benjamin Rush described the epidemic and, based on the science of the time, sought to contain the devastating illness. Yellow fever did not discriminate by gender, race, occupation, or socioeconomic status. Yellow fever may have played a part in shaping the decision to move the nation’s capital out of Philadelphia.1 The disease had such an impact on the local economies that, in 1803, Napoleon, with his troops decimated by yellow fever, had few reservations about selling the affected Louisiana and western territories to the US government.

Yellow fever is a hemorrhagic fever caused by a virus spread by a particular species of mosquito. It’s most common in areas of Africa and South America, affecting travelers to and residents of those areas.
In mild cases, yellow fever causes fever, headache, nausea and vomiting. But yellow fever can become more serious, causing bleeding (hemorrhaging), heart, liver and kidney problems. Up to 50 percent of people with the more severe form of yellow fever die of the disease.
There’s no specific treatment for yellow fever. But getting a yellow fever vaccine before traveling to an area in which the virus is known to exist can protect you from the disease.

During the first three to six days after you’ve contracted yellow fever — the incubation period — you won’t experience any signs or symptoms. After this, the virus enters an acute phase and then, in some cases, a toxic phase that can be life-threatening.

Acute phase
Once the yellow fever virus enters the acute phase, you may experience signs and symptoms including:

  • Fever
  • Headache
  • Muscle aches, particularly in your back and knees
  • Nausea, vomiting or both
  • Loss of appetite
  • Dizziness
  • Red eyes, face or tongue

These signs and symptoms usually improve and are gone within several days.

Toxic phase
Although signs and symptoms may disappear for a day or two following the acute phase, some people with acute yellow fever then enter a toxic phase. During the toxic phase, acute signs and symptoms return and more-severe and life-threatening ones also appear. These can include:

  • Yellowing of your skin and the whites of your eyes (jaundice)
  • Abdominal pain and vomiting, sometimes blood
  • Decreased urination
  • Bleeding from your nose, mouth and eyes
  • Heart dysfunction (arrhythmias)
  • Liver and kidney failure
  • Brain dysfunction, including delirium, seizures and coma

The toxic phase of yellow fever can be fatal.

 When to see a doctor
Make an appointment to see your doctor four to six weeks before traveling to an area in which yellow fever is known to occur. If you don’t have that much time to prepare, call your doctor anyway. Your doctor will help you determine whether you need vaccinations and can provide general guidance on protecting your health while abroad.
Seek emergency medical care if you’ve recently traveled to a region where yellow fever is known to occur and you develop severe signs or symptoms of the disease. If you develop mild symptoms, call your doctor.

Yellow fever is caused by a virus that is spread by the Aedes aegypti mosquito. These mosquitoes thrive in and near human habitations where they breed in even the cleanest water. Most cases of yellow fever occur in sub-Saharan Africa and tropical South America.
Humans and monkeys are most commonly infected with the yellow fever virus. Mosquitoes transmit the virus back and forth between monkeys, humans or both. When a mosquito bites a human or monkey infected with yellow fever, the virus enters the mosquito’s bloodstream and circulates before settling in the salivary glands. When the infected mosquito then bites another monkey or human, the virus then enters the host’s bloodstream, where it may cause illness.

Risk factors: Traveling to Africa or South America
Traveling to an area in which the yellow fever virus is known to be present puts you at risk of the disease. These areas include sub-Saharan Africa and tropical South America.
Even if there aren’t current reports of infected humans in these areas, it doesn’t mean you’re risk-free. It’s possible that local populations have been vaccinated and are protected from the disease, or that cases of yellow fever just haven’t been detected and officially reported.

If you’re planning on traveling to these areas, you can protect yourself by getting a yellow fever vaccine at least 10 to 14 days prior to traveling.
Anyone can be infected with the yellow fever virus, but older adults are at greater risk of getting seriously ill.

Yellow fever results in death for 20 to 50 percent of those who develop severe disease. This usually occurs within two weeks from the start of infection. Complications during the toxic phase of a yellow fever infection include kidney and liver failure, jaundice, delirium and coma.

People who survive the infection recover gradually over a period of several weeks to months, usually without significant organ damage. During this time a person may experience fatigue and jaundice. Other complications include secondary bacterial infections, such as pneumonia, or blood infections.

Tests and diagnosis
Diagnosing yellow fever based on signs and symptoms can be difficult because its early signs and symptoms can be easily confused with those of other diseases, such as malaria, typhoid, dengue fever and other viral hemorrhagic fevers. To diagnose your condition, your doctor will likely ask about your medical and travel history and order blood tests.

If you have yellow fever, your blood may reveal the virus itself. If not, blood tests known as enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) also can detect antigens and antibodies specific to the virus. Results for these tests may take several days.

Treatments and drugs
No antiviral medications have proved helpful in treating yellow fever. As a result, treatment consists primarily of supportive care in a hospital. This includes providing fluids and oxygen, maintaining adequate blood pressure, replacing blood loss, providing dialysis for kidney failure, and treating any other infections that develop. Some people receive transfusions of plasma to replace blood proteins that improve clotting.

If you have yellow fever, you may also be kept away from mosquitoes, to avoid transmitting the disease to others.

Yellow Fever Treatment in Mild Cases
People who experience mild yellow fever symptoms usually have symptoms for a couple of days. During this time, treatment to relieve symptoms can include:

•  Resting in bed
•  Drinking plenty of fluids
•  Taking common medication such as acetaminophen (not aspirin) to relieve fever and discomfort.

Common medications used at home for pain and fever in children with yellow fever include:
•  Acetaminophen
•  Ibuprofen
•  Naproxen

Aspirin and most of the other nonsteroidal anti-inflammatory drugs (NSAIDS) are not used in children except under a doctor’s care.

_Acetaminophen (Tylenol and others)
•  Acetaminophen decreases fever and pain, but does not help inflammation.
•  Dosing is 10-15 mg per kilogram (5-7 mg per pound) of body weight every 4-6 hours, up to the adult dose.
•  Do not exceed the maximum daily dose.
•  Acetaminophen products come in various strengths. Always follow the package instructions.
•  Avoid this drug in children with liver disease or an allergy to acetaminophen.
•  Common acetaminophen products include Tylenol, Panadol and many others.

•  Ibuprofen decreases pain, fever and inflammation.
•  It is a nonsteroidal anti-inflammatory medication (NSAID).
•  Dosing for children over 6 months of age is 7-10 mg per kilogram (4-5 mg per pound) of body weight every 6 hours, up to the adult dose.
•  Do not exceed the maximum daily dose.
•  Always follow the package instructions.
•  Avoid this drug in children with liver, kidney, stomach or bleeding problems.
•  Brand names include Advil, Motrin and Nuprin.

•  Naproxen decreases pain, fever and inflammation.
•  It is a nonsteroidal anti-inflammatory medication (NSAID).
•  Dosing for 13 and older is 200 mg twice a day with food.
•  Do not exceed 500 mg per day.
•  Always follow the package instructions.
•  Avoid this drug in children with liver, kidney, stomach or bleeding problems.
•  The brand name for naproxen is Aleve.

The case-fatality rate of yellow fever has been reported at 5%-70%.
•  In recent outbreaks, the fatality rate was approximately 20% among patients with jaundice.
•  Up to 50% of patients who progress to the toxic phase die.


B.  Prevention
1.  Vaccine
A safe and highly effective vaccine prevents yellow fever. Yellow fever is known to be present in sub-Saharan Africa and parts of South America. Talk to your doctor about whether you need the yellow fever vaccine at least 10 to 14 days before traveling to these areas or if you are a resident of one of them. Some of these countries require a valid certificate of immunization in order to enter the country.

A single dose of the vaccine provides protection for at least 10 years. Side effects of the yellow fever vaccine are usually mild, lasting five to 10 days, and may include headaches, low-grade fevers, muscle pain, fatigue and soreness at the site of injection. More-significant reactions — such as developing a syndrome similar to actual yellow fever, inflammation of the brain (encephalitis) or death — can occur, most often in infants and older adults. The vaccine is considered safest for those between the ages of 9 months and 60 years. Talk to your doctor about whether the vaccine is appropriate if your child is younger than 9 months or you’re older than 60 years.

2.  Mosquito protection
In addition to getting the vaccine, you can help protect yourself against yellow fever by protecting yourself against mosquitoes.

To reduce your exposure to mosquitoes:

  • Avoid unnecessary outdoor activity when mosquitoes are most prevalent, such as at dawn, dusk and early evening.
  • Wear long-sleeved shirts and long pants when you go into mosquito-infested areas.
  • Stay in air-conditioned or well-screened housing.

To ward off mosquitoes with repellent, use both of the following:

  • Nonskin repellent. Apply permethrin-containing mosquito repellent to your clothing, shoes, and camping gear and bed netting. Some products pre-treated with permethrin are available to buy. Permethrin is not intended for use on your skin.
  • Skin repellent. Products with the active ingredients DEET or picaridin provide the longest lasting skin protection. Choose the concentration based on the hours of protection you need. In general, higher concentrations last longer. Keep in mind that chemical repellents can be toxic, and use only the amount needed for the time you’ll be outdoors. Don’t use DEET on the hands of young children or on infants under 2 months of age. Instead, cover your infant’s stroller or playpen with mosquito netting when outside.

According to the Centers for Disease Control and Prevention, oil of lemon eucalyptus, a more natural product, offers the same protection as DEET when used in similar concentrations. However, these products should not be used on children younger than age 3.

_United States
Reports of yellow fever in the United States are exceedingly rare, with the last outbreak reported in New Orleans in 1905. It is a rare cause of illness in returning travelers. In 1999, the Centers for Disease Control and Prevention (CDC) reported a case of fatal yellow fever in a previously healthy California man who had returned from a 10-day trip to Venezuela. A second case of fatal yellow fever was reported in 1996 in a US resident returning from South America. Prior to these reports, the last case was reported in 1924. Neither patient had received a yellow fever vaccine prior to travel.
•  World Health Organization (WHO) data suggest that the rate of yellow fever transmission is increasing, especially in sub-Saharan Africa. In addition, the number of US residents traveling to South America and Africa is also increasing. The WHO estimates that travelers from the United States to endemic areas has doubled since 1988.  Without proper precautions, including vaccination, these travelers are at risk of contracting yellow fever.
•  A aegypti mosquitoes are present in the southeastern United States, making the outbreak of yellow fever in that region a potential risk.

•  After adjustment for underreporting, an estimated 200,000 cases of yellow fever occur annually, with 30,000 deaths per year.
•  Thirty-three countries in Africa are at risk. Transmission in Africa is facilitated by the close proximity of vector mosquito populations to unvaccinated human populations.The case-fatality rate of yellow fever in Africa approximates 20%. Infants and children are at highest risk.
•  Yellow fever is endemic in 9 South American countries and several Caribbean islands. Bolivia, Brazil, Ecuador, and Peru are considered at highest risk.The incidence of yellow fever in South America is lower than in Africa because the infected monkeys in the rain forest canopy do not often come in contact with human populations. Indigenous human populations have immunity as a part of mass immunization campaigns.  Yellow fever occurs most frequently in young men through occupational exposure in forested areas.
•  Outbreaks of yellow fever have not been reported in Asia, but this region remains at risk because of the presence of competent vector mosquitoes and nonhuman primates.  

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

Anthrax Introduction
Anthrax is described in the early literature of the Greeks, Romans, and Hindus. The fifth plague, described in the book of Genesis, may be among the earliest descriptions of anthrax.

Anthrax is caused by exposure to the spores of the bacteria Bacillus anthracis that become entrenched in the host body and produce lethal poisons. It is primarily a disease of grazing animals such as cattle, sheep, goats, and horses. Pigs are more resistant, as are dogs and cats. Birds usually are naturally resistant to anthrax. Buzzards and vultures are naturally resistant to anthrax but may transmit the spores on their talons and beaks.

The bacteria that cause anthrax are able to go into a dormant phase, in which they form spores. Spores can exist in the environment for decades. Under the right conditions, the dormant spores can germinate and multiply.

If terrorists were to use the anthrax spores, they would most likely want to disperse it into the air for mass effect. As was seen in October 2001, terrorists could also deliver anthrax by other means, such as placing spores in letters or packages to be opened and inhaled and handled by unsuspecting recipients.

People of any age may be affected. Most cases are mild and go away with treatment. Anthrax, however, can be lethal. There are several ways anthrax can cause illness. These are the 3 main ways anthrax affects humans:
1.  Cutaneous (skin) anthrax causes a characteristic sore on the skin and results from exposure to the spores after handling sick animals or contaminated animal wool, hair, hides, or bone meal products. It is an occupational hazard for veterinarians, farmers, and people who handle animal products. Where the bacteria are common, human infection remains uncommon. Humans are relatively resistant, but the spores may gain access through even tiny breaks in the skin. Cutaneous anthrax is easy to cure if it is treated early with appropriate antibiotics.
2.  Inhalational anthrax results from breathing anthrax spores into the lungs. People who handle animal hides infested with spores may develop inhalational anthrax, known as woolsorter’s disease. Once inhaled, the organisms multiply and may spread their toxins to the bloodstream and many other organs. Infection may spread from the liver, spleen, and kidneys back into the bloodstream, thus causing an overwhelming infection and death. This type of infection (known as septicemic anthrax) most commonly follows inhalational anthrax.
3  Gastrointestinal anthrax results from eating meat products that contain anthrax. Gastrointestinal anthrax is difficult to diagnose. It can produce sores in the mouth and throat. A person who has eaten contaminated products may feel throat pain or have difficulty swallowing. This form of anthrax has a very high death rate.

Anthrax Signs and Symptoms
1.  Cutaneous (skin) anthrax
•  Cutaneous anthrax occurs 1-7 days (usually 2-5) after spores enter the body through breaks in the skin.
•  This form most commonly affects the exposed areas of the arms and, to a lesser extent, the head and neck.
•  The infection may spread throughout the body in up to 20% of untreated cases.
•  Cutaneous anthrax begins as a small pimple like lesion (a sore) that enlarges in 24-48 hours to form a “malignant pustule” at the site of the infection. This sore (about 2-3 cm or about an inch) is round with a raised edge. The sore is not painful. The central area of infection is surrounded by small blisters filled with bloody or clear fluid containing many bacteria. A black scab forms at the site of the sore in 7-10 days and lasts for 7-14 days before separating. The surrounding area may be swollen and painful and may last long after the scab forms.
•  Sores that affect the neck may cause swelling that could affect breathing.
2.  Inhalational anthrax
•  Inhalational anthrax begins abruptly, 1-60 days (usually 1-3 days) after inhaling large amounts of anthrax spores. The size of the spores is extremely important when it comes to causing disease, and this depends upon the techniques of the person producing the spores. Spores that are too small are inhaled but then immediately exhaled and do not remain in the lungs to cause disease. Spores that are made too large do not remain suspended in the air when released and drop to the ground and are thus never inhaled in the first place. Optimal sized spores for an anthrax biological weapon measure 1-5 micrograms in diameter.
•  A person may initially have no specific respiratory or breathing symptoms but might have a low-grade fever and a nonproductive cough. An exposed person may feel chest pain early in the illness and improve temporarily before rapidly progressing to having severe breathing problems.
•  Inhalational anthrax progresses rapidly with high fever, severe shortness of breath, rapid breathing, bluish color to the skin, a great deal of sweating, vomiting blood, and chest pain that may be so severe as to seem like a heart attack.
•  Inhalational anthrax usually causes death when the poisonous toxins produced by the bacteria overwhelm the body systems.
3.  Intestinal anthrax
•  Swallowing spores may cause intestinal anthrax 2-5 days later.
•  People with intestinal anthrax may have nausea, vomiting (also vomit blood), tiredness, no appetite, abdominal pain, and bloody diarrhea, plus a fever.
•  Intestinal anthrax is difficult to recognize. Shock and death may occur 2-5 days after it begins.
•  Oropharyngeal (mouth and throat) anthrax
•  Swallowing of spores may result in anthrax appearing in the mouth and throat 2-7 days after exposure.
•  People with this type of anthrax may have a sore throat on one side or difficulty swallowing.
•  Death may occur because the person’s throat may swell and cause difficulty breathing.
4.  Septicemic (bloodstream) anthrax
•  Septicemic anthrax refers to an overwhelming blood infection by anthrax. This can be a complication of inhalational anthrax.
•  Internal organs may become darkly colored with widespread bleeding. The bacteria multiply in the blood and overwhelm the red blood cells. The term anthrax is derived from the Greek word for coal and was descriptive in that the lesions produced turned black.
•  Most cases of septicemic anthrax occur following inhalational anthrax. The number of organisms released from the liver or spleen into the bloodstream overwhelm the body’s defenses and produce massive amounts of lethal toxin that result in shock and death.
•  Anthrax meningitis
•  This type of anthrax may complicate any form of anthrax and spread throughout the central nervous system and to the brain.

Home Care
There is no home care for anthrax before a doctor makes the diagnosis.

 When to Seek Medical Care
Anthrax develops rapidly, so immediate medical attention is required. Go to a hospital’s emergency department if you have been or think you have been exposed to spores.

Physician Diagnosis
•  The skin lesions will eventually turn black. If you have a painless ulcer (sore) that is suspected to be cutaneous anthrax, the doctor will take a small sample of the fluid and see if it grows under special conditions in the laboratory. Samples will be viewed under a microscope. The anthrax bacteria will look different from other, similar organisms. If anthrax is suspected, laboratory personnel will take special care with the sample because it is considered a biohazard. Anthrax is not contagious from person to person, however, and standard hospital practices of hygiene, known as universal precautions, will prevent spread from one person to another.
•  If you have cutaneous anthrax and have developed a fever and other symptoms throughout your body, the doctor may test your blood for the bacteria.
•  If the doctor thinks you may have inhalational anthrax, you will have a chest x-ray or a CT scan. Other tests may be performed, including a lumbar puncture (spinal tap). You will also be admitted to the hospital.
•  An infectious disease specialist may be among the doctors called in

Anthrax Treatment
The preferred way to treat anthrax is with antibiotics. The goal of antibiotics is to destroy the infection and prevent complications and death. Anthrax spores grow like plant seeds. If you plant seeds and give them sun and water, they will grow into plants. If you give anthrax spores the right environment, such as the human body, they can grow into the harmful form of the bacteria that can cause anthrax disease. It takes anthrax spores an average of 7 days to grow into the harmful form of the bacteria, but it can take longer. For this reason, you must continue taking preventive antibiotics for the full 60 days.

The recommended doxycycline dose in people who have been exposed to anthrax or who have a diagnosed active anthrax infection is 100 mg, taken twice a day for 60 days.
_Smaller children (weighing less than 100 pounds) older than 8 years of age can be given 1 mg per pound of body twice a day for 60 days.
_Larger children (weighing more than 100 pounds) older than 8 years old can receive the usual adult dosage.

Many antibiotics are effective against B anthracis and include the following:
•  Doxycycline (Vibramycin)
• Penicillin
Amoxicillin (Trimox, Amoxil, Biomox)
Ampicillin (Marcillin, Omnipen, Polycillin, Principen, Totacillin)
Ciprofloxacin (Cipro)
• Levofloxacin (Levaquin)
• Gatifloxacin (Tequin)
• Chloramphenicol (Chloromycetin)

Severely ill people may be given medications through an IV. Treatment may continue for several weeks. People exposed to anthrax may be given preventive antibiotics usually to be taken for 60 days.

Prognosis and Follow-up
•  Prognosis: If treated early, people with cutaneous anthrax recover. Those with oropharyngeal or intestinal anthrax have a less favorable outcome, and people with inhalational anthrax have the worst outcomes. About one-half of the victims of the fall 2001 anthrax attacks died.
•  Follow-up: With cutaneous anthrax, 80% of people who are not treated will recover. If treated, they may be given medication and sent home. A permanent circular scar may remain at the site of the original lesion. For others, with inhalational, meningeal, or septicemic anthrax, hospitalization is required.

An anthrax vaccine exists, but is not readily available. It consists of a series of 6 immunizations given over 18 months. A booster is then available to be given annually, especially to those who have exposure to anthrax-containing animals or animal products. A skin test can determine if the vaccine is active.

To prevent infection from spores of B anthracis released in the air after a suspected bioterrorist attack, your doctor may prescribe ciprofloxacin or doxycycline for 60 days. Other antibiotics may be used once lab tests return showing which ones are effective.



Media file 1:  Microscopic picture of anthrax. Image courtesy of AVIP agency, Office of the Army Surgeon General, US.


Media file 2:  Cutaneous (skin) anthrax. Picture courtesy of AVIP agency, Office of the Army Surgeon General, US.

Media file 3:  Skin lesion of anthrax on face. Picture courtesy of the Public Health Image Library, CDC, Atlanta, Georgia.

Media file 4:  Skin lesions of anthrax on neck. Picture courtesy of the Public Health Image Library, CDC, Atlanta, Georgia.




Media file 5:  Chest x-ray showing widened chest cavity resulting from inhalation anthrax. Image courtesy of Dr. P.S. Brachman, Public Health Image Library, CDC, Atlanta, Georgia.

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(Survival manual/6. Medical/c) Disease/Smallpox)

Smallpox is a contagious, disfiguring and deadly disease caused by the Variola virus. Smallpox is believed to have been around for thousands of years. Few other illnesses have had such a devastating effect on human health and history.
There’s no treatment or cure for smallpox. The only prevention is vaccination.

Naturally occurring smallpox was eradicated worldwide by 1980 — the result of an unprecedented immunization campaign. However, interest in the disease remains high because stocks of smallpox virus, kept for research purposes, are stored in two high-security labs — one in the United States and one in Siberia. In addition, its suspected that other governments or entities may hold stockpiles. This has led to concerns that smallpox may be used as a biological warfare agent.

Until its ‘eradication’ in 1980, smallpox killed 100s of millions of people. An estimated 300 million died in the 20th Century alone.  Smallpox has killed more people than all the other disease in history, combined. While there are several virulence’s of smallpox, the Black Pox is always 100% fatal

The danger
This  is a time [right now] when even one case of smallpox could be catastrophic. At one time, not long ago, most of us were vaccinated against the disease, but this resistance only lasts about 10 years. Everyone vaccinated before 1980 has lost their resistance, everyone born after 1983-85 (when civilian vaccinations were terminated) has not had a vaccination for the disease. The world’s population, is now like the pre 1500 AD, North American Indians, who having no history of the disease were decimated by it.
Smallpox is explosively contagious. As few as  1  virus is said to be able to infect  the next victim. There follows a 10 day incubation period during which time the victim feels no effects of their infection. Then the disease hits: First a headache with a backache and uncontrollable vomiting. Small spots start to appear all over the body. The spots turn into puss filled blisters. The blisters join and cover the entire
body, the skin continues to erupt and split. Victims cannot speak because of blisters in their throat, their eyes are squeezed shut from pus sacks, lastly the internal organs disintegrate and are discharged with the diarrhea and vomiting. The victims die in the most excruciating painful manner possible.

Within a community of humans, the virus must find new victims in not over 14 days intervals or it begins to die out. The virus can live 14-20 outside  a host. Plants and animals do not harbor the disease, just humans.
The government has set the stage for a global catastrophe when they made it impossible for citizens to secure inoculation protection.

The first symptoms of smallpox usually appear 12 to 14 days after you’re infected. During the incubation period of seven to 17 days, you look and feel healthy and can’t infect others.
Following the incubation period, a sudden onset of flu-like signs and symptoms occurs.
These include:

  • Fever
  • Overall discomfort (malaise)
  • Headache
  • Severe fatigue (prostration)
  • Severe back pain
  • Sometimes vomiting, diarrhea or both

A few days later, the characteristic smallpox rash appears as flat, red spots (lesions). Within a day or two, many of these lesions turn into small blisters filled with clear fluid (vesicles) and later, with pus (pustules). The rash appears first on your face, hands and forearms, and later on your trunk. It’s usually most noticeable on the palms of your hands and the soles of your feet. Lesions also develop in the mucous membranes of your nose and mouth. The distribution of lesions is a hallmark of smallpox and a primary way of diagnosing the disease.

When the pustules erupt, the skin doesn’t break, but actually separates from its underlying layers. The pain can be excruciating. Scabs begin to form eight to nine days later and eventually fall off, leaving deep, pitted scars. All lesions in a given area progress at the same rate through these stages. People who don’t recover usually die during the second week of illness.
 [The Smallpox rash progression shown above has a sanitary and optimistic outcome; not showing burst pustules or skin seperation followed by death. Typically, Day 15 above would be worse than Day 10, there woul be no Day 25.]

 Smallpox vs. chickenpox
In the past, smallpox was sometimes confused with chickenpox, a childhood infection that’s seldom deadly. Yet chickenpox differs from smallpox in several important ways:

  • Severity and location of lesions. Chickenpox lesions are much more superficial than are those of smallpox and occur primarily on the trunk, rather than on the face, arms and hands.
  • Types of lesions. You’ll often see a combination of scabs, vesicles and pustules in someone with chickenpox. In smallpox, all of the lesions in a given area are at the same stage.
  • Timing of transmission. A person infected with chickenpox can unknowingly transmit the virus to others before symptoms develop. But smallpox becomes infectious only when signs and symptoms appear and remains contagious until scabs fall from the pustules. Smallpox is most contagious after the fever starts and during the first week of the rash. You’re less likely to become infected if you’re exposed to someone in the later stages of the disease.

The variola virus causes smallpox. Once you’re infected, the virus replicates inside your cells — first in the lymph nodes and then in your spleen and bone marrow. Eventually, the virus settles in the blood vessels in your skin and the mucous membranes of your nose and throat. When the lesions in your mouth slough off, large amounts of virus are released into your saliva. This is when you’re most likely to transmit the disease to others.

How smallpox spreads
Smallpox usually requires fairly prolonged face-to-face contact to spread. It’s most often transmitted in air droplets when an infected person coughs, sneezes or talks. In rare instances, airborne virus may spread further, possibly through the ventilation system in a building, infecting people in other rooms or on other floors. Smallpox can also spread through contact with contaminated clothing and bedding, although the risk of infection from these sources is slight.

Types of smallpox
Two main forms of smallpox exist:

  • Variola minor. This is a milder form of the disease and causes a less serious illness. It’s fatal in less than 1 percent of people who contract it.
  • Variola major. By contrast, this form of the disease kills one-third of the people it infects.

Variola major smallpox is further divided into five subtypes:

  • Ordinary smallpox. This is the most frequently occurring type, accounting for more than 70 percent of all smallpox cases.
  • Modified smallpox. This milder form of the disease occurs in people who have been vaccinated against smallpox in the past.
  • Variola sine eruptione. People with this form of the disease develop fever but no rash.
  • Hemorrhagic smallpox. This rare form is characterized by a red, pinpoint rash and bleeding in the skin and mucous membranes. In some cases, hemorrhagic smallpox may destroy the entire skin surface and all mucous membranes. Hemorrhagic smallpox is almost always fatal within three to four days.
  • Flat smallpox. This rare form, which occurs mainly in children, also is often fatal. The early signs and symptoms are similar to other forms of the disease, but the lesions are flat and never become filled with pus. Eventually, the skin takes on a rubbery appearance. Bleeding in the
    skin and intestinal tract also may occur.

Although most people who get smallpox survive, variola major is fatal in about 30 percent of people who contract it. Almost no one survives the hemorrhagic and flat forms of the disease. People who recover from smallpox usually have severe scars, especially on the face, arms and legs. In some cases, smallpox may cause blindness.

Tests and diagnosis
Even a single confirmed case of smallpox would be considered an international health emergency. Based on symptoms and appearance of the rash, the Centers for Disease Control and Prevention (CDC) or
a CDC Laboratory Response Network-designated variola testing laboratory can do definitive testing using a tissue sample taken from one of the lesions on the skin of the infected person.

Treatments and drugs
No cure for smallpox exists. The smallpox vaccine can prevent or lessen the severity of the disease for some people if given within four days of infection. But vaccination doesn’t help once signs and symptoms develop. For now, the best that doctors can offer people with symptomatic smallpox is supportive therapy and antibiotics to treat secondary bacterial infections.

[Photo right: An actress with make up, simulating Smallpox.]

Apart from immediate vaccination, isolation of the infected person is the only way to manage the disease. Unfortunately, isolation can only contain the spread of the virus, not eradicate it.

Because of the bio-terrorism threat, new treatments are under investigation. One of these, cidofovir, has shown promise in laboratory studies.

Smallpox vaccine: In 1967, the World Health Organization (WHO) launched a global immunization campaign to eradicate smallpox. The WHO’s efforts were remarkably effective, and the last naturally occurring case of smallpox was reported in 1977. In 1980, smallpox vaccinations were discontinued worldwide.
The vaccine today: The United States currently has enough smallpox vaccine to vaccinate all Americans. The CDC has provided public health officials with a contingency plan to quickly inoculate every American should the need arise.
Such a decision would not be undertaken lightly because the smallpox vaccine also has the small but real potential to cause serious harm. Unlike many other vaccines, the smallpox vaccine contains a live vaccina virus — a pox-type virus related to smallpox, but milder than smallpox. The vaccine can’t cause smallpox, but because it’s live, care must be taken of the vaccination site to keep the virus from spreading. Touching the vaccination site before it’s healed, or touching bandages or clothing contaminated with the virus, can cause it to spread to other parts of your body or to other

Experts in virology say the vaccine causes a fatal complication in about 1 of every 1 million people who receive it. That means that if the entire American population were to be vaccinated, 300 people
would be expected to die of complications from the vaccine. Many others who are vaccinated might develop painful sores and severe scars, and others would likely have residual brain damage from encephalitis — a potentially fatal brain inflammation.

Who should not receive the vaccination
Because of the risk of severe and sometimes fatal reactions, the CDC and WHO recommend that the general public not be vaccinated. But because military personnel and some health care workers
continue to be vaccinated, it’s important to know who should not receive the vaccine.

You should not receive the smallpox vaccine if you:

  • Have certain skin conditions. This includes eczema, a history of eczema or other chronic skin conditions, or sharing a household with someone with eczema, a history of eczema or skin conditions such as impetigo.
  • Are pregnant. The vaccine is not known to cause birth defects, but in rare cases it may cause infection of the fetus, leading to stillbirth or death soon after delivery.
  • Have impaired immunity. You shouldn’t have a vaccination if you have a disease or are undergoing treatment that suppresses your immune system. This includes people with cancer, people with organ transplants, and those undergoing radiation therapy or treatment with drugs that suppress the immune system.
  • Have AIDS or are HIV-positive. The human immunodeficiency virus (HIV) wasn’t identified before the end of routine smallpox vaccination, so it’s not known what effect the vaccine might have on people with the disease. Currently, the CDC recommends that HIV-positive people not be vaccinated.
  • Are allergic to any of the ingredients in the vaccine. This includes the antibiotics polymyxin B sulfate, streptomycin sulfate, chlortetracycline hydrochloride and neomycin sulfate.
  • Have underlying heart disease. You also shouldn’t be vaccinated if you have three or more known risk factors for heart disease, including high blood pressure, diabetes, high cholesterol and smoking, or a parent or sibling of someone with heart disease.

Smallpox in the New World:
by O. Ned Eddins
…Some of the African slaves brought by Columbus to be used on the sugar plantation of the West Indies carried the smallpox virus. In 1495, fifty-seven to eighty percent of the native population of Santa Domingo, and in 1515, two-thirds of the Indians of Puerto Rico were wiped out by smallpox. Ten years after Cortez arrived in Mexico, the native population dropped from twenty-five million to six million five hundred thousand a reduction of seventy-four percent.

Prior to the arrival of Europeans, various sources estimate native population in North and South America at ninety to one hundred million (about 1/3 the current US population). It is impossible to arrive at the number of Indians in the Americas killed by European diseases with smallpox the deadliest by far. Even the most conservative estimates place the deaths from smallpox above 65%.
Stearn and Stearn estimated there were approximately one million Indians living north of the Rio Grande in the early sixteenth-century. By the end of the sixteen hundreds, smallpox had spread up and down the eastern seaboard and as far west as the Great Lakes. Bray estimated by 1907 there were less than four hundred thousand Indians. This decline was not due to smallpox alone. Other diseases played a role, as did intertribal warfare and conflicts with the United States.

Smallpox reached the Atlantic Coast of what was to become the United States either from Canada or the West Indies. The first major outbreak recorded of an infectious disease was 1616-19. The Massachusetts and other Algonquin tribes in the area were reduced from an estimated thirty thousand to three hundred (Bray). When the Pilgrims landed in 1620, there were few Indians left to greet them. Many observers believe this infectious disease was smallpox.

In the Americas, mortality rates were higher due to the virgin soil phenomenon, in which indigenous populations were at a higher risk of being affected by epidemics because there had been no previous contact with the disease, preventing them from gaining some form of immunity [A situation that is now occurring in our post 1972 population. Mr Larry]. Estimates of mortality rates resulting from smallpox epidemics range between 38.5% for the Aztecs, 50% for the Piegan, Huron, Catawba, Cherokee, and Iroquois, 66% for the Omaha and Blackfeet, 90% for the Mandan, and 100% for the Taino.  Smallpox epidemics affected the demography of the stricken populations for 100 to 150 years after the initial first infection..

If you were vaccinated before 1972
Many people may have never been vaccinated against smallpox. Others received the vaccine more than 25 years ago. It’s not known how long immunity lasts, although it’s likely the vaccine is most effective for about three to five years, with immunity decreasing after that.
Partial immunity may last much longer. People who are revaccinated appear to have increased immunity, although one recent study indicates that recent or multiple vaccinations aren’t essential for maintaining antibodies that protect against the disease.

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Insects: Disease, Pests & Control

( Survival manual/6. Medical/b) Disease/Insects, disease & pest control)

      Many invertebrates are responsible for transmitting diseases. Mosquitoes are perhaps the best known invertebrate vector and transmit a wide range of tropical diseases including malaria, dengue fever and yellow fever. Another large group of vectors are flies. Sandfly species transmit the disease leishmaniasis, by acting as vectors for protozoan Leishmania species, and tsetse flies transmit protozoan trypansomes (Trypanosoma brucei gambiense and Trypansoma brucei rhodesiense) which cause African Trypanosomiasis (sleeping sickness). Ticks and lice form another large group of invertebrate vectors. The bacterium Borrelia burgdorferi, which causes Lyme Disease, is transmitted by ticks and members of the bacterial genus Rickettsia are transmitted by lice. For example, the human body louse transmits the bacterium Rickettsia prowazekii which causes epidemic typhus.

Although invertebrate-transmitted diseases pose a particular threat on the continents of Africa, Asia and South America, there is one way of controlling invertebrate-borne diseases, which is by controlling the invertebrate vector. For example, one way of controlling malaria is to control the mosquito vector through the use of mosquito nets, which prevent mosquitoes from coming into contact with humans.

 A.  List of diseases spread by invertebrates
US diseases below, see global list at:
(If the disease is encountered in North America during an emergency survival situation where medical help is not available, see Survival Manual/6. Medical/b) Disease/  for home medical treatment details; otherwise consult your doctor.)

Disease Vector Causative organism Symptoms Treatment
Chagas disease (American
Various assassin bugs of subfamily Triatominae Trypanosoma cruzi (protozoan) Mild symptoms, then chronic heart or brain inflammation Antiparasitic drugs; treatment of symptoms
Dengue fever Mosquito Flavivirus (virus) Fever then arthritis Observation/supportive treatment
Tick Tick-borne encephalitis virus Ill with flu then meningitis prevention and vaccination
Leishmaniasis Sandfly Leishmania (protozoan) Fever, damage to the spleen and liver,   and anaemia Treatment of infected
Lyme disease Tick Borrelia burgdorferi (bacterium) Skin rash then paralysis Prevention and antibiotics
Malaria Mosquito Plasmodium (protist) Headache then heavy fever Prevention and anti-malaria
Plague Flea Prevention and Antibiotics
Rickettsial diseases:Typhusrickettsial poxBoutonneuse
African tick bite feverRocky Mountain spotted fever
Tick, lice Rickettsia species (bacteria) Fever with bleeding around the bite Prevention and antibiotics
West Nile disease Mosquito West Nile virus Fever then meningitis None

B.  Bug Proof Your Home 

In addition to the information provided in this section, I recommend you visit:

(under construction) ….more to come

C.  Ants
“How can I get rid of ants in my house?” . . . . .is one of the most common homeowner complaints heard by insect pest control specialists. Ants invade the home to forage for food or seek shelter or both. This Web site explains ant behavior and provides control tips so you, the homeowner, are better equipped to deal with this pest.

 Ant behavior
All ants live in colonies, consisting of an egg-laying female (queen), short-lived males, and workers (sterile females). The ants you see foraging in your garden or kitchen are workers. Workers that find food communicate with other workers by depositing a chemical message on the substrate as they crawl back to the nest.
Although we cannot smell it, this “trail pheromone” sticks to the substrate for long periods of time and helps other ants find the food at the end of the trail.

Ants that live outside will travel inside the home to search for food. Some species may ultimately reside in houses, discussed later in this fact sheet. To prevent both of these scenarios, follow these procedures:
•  First, cracks and crevices should be sealed to eliminate passages into the home. If you do not seal entry points, ants will probably find their way into your house at some later time.
•  Second, scrub around entry points with a detergent (to remove the trail pheromone) and spray a residual insecticide around entry points.
•  Bait treatments and insecticides can be used to control ants in the outside nest. To be effective
baits must be placed in areas where ants frequent, eaten and be taken back to the nest. There are several different kinds of baits available, and you may have to do a little trial-and-error to find the proper bait. Because the ants must get back to the nest for satisfactory control this strategy may be incompatible with insecticide sprays which may kill worker ants before they can get back to the nest with the bait. The successful use of a bait may take several weeks or more.
•  Insecticide dilutions can be used outside to successfully drench ant nests. Be sure to follow label recommendations for correct procedures when applying the insecticide.

Fire Ants
Even a single fire ant bite is immensely painful and can leave a red welt on your skin for days. Trouble is, if you’ve disturbed one it’s almost certain that more are on the way.  Fire ants get their name for their sting, which feels like being burned alive. The ant latches on with its jaws and injects an alkaloid venom that causes pain and, in sufficient quantities, death. Fire ants are known to kill small animals regularly. Very few humans, however, are killed by the ants. Those who have been killed were almost all allergic to the insects’ venom.  In an interesting side note, global warming effects seem to be helping fire ants thrive like never before. With warmer winters and longer summers, the ants are able to move and stay farther north rather than return south in the winter.

Treating Fire Ant stings
Symptoms of fire ant stings may include redness, itchiness and pain around the site of the bites. Pus-filled blisters may last 3-10 days and scabs over the bite site may follow as well. Some people are allergic to the venom and may have difficulty breathing, a rapid heart rate and throat swelling.
Treating these stings at home, assuming there is not an allergic reaction, could include washing the area with soap and water, do not use alcohol. Sometimes ice wrapped in a wash cloth on the bite area for 10 minutes and then off for 10 minutes will relieve the pain.
If the person stung has an allergic reaction, immediately seek medical help by calling 9-1-1 or poison control. There are bee sting kits that require a doctor’s prescription for those who know they are allergic. Be sure to know how to use the kit if you get one.

Killing Fire Ants – Two steps to success
The two-step process for fire ant elimination is advocated by Texas A&M University as the best method of killing fire ants and maintaining fire ant control over the long-term. The method includes two steps: wide area fire ant bait broadcasting plus individual fire ant hill treatment. This method can include organic and non-organic pesticides as desired.

 Step one – Fire Ant Bait
__Fire ant bait: broadcasting is best done in the spring and again in the fall. Bait broadcasting involves the use of a spreader and your choice of fire ant bait. Worker ants will pick up the bait and take it back to the colony, where it will be eaten by the fire ant queen. When the queen dies the colony dies.
We recommend the organic bait from Green Light called Fire Ant Control.

Please follow the directions on the packaging for specific instructions:
•  Use fresh bait from an unopened container.
•  Rain will wash the bait away. Make sure to check the  forecast and spread the bait when it will be sure to have a few days exposure.
•  Fire ants generally look for food in the late afternoon or evening. Spread the bait then to assure the most effective distribution amongst the colony.
•  Use a fire ant bait  spreader.
•  Apply baits twice a year, in early summer and early fall.

Step two – Fire ant hill treatments
__a)  Non-organic treatment – There are a number of highly effective products like the Over n’ Out Fire Ant Killer Granules that  will do the job nicely.
Organic treatment – Some people advocate pouring boiling water  on fire ant hills as an effective method of fire ant control. While this may seem like a good way of killing fire ants, it will usually only partially affect them. They will quickly find a new home in a separate part of the yard.  Perhaps, this time, closer to the house.

D.  Wasps
Unless you’re allergic to them yellow jackets aren’t particularly dangerous on their own, although they’re extremely unpleasant to be stung by. Get a group of them together, though, and you could find yourself dying an agonizingly painful death. Yellow jackets are often mistaken for bees, but they’re actually a species of wasp. This means they can sting repeatedly without dying, unlike most bee species.  They’ll also aggressively defend their nests, which can hold huge numbers of the wasps. Although it is estimated to take around 1500 stings from the insects to kill an adult male, it still happens.

Controlling Wasps
What kind of wasp is it? If the nest is big and papery, it is probably a social wasp like a hornet or
yellow jacket. Social wasps are the most dangerous and aggressive kind of wasp.
They have a queen who lays eggs, which are usually sterile females; upon hatching they form the workforce of the hive. It is important that you do not confuse bees and wasps; it is easy to tell the difference. The most obvious difference is that bees are hairy; the hair is used to collect pollen, something social wasps do not do. Solitary wasps are longer and skinnier and tend to live a “solitary” life, building little mud or paper nests, not bothering anybody—that is unless you bother them.
•  Remove  all food sources. Depending on the season, social wasps will be attracted to different kinds of foods. In the spring and early summer they are going to be looking for protein; this means your kitchen waste, manure, and dead animals. You can keep this to a minimum by making sure your garbage can is sealed. If you are composting your kitchen waste, keep turning it over, thereby burying the newer additions. This will not only reduce wasp populations, but also many other annoying pests—such as flies. Later in the summer, they will be looking for more carbohydrate-based foods; this means sugars, fruits, soft drinks, hummingbird feeders, and fruit trees.
•  Use barriers to keep wasps away. If wasps are getting into your house, you need to figure out their entrance point and seal it up. Check around your screened windows for holes, or separated wood framing. They could just as well be sitting by your door waiting for you to open it and slip inside. Is your picnic table being haunted by hornets? Consider buying a screened tent or picnic canopy that will fit around your eating area. There is a product I have seen available for lining areas of concern, such as your eaves or soffits which is called insect mesh. It will deter wasps from building their nests there, and keep them (and other insects) from entering your house through exposed wood.
•  Control wasps with wasp traps. They work in a similar fashion to most insect traps, i.e., there is bait and a funnel-like structure that leads to a death chamber. There is a pretty simple DIY version out there, and building it just involves cutting off the top one-third of a lidless two-liter soda bottle and inverting it into the bottom of the bottle. You can  use staples or string to join the two halves together, but aside from that, the construction is done. Bait with something sweet and sticky or a stinky protein
source (decomposing meat) in the spring season. Add water mixed with a dash of dish soap to the bottom of the bottle and place in the wasp problem area.
•  Use  poison sprays to kill wasps dead. Nests in trees or in the eaves of houses will require a projectile spray that can reach 20 feet or so. It is best to wait until the air is cool. Stand a safe distance back and start spraying the nest, aiming for the entrance on the bottom. Leave once the nest is saturated. Check back after a day to ensure that all activity has ceased in the nest. If not, reapply. When dealing with wasps inside walls, professionals will use an air duster with a powder like Sevin. It will stick around in the air and make its way up into the nest or settle on the surfaces between the nest and the exit.


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(Survival manual/6. Medical/b) Disease/Pneumonia)

Pneumonia is an inflammation of your lungs, usually caused by infection. Bacteria, viruses, fungi or parasites can cause pneumonia. Pneumonia is a particular concern if you’re older than 65 or have a chronic illness or impaired immune system. It can also occur in young, healthy people.
Pneumonia can range in seriousness from mild to life-threatening. Pneumonia often is a complication of another condition, such as the flu. Antibiotics can treat most common forms of bacterial pneumonias, but antibiotic-resistant strains are a growing problem. The best approach is to try to prevent infection.

Pneumonia symptoms can vary greatly, depending on any underlying conditions you may have and the type of organism causing the infection. Pneumonia often mimics the flu, beginning with a cough and a fever, so you may not realize you have a more serious condition.
Common signs and symptoms of pneumonia may include:
•  Fever
•  Cough
•  Shortness of breath
•  Sweating
•  Shaking chills
•  Chest pain that fluctuates with breathing (pleurisy)
•  Headache
•  Muscle pain
•  Fatigue
Ironically, people in high-risk groups such as older adults and people with chronic illnesses or weakened immune systems may have fewer or milder symptoms than less vulnerable people do. And instead of having the high fever that often characterizes pneumonia, older adults may even have a lower than normal temperature.

When to see a doctor
Because pneumonia can be life-threatening, see your doctor as soon as possible if you have a persistent cough, shortness of breath, chest pain, unexplained fever — especially a lasting fever of 102 F (38.9 C) or higher with chills and sweating — or if you suddenly feel worse after a cold or the flu.
Be especially prompt about seeking medical care if you’re an older adult or you smoke, drink excessively, have an injury, are undergoing chemotherapy or take medication such as prednisone that suppresses your immune system. For some older adults and people with heart failure or lung ailments, pneumonia can quickly become a life-threatening condition.

Your body has ways to protect your lungs from infection. In fact, you’re frequently exposed to bacteria and viruses that can cause pneumonia, but your body normally uses a number of defenses, such as cough and the normal microorganisms (flora) in your body, to prevent harmful organisms from invading and overwhelming your airways. However, numerous conditions, including malnutrition and systemic illness, can lower your protection and allow harmful organisms to get past your body’s defenses and into your lungs.
Once the invading organisms are in your lungs, white blood cells — a key part of your immune system — begin to attack them. The accumulating invaders, white blood cells and immune system proteins cause the tiny air sacs in your lungs to become inflamed and filled with fluid, leading to the difficult breathing that characterizes many types of pneumonia.

Classifications of pneumonia
Pneumonia is sometimes classified according to the cause of pneumonia:
1.  Community-acquired pneumonia. This refers to pneumonia you acquire in the course of your daily life — at school, work or the gym, for instance. The most common cause is the bacterium Streptococcus pneumoniae. Another, less common cause is Mycoplasma pneumoniae, a tiny organism that typically produces milder signs and symptoms than other types of pneumonia. Walking pneumonia, a term used to describe pneumonia that isn’t severe enough to require bed rest, may result from Mycoplasma pneumoniae.
2.  Hospital-acquired (nosocomial) pneumonia. If you’re hospitalized, you’re at a higher risk of pneumonia, especially if you’re breathing with the help of a mechanical ventilator, in an intensive care unit or have a weakened immune system. This type of pneumonia can be extremely serious, especially for older adults, young children and people with chronic obstructive pulmonary diseases (COPD) or HIV/AIDS.
Hospital-acquired pneumonia develops at least 48 hours after you’re admitted to the hospital. This category includes post-operative pneumonia — most common in people older than age 70 who have abdominal or chest surgery — and health-care associated pneumonia — acquired in chronic care facilities, centers where drugs are given by intravenous drip (infusion) and kidney dialysis centers.
A common predisposing factor for this type of pneumonia is gastroesophageal reflux disease (GERD). This occurs when some of the contents of your stomach flow back into the upper esophagus. From there, the gastroesophageal contents can be inhaled (aspirated) into your windpipe and then into your lower airways. Even small amounts of gastroesophageal reflux can lead to pneumonia in people who are hospitalized.
3.  Aspiration pneumonia. This type of pneumonia occurs when you aspirate foreign matter into your lungs — most often when the contents of your stomach enter your lungs after you vomit. This commonly happens when a brain injury or other condition affects your normal gag reflex.
Another cause of aspiration pneumonia is consuming too much alcohol. Aspiration occurs when the inebriated person passes out and then vomits due to the effects of alcohol on the stomach. If someone’s unconscious, it’s possible to aspirate the liquid contents and possibly solid food from the stomach into the lungs, causing aspiration pneumonia.
Difficulty swallowing, which occurs with diseases such as amyotrophic lateral sclerosis (ALS), Parkinson’s disease and strokes, may also lead to aspiration pneumonia.
4.  Pneumonia caused by opportunistic organisms. This type of pneumonia strikes people with weakened immune systems. Organisms that aren’t harmful for healthy people can be dangerous for people with AIDS and other conditions that impair the immune system, as well as people who have had an organ transplant. Medications that suppress your immune system, such as corticosteroids or chemotherapy, also can put you at risk of opportunistic pneumonia.
5.  Other pathogens. Outbreaks of the H5N1 influenza (bird flu) virus and severe acute respiratory syndrome (SARS) have caused serious, sometimes deadly pneumonia infections, even in otherwise healthy people. Although rare, anthrax, plague and tularemia also may cause pneumonia. Some forms of fungi, when inhaled can cause pneumonia. Tuberculosis in the lung also can cause pneumonia.

Risk factors
Factors associated with an increased risk of pneumonia include:
•  Age. If you’re age 65 or older, particularly if you have other conditions that make you more prone to developing pneumonia, you’re at increased risk of pneumonia. Very young children, whose immune systems aren’t fully developed, also are at increased risk of pneumonia.
•  Certain diseases. These include immune deficiency diseases such as HIV/AIDS and chronic illnesses such as cardiovascular disease, emphysema and other lung diseases, and diabetes. You’re also at increased risk if your immune system has been impaired by chemotherapy or long-term use of immunosuppressant drugs.
•  Smoking, alcohol abuse. Millions of microscopic hairs (cilia) cover the surface of the cells lining your bronchial tubes. The hairs beat in a wave-like fashion to clear your airways of normal secretions, but irritants such as tobacco smoke paralyze the cilia, causing secretions to accumulate. If these secretions contain bacteria, they can develop into pneumonia. Alcohol interferes with your normal gag reflex as well as with the action of the white blood cells that fight infection.
•  Hospitalization in an intensive care unit. Pneumonia acquired in the hospital tends to be more serious than other types of pneumonia. People who need mechanical ventilation are particularly at risk because the breathing tube bypasses the normal defenses of the upper respiratory tract, prevents coughing, may allow the stomach’s contents to back up into the esophagus where they can be inhaled (aspirated), and can harbor bacteria and other harmful organisms.
•  Having COPD and using inhaled corticosteroids for more than 24 weeks. Research indicates that this greatly increases your risk of developing pneumonia, possibly serious pneumonia.
•  Exposure to certain chemicals or pollutants. Your risk of developing some uncommon types of pneumonia may be increased if you work in agriculture, in construction or around certain industrial chemicals or animals. Exposure to air pollution or toxic fumes can also contribute to lung inflammation, which makes it harder for the lungs to clear themselves.
•  Surgery or traumatic injury. People who’ve had surgery or who are immobilized from a traumatic injury have a higher risk of pneumonia because surgery or serious injuries may make coughing — which helps clear your lungs — more difficult, and lying flat can allow mucus to collect in your lungs, providing a breeding ground for bacteria.
•  Ethnicity. If you’re a Native Alaskan or from certain Native American tribes, you’re at greater risk for contracting pneumonia.

How serious pneumonia is for you usually depends on your overall health and the type and extent of pneumonia you have. If you’re young and healthy, your pneumonia often can be treated successfully. However, some organisms that cause pneumonia are so virulent that they overwhelm the defense mechanisms, even in otherwise healthy people.
If you have heart failure or lung ailments, especially if you smoke, or if you’re older, your pneumonia may be harder to treat successfully. You’re also more likely to develop complications, some of which can be life-threatening.

Pneumonia complications may include:
•  Bacteria in your bloodstream. Pneumonia can be life-threatening when inflammation from the disease fills the air sacs in your lungs and interferes with your ability to breathe. In some cases the infection may invade your bloodstream (bacteremia). It can then spread quickly to other organs.
•  Fluid accumulation and infection around your lungs. Sometimes fluid accumulates between the thin, transparent membrane (pleura) covering your lungs and the membrane that lines the inner surface of your chest wall — a condition known as pleural effusion. Normally, the pleurae are smooth, allowing your lungs to slide easily along your chest wall when you breathe in and out. But when the pleurae around your lungs become inflamed (pleurisy) — often as a result of pneumonia — fluid can accumulate and may become infected (empyema).
•  Lung abscess. A cavity containing pus (abscess) that forms within the area affected by pneumonia is another potential complication.
•  Acute respiratory distress syndrome (ARDS). The pneumonia involves most areas of both lungs, making breathing difficult and depriving your body of oxygen. Underlying lung disease of any kind, but especially COPD, makes you more susceptible to ARDS.

Tests and diagnosis
Your doctor may first suspect pneumonia based on your medical history and a physical exam. You may undergo some or all of these tests:
•  Physical exam. During the exam, your doctor listens to your lungs with a stethoscope to check for abnormal bubbling or crackling sounds (rales) and for rumblings (rhonchi) that signal the presence of thick liquid.
•  Chest X-rays. X-rays can confirm the presence of pneumonia and determine the extent and location of the infection.
•  Blood and mucus tests. You may have a blood test to measure your white cell count and look for the presence of viruses, bacteria or other organisms. Your doctor also may examine a sample of your mucus or your blood to help identify the particular microorganism that’s causing your illness.

Medication Choices
Although experts differ on their recommendations, the first antibiotic used is usually one that kills a wide range of bacteria (broad-spectrum antibiotic). All antibiotics used have a high cure rate for pneumonia.
If you do not have to go to the hospital, your doctor may use any of the following antibiotics:
•  Macrolides, such as azithromycin, clarithromycin, and erythromycin.
•  Tetracyclines, such as doxycycline.
•  Fluoroquinolones, such as gemifloxacin, levofloxacin, and moxifloxacin.
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Home treatment with high-dose oral amoxicillin is equivalent to currently recommended hospitalization and parenteral ampicillin for treatment of severe pneumonia without underlying complications, suggesting that WHO recommendations for treatment of severe pneumonia need to be revised,” the study authors write.

[DOSING: For most infections in adults the dosing regimens for amoxicillin are 250 mg every 8 hours, 500 mg every 8 hours, 500 mg every 12 hours or 875 mg every 12 hours, depending on the type and severity of infection.
Amoxicillin can be taken with or without food.
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•  Bacterial. Doctors usually treat bacterial pneumonia with antibiotics. Although you may start to feel better shortly after beginning your medication, be sure to complete the entire course of antibiotics. Stopping medication too soon may cause your pneumonia to return. It also helps create strains of bacteria that are resistant to antibiotics.
•  Viral. Antibiotics aren’t effective against most viral forms of pneumonia. And although a few viral pneumonias may be treated with antiviral medications, the recommended treatment generally is rest and plenty of fluids.
•  Mycoplasma. Mycoplasma pneumonias are treated with antibiotics. Even so, recovery may not be immediate. In some cases fatigue may continue long after the infection itself has cleared. Many cases of mycoplasma pneumonia go undiagnosed and untreated. The signs and symptoms mimic those of a bad chest cold, so some people never seek medical attention. The symptoms generally go away on their own.
•  Fungal. If your pneumonia is caused by a fungus, you’ll likely be treated with antifungal medication.

Dealing with your symptoms
In addition to these treatments, your doctor may recommend over-the-counter medications to reduce fever, treat your aches and pains, and soothe the cough associated with pneumonia. You don’t want to suppress your cough completely, though, because coughing helps clear your lungs. If you must use a cough suppressant, use the lowest dose that helps you get some rest.

When hospitalization is needed
If you have severe pneumonia, you’ll be hospitalized and treated with intravenous antibiotics and possibly put on oxygen. If you don’t need oxygen, you may recover as quickly at home with oral antibiotics as in the hospital, especially if you have access to qualified home health care. Sometimes you may spend three or four days in the hospital receiving intravenous antibiotics and then continue to recover at home with oral medication.

Follow-up treatment
Your doctor will most likely schedule a follow-up X-ray and an office visit after your initial diagnosis and treatment. By that time your infection should have cleared, but it’s important for your doctor to see you, even if you’re feeling better. Follow-up appointments and X-rays are especially important in smokers.
If you’re not feeling better, the follow-up visit is an opportunity for your doctor to determine whether your course of treatment isn’t working and order more tests to get more information about your condition.

Lifestyle and home remedies
If you have pneumonia, the following measures can help you recover more quickly and decrease your risk of complications:
•  Get plenty of rest. Even when you start to feel better, be careful not to overdo it.
•  Stay home from school or work until after your temperature returns to normal and you stop coughing up mucus. This advice depends partially on how sick you were. If uncertain, ask your doctor. Because pneumonia can recur within a week or so, it may be better not to return to a full workload until you’re sure you’re well.
•  Drink plenty of fluids, especially water. Liquids keep you from becoming dehydrated and help loosen mucus in your lungs.
•  Take the entire course of any prescribed medications. Stopping medication too soon can cause your pneumonia to come back and contributes to the development of antibiotic-resistant bacteria.
•  Keep all of your follow-up appointments. Even though you feel better, your lungs may still be infected. It’s important to have your doctor monitor your progress.

The following suggestions can help keep you healthy:
•  Get vaccinated. Because pneumonia can be a complication of the flu, getting a yearly flu shot is a good way to prevent viral influenza pneumonia, which can lead to bacterial pneumonia. In addition, even though there is some controversy of its effectiveness, especially in older adults, doctors recommend getting a vaccination against pneumococcal pneumonia at least once after age 50, and if you have any risk factors, every five years thereafter. Your doctor will recommend a pneumonia vaccine even if you’re younger than 50 if you’re a smoker, if you have a lung or cardiovascular disease, certain types of cancer, diabetes or sickle cell anemia, if your immune system is compromised, or if you’ve had your spleen removed for any reason.
A vaccine known as pneumococcal conjugate vaccine can help protect young children against pneumonia. It’s recommended for all children younger than age 2 and for children ages 2 to 5 years who are at particular risk of pneumococcal disease, such as those with an immune system deficiency, cancer, cardiovascular disease or sickle cell anemia, or those who attend a group day care center. Side effects of the pneumococcal vaccine are generally minor and include mild soreness or swelling at the injection site.
•  Wash your hands. Your hands are in almost constant contact with germs that can cause pneumonia. These germs enter your body when you touch your eyes or rub the inside of your nose. Washing your hands often and thoroughly and can help reduce your risk. When washing isn’t possible, use an alcohol-based hand sanitizer, which can be more effective than soap and water in destroying the bacteria and viruses that cause disease. What’s more, most hand sanitizers contain ingredients that keep your skin moist. Carry one in your purse or in your pocket.
•  Don’t smoke. Smoking damages your lungs’ natural defenses against respiratory infections.
•  Take care of yourself. Proper rest and a diet rich in fruits, vegetables and whole grains along with moderate exercise can help keep your immune system strong.
•  Get treatment for GERD. Treat symptomatic GERD, and lose weight if you’re overweight.
•  Protect others from infection. If you have pneumonia, try to stay away from anyone with a compromised immune system. When that isn’t possible, you can help protect others by wearing a face mask and always coughing into a tissue.
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My personal choice-action regarding pneumonia vaccination:
[During 2004, at age 62 years and still active in the work force, I had my first pneumonia vaccination; its administration was covered by my company’s medical insurance. (Seven years passed….) Now age 69, and at the beginning of the 2011-2012 flu season, I received both my annual ‘flu shot’ and the 2nd ‘booster’ dose of the pneumococcal polysaccharide vaccine (PPV), these minimal expenses were covered by my Medicare insurance.]

Pneumonia Vaccine: Why immunize?
Pneumococcal disease is the cause of severe illness and even death; it kills more people in the United State each year than all other vaccine-preventable diseases combined. Everyone is susceptible to pneumococcal disease; however, some people are at greater risk from this illness. The at-risk population includes: seniors, 65 and older, the very young, as well as those with health issues including
alcoholism, heart or lung disease, kidney failure, diabetes, HIV infections, frequent acid reflux, and certain types of cancer.

Pneumococcal disease can lead to serious infections of the lungs (pneumonia), the blood
(bacteremia), and the covering of the brain (meningitis). Some statistics:
•  One out of every twenty people die from pneumococcal pneumonia. [5%]
•  Two out of every ten who get bacteremia.
•  Three out of every ten who get meningitis.

People with health issues (as mentioned above) are at even greater risk to die from this disease. Drugs (e.g. penicillin) once so effective in treating these infections are now at a disadvantage as this illness becomes more drug resistant. Immunization now plays a key role in prevention of this disease.
The pneumococcal polysaccharide vaccine (PPV) protects against 23 types of pneumococcal bacteria.
Most healthy adults who receive immunization develop protection to most or all of these types within two to three weeks of receiving the shot. The at-risk population includes: the aged, children under 2 years of age,  and those with certain long-term illnesses may not respond as well, or at all.

How many doses of PPV are needed? One dose of PPV is all that is usually required, however, under some circumstances a second dose may be given. For example: Aged 65 and older who received their first dose before 65 – if 5 or more years have passed since that initial dose.

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Typhoid fever

(Survival manual/6. Medical/b) Disease/Typhoid fever)

Typhoid fever is caused by the bacteria Salmonella typhi. Typhoid fever is rare in industrialized countries; however, remains a serious health threat in the developing world.  Typhoid fever spreads through contaminated food and water or through close contact with someone who’s infected. Signs and symptoms usually include high fever, headache, abdominal pain, and either constipation or diarrhea.
When treated with antibiotics, most people with typhoid fever feel better within a few days, although a small percentage may die of complications. [Please keep in mind, of the many diseases one might contract in the aftermath of a SHTF situation, your chance of recovery and-or rate of recovery is in part, related to your overall state of health, nutrition, access to sanitary water and protection from exposure, as well as the medical care given. Mr Larry]
Vaccines against typhoid fever are available, but they’re only partially effective. Vaccines are usually reserved for those who may be exposed to the disease or are traveling to areas where typhoid fever is common.

Although children with typhoid fever sometimes become sick suddenly, signs and symptoms are more likely to develop gradually — often appearing one to three weeks after exposure to the disease.
1. First week of illness
Once signs and symptoms do appear, you’re likely to experience:
•  Fever, often as high as 103 or 104 F.
•  Headache
•  Weakness and fatigue
•  Sore throat
•  Abdominal pain
•  Diarrhea or constipation
•  Rash
Children are more likely to have diarrhea, whereas adults may become severely constipated. During the second week, you may develop a rash of small, flat, rose-colored spots on your lower chest or upper abdomen. The rash is temporary, usually disappearing in two to five days.

2. Second week of illness
If you don’t receive treatment for typhoid fever, you may enter a second stage during which you become very ill and experience:
•  Continuing high fever
•  Either diarrhea that has the color and consistency of pea soup, or severe constipation
•  Considerable weight loss
•  Extremely distended abdomen

3. Third week of illness
By the third week, you may:
•  Become delirious
•  Lie motionless and exhausted with your eyes half-closed in what’s known as the typhoid state.
Life-threatening complications often develop at this time.

4. Fourth week of illness
Improvement may come slowly during the fourth week. Your fever is likely to decrease gradually until your temperature returns to normal in another week to 10 days. But signs and symptoms can return up to two weeks after your fever has subsided.

When to see a doctor
See a doctor immediately if you suspect you have typhoid fever. If you become ill while traveling in a foreign country, call the U.S. Consulate for a list of doctors.

Typhoid fever is caused by a virulent bacterium called Salmonella typhi. Although they’re related, this isn’t the same as the bacteria responsible for salmonellosis, another serious intestinal infection.

Fecal-oral route
The bacteria that cause typhoid fever spread through contaminated food or water and occasionally through direct contact with someone who is infected. In developing nations, where typhoid is endemic, most cases result from contaminated drinking water and poor sanitation. The majority of people in industrialized countries pick up the typhoid bacteria while traveling and spread it to others through the fecal-oral route.
This means that S. typhi is passed in the feces and sometimes in the urine of infected people. You can contract the infection if you eat food handled by someone with typhoid fever who hasn’t washed carefully after using the bathroom. You can also become infected by drinking water contaminated with the bacteria.

Typhoid carriers
Even after treatment with antibiotics, a small number of people who recover from typhoid fever continue to harbor the bacteria in their intestinal tract or gallbladder, often for years. These people, called chronic carriers, shed the bacteria in their feces and are capable of infecting others, although they no longer have signs or symptoms of the disease themselves.

Risk factors
Typhoid fever remains a serious worldwide threat — especially in the developing world — affecting more than 21 million people each year, according to the Centers for Disease Control and Prevention. [Typhoid is out there and its serious. We in the advanced nations keep it at bay with our energy driven public health sanitary systems. As long as the health infrastructure continue working, we’re safe, but if the power goes out regionally, for a long period of time, Typhoid will be ‘just another dangerous disease’ to deal with. Mr Larry]
The disease is endemic in India, Southeast Asia, Africa, South America and many other areas.
Worldwide, children are at greatest risk of getting the disease, although they generally have milder symptoms than adults do.
If you live in a country where typhoid fever is rare, you’re at increased risk if you:
•  Work in or travel to areas where typhoid fever is endemic
•  Work as a clinical microbiologist handling Salmonella typhi bacteria
•  Have close contact with someone who is infected or has recently been infected with typhoid fever
•  Have an immune system weakened by medications such as corticosteroids or diseases such as HIV/AIDS
•  Drink water contaminated by sewage that contains S. typhi

Treatments and drugs
Antibiotic therapy is the only effective treatment for typhoid fever.
Commonly prescribed antibiotics: Ceftraixone, ciprofloxacin and levofloxacin are the drugs of choice for treatment of typhoid fever.
In the United States, doctors often prescribe ciprofloxacin for nonpregnant adults. Ceftriaxone — an injectable antibiotic — is an alternative for women who are pregnant and for children who may not be candidates for ciprofloxacin. These drugs can cause side effects, and long-term use can lead to the development of antibiotic-resistant strains of bacteria.

Other treatment steps aimed at managing symptoms include:
•  Drinking fluids. This helps prevent the dehydration that results from a prolonged fever and diarrhea. If you’re severely dehydrated, you may need to receive fluids through a vein in your arm (intravenously).
•  Eating a healthy diet. Non bulky, high-calorie meals can help replace the nutrients you lose when you’re sick.
•  Symptoms usually improve in 2 to 4 weeks with treatment. The outcome is likely to be good with early treatment, but becomes poor if complications develop.
•  Symptoms may return if the treatment has not completely cured the infection.
•  When appropriate treatment is started early, the prognosis for typhoid fever is good. With treatment, the mortality rate of typhoid fever is generally under 1 percent and few complications occur.
•  Even with treatment, however, approximately 20 percent of people have another episode (relapse) of typhoid fever, although the relapse is usually not as severe as the first infection. Certain factors that can increase the risk for a relapse include:
_  Age over 50
_  Presence of gallstones
_  Female gender.

In many developing nations, the public health goals [read: infrastructure] that can help prevent and control typhoid — safe drinking water, improved sanitation and adequate medical care — may be difficult to achieve. For that reason, some experts believe that vaccinating high-risk populations is the best way to control typhoid fever.
Two vaccines are currently in use — one is injected in a single dose, and the other is given orally over a period of days. Neither vaccine is 100 percent effective, and both require repeat immunizations as vaccine effectiveness diminishes over time.

If you’re traveling to an area where typhoid fever is endemic, [or it becomes endemic in your community] consider being vaccinated. But because the vaccine won’t provide complete protection, be sure to follow these guidelines as well:
•  Wash your hands. Frequent hand washing is the best way to control infection. Wash your hands thoroughly with hot, soapy water, especially before eating or preparing food and after using the toilet. Carry an alcohol-based hand sanitizer for times when water isn’t available.
•  Avoid drinking untreated water. Contaminated drinking water is a particular problem in areas where typhoid is endemic. For that reason, drink only bottled water or canned or bottled carbonated beverages, wine and beer. Carbonated bottled water is safer than uncarbonated bottled water is. Wipe the outside of all bottles and cans before you open them. Ask for drinks without ice. Use bottled water to brush your teeth, and try not to swallow water in the shower.
•  Avoid raw fruits and vegetables. Because raw produce may have been washed in unsafe water, avoid fruits and vegetables that you can’t peel, especially lettuce. To be absolutely safe, you may want to avoid raw foods entirely.
•  Choose hot foods. Avoid food that’s stored or served at room temperature. Steaming hot foods are best. And although there’s no guarantee that meals served at the finest restaurants are safe, it’s best to avoid food from street vendors — it’s more likely to be contaminated.
[Typhoid prevention techniques are similar to those for ‘Travelers diarrhea’.]

To prevent infecting others
If you’re recovering from typhoid, these measures can help keep others safe:
•  Wash your hands often. This is the single most important thing you can do to keep from spreading the infection to others. Use plenty of hot, soapy water and scrub thoroughly for at least 30 seconds, especially before eating and after using the toilet.
•  Clean household items daily. Clean toilets, door handles, telephone receivers and water taps at least once a day with a household cleaner and paper towels or disposable cloths.
•  Avoid handling food. Avoid preparing food for others until your doctor says you’re no longer contagious. If you work in the food service industry or a health care facility, you won’t be allowed to return to work until tests show that you’re no longer shedding typhoid bacteria.
•  Keep personal items separate. Set aside towels, bed linen and utensils for your own use and wash them frequently in hot, soapy water. Heavily soiled items can be soaked first in disinfectant.

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(Survival manual/6. Medical/b) Disease/Scurvy)

What Is Scurvy?
Scurvy is a condition where an individual has a vitamin C (ascorbic acid) deficiency. The name scurvy comes from the Latin scorbutus, and humans have known about the disease since ancient Greek and Egyptian times. Scurvy commonly is associated with sailors in the 16th to 18th centuries who navigated long voyages without enough vitamin C and frequently perished from the condition. Modern cases of scurvy are very rare.

Humans are unable to synthesize vitamin C – which is necessary for collagen production and iron absorption – and so they must obtain it from external sources (such as citrus fruits). Therefore, people must consume fruits and vegetables that contain or are fortified with vitamin C in order to avoid the vitamin C deficiency known as scurvy.

Scurvy symptoms may begin with appetite loss, poor weight gain, diarrhea, rapid breathing, fever, irritability, tenderness and discomfort in legs, swelling over long bones, bleeding (hemorrhaging), and feelings of paralysis.
As the disease progresses, a scurvy victim may present bleeding of the gums, loosened teeth, petechial hemorrhage of the skin and mucous membranes (a tiny pinpoint red mark), bleeding in the eye, proptopsis of the eyeball (protruding eye), constochondral beading (beading of the cartilage between joints), hyperkeratosis (a skin disorder), corkscrew hair, and sicca syndrome (an automimmune disease affecting connective tissue).  Exhaustion, fainting, diarrhea, and lung and kidney trouble can follow.

Who gets scurvy?
Though scurvy is a very rare disease, it still occurs in some patients – usually elderly people, alcoholics, or those that live on a diet devoid of fresh fruits and vegetables. Similarly, infants or children who are on special or poor diets for any number of economic or social reasons may be prone to scurvy.

How is scurvy diagnosed?
Physicians initially will conduct a physical exam, looking for symptoms described above. Actual vitamin C levels can be obtained by using laboratory tests that analyze serum ascorbic acid levels (or white blood cell ascorbic acid concentration). Sometimes, radiological procedures are ordered for diagnostic purposes and to see what damage scurvy has already done.

How is scurvy treated?
Scurvy is treated by providing the patient with vitamin C, administered either orally or via injection. Orange juice usually functions as an effective dietary remedy, but specific vitamin supplements are also known to be effective.

How can scurvy be prevented?
Scurvy can be prevented by consuming enough vitamin C, either in the diet or as a supplement. Foods that contain vitamin C include:

Oranges          Lemons          Black currants
Guava             Kiwifruit         Papaya
Tomatoes       Strawberries  Carrots
Bell  peppers  Broccoli         Potatoes
Cabbage         Spinach           Paprika
Liver               Oysters

Preventing Scurvy
We’ve all  heard of scurvy and know the disease that causes spotty skin, spongy gums, bleeding and death can be prevented by consuming Vitamin C regularly. What do you do once your stockpile runs out? If you live in a climate that supports citrus, your concern is mild – but what about those of us living in colder climates?
•  Native North Americans didn’t suffer from scurvy although their diet consisted largely of wild game and corn. The reason is they regularly consumed pine tree bark and pine needle tea. Pine nuts are not the only useful part of the pine. Fresh green needles, steeped in boiling water for a few minutes make a tea that contains 8 times as much ascorbic acid (Vitamin C) as orange juice. Pine is an astringent, antiseptic and expectorant.
•  Native Americans also consumed the soft, white inner bark found under the woody outer layer of bark on the tree. It can be eaten raw, in slices or dried and ground up into a flour.
•  The more I learn about the benefits of pine trees, the more I realize how lucky we are here in North America where pine is plentiful in almost every climate zone. Next time I feel a cold coming on I plan on trying a cup of pine tea.

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Streptococcal Infections

(Survival manual/6. Medical/b) Disease/Streptococcal infections) 

Overview of streptococcal infections

Group A streptococcal (strep) infections are caused by group A streptococcus, a bacterium responsible for a variety of health problems. These infections can range from a mild skin infection or sore throat to severe, life-threatening conditions such as toxic shock syndrome and necrotizing fasciitis, commonly known as flesh eating disease.
Most people are familiar with strep throat, which along with minor skin infection, is the most common form of the disease. Health experts estimate that more than 10 million mild infections (throat and skin) like these occur every year.

In addition to step throat and superficial skin infections, group A strep bacteria can cause infections in tissues (group of cells joined together to perform the same function) at specific body sites, including lungs, bones, spinal cord, and abdomen.

In 2004, 3,833 cases of severe group A streptococcal disease were reported to the Centers for Disease Control and Prevention. All severe group A strep infections may lead to shock, organ failure, and death. Health care providers must recognize and treat such infections quickly.

1.  Strep throat
Symptoms of strep throat
Your health care provider may call it acute streptococcal pharyngitis. If you have strep throat infection, you will have a red and painful sore throat and may have white patches on your tonsils. You also may have swollen lymph nodes in your neck, run a fever, and have a headache. Nausea, vomiting, and abdominal pain can occur but are more common in children than in adults.

People at the greatest risk of getting a severe strep infection are
•  Children with chickenpox
•  People with suppressed immune systems
•  Burn victims
•  Elderly people with cellulitis, diabetes, blood vessel disease, or cancer
•  People taking steroid treatments or chemotherapy
•  Intravenous drug users

Indicators that increase
or decrease the likelihood of strep throat

Increased likelihood

Decreased likelihood

Age 3-14 years Age 45 years or older
High fever (> 100.4 °F) Afebrile (no fever)
Absence of a cough Cough
Exudative pharyngitis or tonsillitis Stuffy, runny nose; conjunctivitis
Anterior cervical adenitis Hoarseness
Current group A strep epidemic Discrete oral ulcerative lesions
Recent close exposure to group A strep Diarrhea

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Severe strep infections
Some types of group A strep bacteria cause severe infections. These include
•  Bacteremia (blood stream infections)
•  Toxic shock syndrome (multi-organ infection)
•  Necrotizing fasciitis (flesh-eating disease)

Transmission of strep throat
You can get strep throat and other group A strep infections by direct contact with saliva or nasal discharge from an infected person. Most people do not get group A strep infections from casual contact with others, but a crowded environment like a dormitory, school, or an institutional setting such as a nursing home can make it easier for the bacteria to spread. There have also been reports of contaminated food, especially milk and milk products, causing infection. You can get sick within 3 days after being exposed to the germ. Once infected, you can pass the infection to others for up to 2 to 3 weeks even if you don’t have symptoms. After 24 hours of antibiotic treatment, you will no longer spread the germs to others.

Diagnosis of strep throat
Your health care provider will take a throat swab. This will be used for a culture (a type of laboratory test) or a rapid strep test, which only takes 10 to 20 minutes. If the result of the rapid test is negative, you may get a follow-up culture to confirm the results, which takes 24 to 48 hours. If the culture test is also negative, your health care provider may suspect you do not have strep, but rather another type of infection. The results of these throat cultures will affect what your health care provider decides to be the best treatment. Most sore throats are caused by viral infections, however, and antibiotics are useless against them.

Treatment for strep throat
If you have a strep infection, your health care provider will prescribe an antibiotic. This will help reduce symptoms, and after 24 hours of taking the medicine, you will no longer be able to spread the infection to others. Treatment will also reduce the chance of complications.

Health experts think penicillin is the best medicine for treating strep throat because it has been proven to be effective, safe, and inexpensive. Your health care provider may have you take pills for 10 days or give you a shot. If you are allergic to penicillin there are other antibiotics your health care provider can give you to clear up the illness.

During treatment, you may start to feel better within 4 days. This can happen even without treatment. Still, it is very important to finish all your medicine to prevent complications. Children with strep throat are usually treated with amoxicillin.

Treatments and drugs
A number of medications are available to cure strep throat, relieve its symptoms and prevent its spread.
If you or your child has strep throat, your doctor will likely prescribe an oral antibiotic such as:
__A.  Penicillin. This drug may be given by injection in some cases — such as if you have a young child who is having a hard time swallowing or is vomiting from strep throat.
Penicillin V (Penicillin VK)
Since its introduction in the 1940s, penicillin has been the “gold standard” treatment for strep throat and still remains the drug of choice in many cases of strep throat. The ability of penicillin and other penicillin antibiotics (e.g., amoxicillin) to kill group A streptococci has not changed in more than 50 years. There has never been a group A streptococcus grown from a person that has been resistant to penicillin. Penicillin has proven efficacy and safety. It is a narrow-spectrum agent that does not promote antimicrobial resistance.
Penicillin V dosage:
•  Children: 250 mg two or three times daily for 10 days
•  Adults: 500 mg two or three times for daily 10 days
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__B.  Amoxicillin. This drug is in the same family as penicillin, but is often a preferred option for children because it tastes better and is available as a chewable tablet.
Amoxicillin, a broader spectrum penicillin, may have some advantages because of higher blood levels, longer plasma half-life, and lower protein binding activity. Suspensions of this drug taste better than penicillin V suspensions, and chewable tablets are available. However, gastrointestinal side effects and skin rash may be more common with amoxicillin.

Amoxicillin has no microbiologic advantage over the less expensive penicillin. Some studies show that amoxicillin given just once a day may work as well as penicillin V given more often.
Amoxicillin dosage:
•  Children: 40 mg/kg per day in three divided doses for 10 days
•  Adults: 500 mg three times daily for 10 days
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Symptom relievers
In addition to antibiotics, your doctor may suggest over-the-counter medications to relieve throat pain and reduce fever, such as:

•  Ibuprofen (Advil, Motrin, others)
•  Acetaminophen (Tylenol, others)

Because of the risk of Reye’s syndrome, a potentially life-threatening illness, don’t give aspirin to young children and teenagers. Be careful with acetaminophen, too.
Taken in large doses, it can cause liver problems. Read and follow label directions. Talk to your doctor or pharmacist if you have questions.
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Complications of strep throat
Untreated group A strep infection can result in rheumatic fever and post-streptococcal lomerulonephritis (PSGN).
Rheumatic fever develops about 18 days after a bout of strep throat and causes joint pain and heart disease. It can be followed months later by Sydenham’s chorea, a disorder where the muscles of the torso and arms and legs are marked with dancing and jerky movements. PSGN is an inflammation of the kidneys that may follow an untreated strep throat but more often comes after a strep skin
infection. Both disorders are rarely seen in the United States because of prompt and effective treatment of most cases of strep throat.

2.  Skin infections: Impetigo, Cellulitis, Erysipelas
a)  Impetigo
Impetigo is an infection of the top layers of the skin and is most common among children ages 2 to 6 years. It usually starts when the bacteria get into a cut, scratch, or insect bite. Impetigo is usually caused by staphylococcus (staph), a different bacterium, but can be caused by group A streptococcus. Skin infections are usually caused by different types (strains) of strep bacteria than those that cause strep throat. Therefore, the types of strep germs that cause impetigo are usually different from those that cause strep throat.
Symptoms of impetigo
Symptoms start with red or pimple-like lesions (sores) surrounded by reddened skin. These lesions can be anywhere on your body, but mostly on your face, arms, and legs. Lesions fill with pus, then break open after a few days and form a thick crust. Itching is common. Your health care provider can diagnose the infection by looking at the skin lesions.
Transmission of impetigo
The infection is spread by direct contact with wounds or sores or nasal discharge from an infected person. Scratching may spread the lesions. From the time of infection until you show symptoms is usually 1 to 3 days. If your skin doesn’t have breaks in it, you can’t be infected by dried streptococci in the air.
Treatment for impetigo
Impetigo can be treated with a topical ointment or oral antibiotic. Mupirocin is a typical ointment that may be prescribed by your doctor. Oral antibiotics such as penicillins or cephalosporins are used for more severe infections. To prevent the spread of the infection to other parts of the body, avoid scratching the blisters or sores. Because impetigo is commonly seen in children, it may be helpful to cut the fingernails and cover the affected areas of the body with bandages or gauze. It also is important to prevent the spread of infection to other individuals in close contact by not sharing things such as blankets, linens, toys, or clothing.

b) Cellulitis and erysipelas
Cellulitis is inflammation of the skin and deep underlying tissues. Erysipelas is an inflammatory disease of the upper layers of the skin. Group A strep germs are the most common cause of both conditions.
Symptoms of cellulitis and erysipelas
Symptoms of cellulitis may include fever and chills and swollen “glands” or lymph nodes. Your skin will be painful, red, and tender. Your skin may blister and then scab over. You may also have perianal (around the anus) cellulitis may with itching and painful bowel movements.
With erysipelas, a fiery red rash with raised borders may occur on your face, arms, or legs. Your skin will be hot, red, and have sharply defined raised areas. The infection may come back, causing chronic swelling of your arms or legs (lymphedema).
Transmission of cellulitis or erysipelas
Both cellulitis and erysipelas begin with a minor incident, such as a bruise. They can also begin at the site of a burn, surgical cut, or wound, and usually affect your arm or leg. When the rash appears on your trunk, arms, or legs, however, it is usually at the site of a surgical cut or wound. Even if you have no symptoms, you carry the germs on your skin or in your nasal passages and can transmit the disease to others.
Treatment of  cellulitis and erysipelas
Oral antibiotics are used to treat mild cellulitis; more severe cases must be treated with intravenous antibiotics in a hospital. Antibiotics that may be used include cephalosporins, dicloxacillin,  clindamycin, or vancomycin. Swelling can be lessened by elevating the affected area, such as the legs or arms. To stop cellulitis from occurring again, it is important to keep applying lotion to the skin and to maintain good skin cleanliness.

3.  Scarlet Fever
Scarlet fever is another form of group A strep disease  that can follow strep throat. It is usually contagious and lasts for a specific length of time whether or not it is treated.

Symptoms of scarlet fever
In addition to the symptoms of strep throat, a red rash appears on the sides of your chest and abdomen. It may spread to cover most of your body. This rash appears as tiny, red pinpoints and has a rough texture like sandpaper. When pressed on, the rash loses color or turns white. There may also be dark red lines in the folds of skin. You may get a bright strawberry-red tongue and flushed (rosy) face, while the area around your mouth remains pale. The skin on the tips of your fingers and toes often peels after you get better. If you have a severe case, you may have a high fever, nausea, and vomiting. 

What are the signs and symptoms of scarlet fever?
Scarlet fever usually starts with a sudden fever associated with sore throat, swollen neck glands, headache, nausea, vomiting, loss of appetite, swollen and red strawberry tongue, abdominal pain, body aches, and malaise.

Symptoms of  Scarlet Fever
The rash is the most striking sign of scarlet fever. It usually begins looking like a bad sunburn with tiny bumps and it may itch. The rash usually appears first on the neck and face, often leaving a clear unaffected area around the mouth. It spreads to the chest and back, then to the rest of the body. In body creases, especially around the underarms and elbows, the rash forms classic red streaks. Areas of rash usually turn white when you press on them. By the sixth day of the infection the rash usually fades, but the affected skin may begin to peel.

Aside from the rash, there are usually other symptoms that help to confirm a diagnosis of scarlet fever, including a reddened sore throat, a fever above 101° Fahrenheit (38.3° Celsius), and swollen glands in the neck. The tonsils and back of the throat may be covered with a whitish coating, or appear red,
swollen, and dotted with whitish or yellowish specks of pus. Early in the  infection, the tongue may have a whitish or yellowish coating. A child with scarlet fever also may have chills, body aches, nausea, vomiting, and loss of appetite.

When scarlet fever occurs because of a throat infection, the fever typically stops within 3 to 5 days, and the sore  throat passes soon afterward. The scarlet fever rash usually fades on the sixth day after sore throat symptoms began, but skin that was covered by rash may begin to peel. This peeling may last 10 days. With antibiotic treatment, the infection itself is usually cured with a 10-day course of antibiotics, but it may take a few weeks for tonsils and swollen glands to return to normal.

Scarlet fever, synopsis
The characteristic rash appears 12-48 hours after the start of the fever. The rash usually starts below the ears, neck, chest, armpits and groin before spreading to the rest of the body over 24 hours.
Scarlet spots or blotches, giving a boiled lobster appearance, are often the first sign of rash.
As skin lesions progress and become more widespread, they start to look like sunburn with goose pimples. The skin may have a rough sandpaper-like feel.
In body folds, especially the armpits and elbows, fragile blood vessels (capillaries) can rupture and cause classic red streaks called Pastia lines. These may persist for 1-2 days after the generalised rash has
In the untreated patient, the fever peaks by the second day and gradually returns to normal in 5-7 days. When treated with appropriate antibiotics, the fever usually resolves within 12-24 hours.
By about the sixth day of the infection the rash starts to fade and peeling, similar to that of sunburned skin, occurs. Peeling of the skin is most prominent in the armpits, groin, and tips of the fingers and/or toes and may continue up to 6 weeks.
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Transmission of scarlet fever
You can get scarlet fever the same way as strep throat-through direct contact with throat mucus, nasal discharge, and saliva of an infected person.

Treatments and drugs
A number of medications are available to cure strep throat, relieve its symptoms and prevent its spread.
Scarlet fever is treated with antibiotics. The standard treatment is penicillin, but amoxicillin is usually
given instead. Amoxicillin is a derivative of penicillin and tastes better, which makes it easier to give it to children.
Although treatment for just five days may be enough to treat the infection, treatment is given for ten days in order to prevent future complications of rheumatic fever and rheumatic heart disease.
Ten days of treatment has been proven to prevent these complications.[3]

If a person is allergic to penicillin, then erythromycin, clindamycin, or azithromycin is used. Azithromycin (Zithromax) may be used instead of penicillin because fewer doses are needed. However, it has not yet been proven that this azithromycin definitely prevents rheumatic fever or rheumatic heart disease.

An intramuscular dose of penicillin G as a one-time shot is also effective and may be used instead, particularly where compliance may be difficult. Some parents of children with scarlet fever and some adults may prefer the one-time shot instead of the 10-day course of antibiotics.

There is no need to retest a person who has been treated for strep throat or scarlet fever, as the cure rate is virtually 100%.

Home comfort
•  Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin and others) to relieve pain and reduce fever
•  Soothing gargles to fight sore throat (in adults and older children who can gargle safely)
•  A cool-mist humidifier to soothe the breathing passages and throat
•  A liquid diet, including warm soups or cold milkshakes, if the patient’s sore throat makes it difficult to swallow solid foods

You Need To Know
•  The rash of scarlet fever is caused by streptococcal pyrogenic exotoxins produced by certain strains of the group A strep bacteria that causes strep throat. Since not all strains of strep produce this exotoxin, you don’t get scarlet fever every time you get strep throat.
•  The rash of scarlet fever usually lasts about 3 or 4 days.
•  Scarlet fever used to be a much more serious infection then it is today.
•  Children with scarlet fever are contagious until they have been on an antibiotic for at least 24 hours.
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Common cold

      The common cold is a viral infection of your upper respiratory tract — your nose and throat. A common cold is usually harmless, although it may not feel that way. If it’s not a runny nose, sore  throat and cough, it’s the watery eyes, sneezing and congestion — or maybe all of the above. In fact, because any one of more than 100 viruses can cause a common cold, signs and symptoms tend to vary greatly.
Preschool children are at greatest risk of frequent colds, but even healthy adults can expect to have a few colds each year. Most people recover from a common cold in about a week or two. If symptoms don’t improve, see your doctor.

      Symptoms of a common cold usually appear about one to three days after exposure to a cold-causing virus. Signs and symptoms of a common cold may include:

  • Runny or stuffy nose
  • Itchy or sore throat
  • Cough
  • Congestion
  • Slight body aches or a mild headache
  • Sneezing
  • Watery eyes
  • Low-grade fever
  • Mild fatigue

The discharge from your nose may become thicker and yellow or green in color as a common cold runs its course. What makes a cold different from other viral infections is that you generally won’t have a high fever. You’re also unlikely to experience significant fatigue from a common cold.

When to see a doctor
For adults — seek medical attention if you have:

  • Fever of 103 F (39.4 C) or higher
  • Fever accompanied by sweating, chills and a cough with colored phlegm
  • Significantly swollen glands
  • Severe sinus pain

For children — in general, children are sicker with a common cold than adults are and often develop complications, such as ear infections. Your child doesn’t need to see the doctor for a routine common
cold. But seek medical attention right away if your child has any of the following signs or symptoms:

  • Fever of 103 F (39.4 C) or higher in children age 2 or older
  • Fever of 102 F (38.9 C) or higher in children ages 6 weeks to 2 years
  • Fever of 100 F (37.8 C) in newborns up to 6 weeks
  • Signs of dehydration, such as urinating less often than usual
  • Not drinking adequate fluids
  • Fever that lasts more than three days
  • Vomiting or abdominal pain
  • Unusual sleepiness
  • Severe headache
  • Stiff neck
  • Difficulty breathing
  • Persistent crying
  • Ear pain
  • Persistent cough

If symptoms in a child or an adult last longer than 10 days, call your doctor.

Although more than 100 viruses can cause a common cold, the rhinovirus is the most common culprit, and it’s highly contagious.
A cold virus enters your body through your mouth or nose. The virus can spread through droplets in the air when someone who is sick coughs, sneezes or talks. But it also spreads by hand-to-hand contact with someone who has a cold or by using shared objects, such as utensils, towels, toys or telephones. If you touch your  eyes, nose or mouth after such contact or exposure, you’re likely to “catch” a cold.

Risk factors
Cold viruses are almost always present in the environment. But the following factors can increase your chances of getting a cold:
•  Age. Infants and preschool children are especially susceptible to common colds because they haven’t yet developed resistance to most of the viruses that cause them. But an immature immune system isn’t the only thing that makes kids vulnerable. They also tend to spend lots of time with other children and frequently aren’t careful about washing their hands and covering
their mouth and nose when they cough and sneeze. Colds in newborns can be problematic if they interfere with nursing or breathing through the nose.
•  Immunity. As you age, you develop immunity to many of the viruses that cause common colds. You’ll have colds less frequently than you did as a child. However, you can still come down with a cold when you are exposed to cold viruses or have a weakened immune system. All of these
factors increase your risk of a cold.
•  Time of year. Both children and adults are more susceptible to colds in fall and winter. That’s because children are in school, and most people are spending a lot of time indoors. In places where there is no winter season, colds are more frequent in

•  Acute ear infection (otitis media). Ear  infection occurs when bacteria or viruses infiltrate the space behind the eardrum. It’s a frequent complication of common colds in children. Typical
signs and symptoms include earache and, in some cases, a green or yellow discharge from the nose or the return of a fever following a common cold.
Children who are too young to verbalize their distress may simply cry or sleep restlessly. Ear pulling is not a reliable sign.
•  Wheezing. A cold can trigger wheezing in children with asthma.
•  Sinusitis. In adults or children, a common  cold that doesn’t resolve may lead to sinusitis — inflammation and infection of the sinuses.
•  Other secondary infections. These include strep throat (streptococcal pharyngitis), pneumonia, bronchitis in adults, and croup or bronchiolitis in children. These infections need to be treated by a doctor.

Treatment and drugs
There’s no cure for the common cold.
Antibiotics are of no use against cold viruses. Over-the-counter (OTC) cold preparations won’t cure a common cold or make it go away any sooner, and most have side effects. Here’s a look at the pros and cons of some common cold remedies.
•  Pain relievers. For fever, sore throat and headache, many people turn to acetaminophen (Tylenol, others) or other mild pain relievers. Keep in mind that acetaminophen can cause liver damage,
especially if taken frequently or in larger than recommended doses. Don’t give acetaminophen to children under 3 months of age, and be especially careful when giving acetaminophen to older babies and children because the dosing guidelines can be confusing. Never give aspirin  to children. It has been associated with Reye’s syndrome — a rare but potentially fatal illness.
•  Decongestant nasal sprays. Benadryl® Allergy contains the histamine-blocker diphenhydramine. This product relieves: runny nose; sneezing; itchy, watery eyes; itchy throat.
Adults shouldn’t use decongestant drops or sprays for more than a few days because prolonged use can cause chronic rebound inflammation of mucous membranes. And children shouldn’t use decongestant drops or sprays at all. There’s little evidence that they work in young children, and they may cause side effects.
•  Cough syrups. Mucinex Oral This medication is used for the temporary relief of coughs caused by the common cold, bronchitis, and other breathing illnesses. Dosage is based on your age, medical condition, and response to treatment.  Pasted from

Note: The Food and Drug Administration (FDA) and the American Academy of Pediatrics strongly recommend against giving OTC cough and cold medicines to children younger than age 2.
Over-the-counter cough and cold medicines don’t effectively treat the underlying cause of a child’s cold, and won’t cure a child’s cold or make it go away any sooner. These medications also have potential side effects, including rapid heart rate and convulsions. Don’t give your child two medicines with the same active ingredient, such as an antihistamine, decongestant or pain reliever.

Lifestyle and home remedies
You may not be able to cure your common cold, but you can make yourself as comfortable as possible. These tips may help:
1.  Drink lots of fluids. Water, juice, clear broth or warm lemon water are all good choices. They help replace fluids lost during mucus production or fever. Avoid alcohol and caffeine, which can cause dehydration, and cigarette smoke, which can aggravate your symptoms.
2.  Try chicken soup. Generations of parents have spooned chicken soup into their sick children’s mouths. Now scientists have put chicken soup to the test, discovering that it does seem to help relieve cold and flu symptoms in two ways. First, it acts as an anti-inflammatory by inhibiting the
movement of neutrophils — immune system cells that help the body’s response to inflammation. Second, it temporarily speeds up the movement of mucus through the nose, helping relieve congestion and limiting the time viruses are in contact with the nasal lining.
3.  Get some rest. If possible, stay home from work if you have a fever or a bad cough, or are drowsy after the medications. This will give you a chance to rest as well as reduce the chances that you’ll infect
others. Wear a mask when you have a cold if you live or work with someone with a chronic disease or compromised immune system.
4.  Adjust your room’s temperature and humidity. Keep your room warm, but not overheated. If the air is dry, a cool-mist humidifier or vaporizer can moisten the air and help ease congestion and coughing. Be sure to keep the humidifier clean to prevent the growth of bacteria and molds.
5.  Soothe your throat. A saltwater gargle — 1/4 to 1/2 teaspoon (1.2 milliliters to 2.5 milliliters) salt dissolved in an 8-ounce (237 milliliters) glass of warm water — can temporarily relieve a sore or scratchy throat.
6.  Use saline nasal drops. To help relieve nasal congestion, try saline nasal drops. You can buy these drops over-the-counter, and they’re effective, safe and nonirritating, even for children. In infants, experts recommend instilling several saline drops into one nostril, then gently suctioning that nostril with a bulb syringe (push the bulb in about 1/4 to 1/2 inch, or about 6 to 12 millimeters). Doing this before feeding your baby can improve your child’s ability to nurse or take a bottle, and before bedtime it may improve sleep. Saline nasal sprays may be used in older children.

Alternative medicine
Various herbs and supplements are popular for preventing or relieving colds, but scientific support is uneven for most. Here’s an update on some popular choices:
Zinc. A comprehensive analysis of clinical-trial data on zinc and colds concluded that zinc actually appears to be beneficial. The conclusion comes with a few caveats. Researchers haven’t determined the most effective formulation, dose or duration of zinc treatment for colds. Zinc lozenges can leave a bad taste in your mouth, and some trial participants reported nausea as a side effect of the lozenges. Zinc-based nasal sprays, not included in the recent, positive analysis, pose a different problem. The FDA warns that these products can take away your sense of smell, possibly for good.
Vitamin C. It appears that for the most part taking vitamin C won’t help the average person prevent colds. However, taking vitamin C at the onset of cold symptoms may shorten the duration of symptoms.
Echinacea. Studies on the effectiveness of echinacea at preventing or shortening colds are mixed. Some studies show no benefit. Others show a significant reduction in the severity and duration of
cold symptoms when taken in the early stages of a cold. One reason study results have been inconclusive may be that the type of echinacea plant and preparation used from one study to the next have varied considerably. Research on the role of echinacea in treating the common cold is ongoing. In the meantime, if your immune system is healthy and you are not taking prescription medications, using echinacea supplements is unlikely to cause harm.

      No vaccine has been developed for the common cold, which can be caused by many different viruses. But you can take some common-sense precautions to slow the spread of cold viruses:
1.  Wash your hands. Clean your hands thoroughly and often, and teach your children the importance of hand washing. Wash hands immediately upon arriving home from any ‘away’ activities.
2.  Scrub your stuff. Keep kitchen and bathroom countertops clean, especially when someone in your family has a common cold. Wash children’s toys periodically.
3.  Use tissues. Always sneeze and cough into tissues. Discard used tissues right away, and then wash your hands carefully. Teach children to sneeze or cough into the bend of their elbow when they don’t
have a tissue. That way they cover their mouths without using their hands.
4.  Don’t share. Don’t share drinking glasses or utensils with other family members. Use your own glass or disposable cups when you or someone else is sick. Label the cup or glass with the name of the person with the cold.
5.  Steer clear of colds. Avoid close, prolonged contact with anyone who has a cold.
6.  Choose your child care center wisely. Look for a child care setting with good hygiene practices and clear policies about keeping sick children at home.
(Survival Manual/6. Medical/b) Disease/Common cold)

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