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  • William W. Forgey, MD

Bioterrorism and Infectious Disease part 3 of 3

Updated: Nov 12, 2020



Excerpt from The Prepper's Medical Handbook. Page reference numbers point to more in-depth treatment and self-reliant care available within the book.


STARI

Southern tick-associated rash illness (STARI) develops around the site of a lone star tick bite and develops within 7 days of the bite. It can expand to a diameter of 3 inches (8 centimeters). Patients possibly experience fatigue, headache, fever, and muscle pains. Lone star tick bites almost always cause a local small inflamed area, but that by itself is not an indication that a patient has STARI. Lone star ticks do not carry Lyme disease. While the CDC does not recommend, at the time of this writing, the use of antibiotics in treating STARI, since the causative organism is not known, studies have shown taking an antibiotic such as doxycycline clears the symptoms quicker.



Tapeworms

Three species of tapeworm infect humans: Taenia saginata larvae found in beef, T. solium in pork, and Diphyllobothrium latum in fish. In all three the human ingests undercooked flesh of the host animal, acquiring the infective cysts.


The beef tapeworm can be huge, forming lengths of 10 to 30 feet inside the human host. It is common in Mexico, South America, Eastern Europe, the Middle East, and Africa. Symptoms can include stomach pain, weight loss, and diarrhea, but frequently the human host has no clue of the infestation.


The pork tapeworm infects victims in South America, eastern Europe, Russia, and Asia. Generally, it is without symptoms; at times vague abdominal complaints are noted. A complication of this disease is cysticercosis: The tapeworm larvae penetrate the human intestinal wall—after the human drinks infected water—and invade body tissues, frequently skeletal muscle and the brain. There they mature into cystic masses. After several years the cysts degenerate and produce local inflammatory reactions that can then cause convulsions, visual problems, or mental disturbances. In this case the human replaces the pig in the maturation cycle of the tapeworm, and it is the human flesh that is contaminated by the tapeworm cyst. This is an unlucky break for the involved human and any cannibals he might meet. Any water filtration or purification system can prevent cysticercosis.


The fish tapeworm occurs worldwide but is a particular hazard in Scandinavia and the Far East. A single tapeworm, usually without symptoms, develops. The worm’s absorption of vitamin B-12 may cause pernicious anemia in the host.



Tetanus

Although caused by a bacterium (Clostridium tetani) that is located worldwide, most cases of tetanus occur from very minor wounds such as a paper cut, rather than from rusty barbed wire, as so many people think. In fact, a hiker on the Appalachian Trail got tetanus from a blister on his heel and inadequate immunization. Onset is gradual, with an incubation period of 2 to 50 (usually 5 to 10) days. The earliest symptom is stiffness of the jaw, then sore throat, stiff muscles, headache, low-grade fever, and muscle spasm. As the disease progresses, the patient is unable to open their jaw, and the facial muscles may be fixed in a smile with elevated eyebrows. Painful generalized spasms of muscles occur with minor disturbances such as drafts, noise, or someone jarring the patient’s bed. Death from loss of respiratory muscle function, or even unknown causes, may ensue. The disease is frequently fatal. Prevention is obtained by adequate immunization.


Tick Paralysis

Five species of ticks in North America produce a neurotoxin in their saliva that can paralyze their victims. Most cases are found in the Pacific Northwest, Rocky Mountain states, and seven southern states, as well as Australia. Spring and summer are the times of highest risk. The toxin is usually carried by an engorged pregnant tick. Symptoms begin 2 to 7 days after the tick begins feeding. Throughout the ordeal the patient’s mental function is usually spared. Symptoms start as weakness in the legs, which progressively ascends until the entire body is paralyzed within several hours to days. At times the condition presents as ataxia (loss of coordination) without muscle weakness.


The diagnosis is made by finding an embedded tick. After removing the tick, symptoms resolve in hours to days, rarely longer. Untreated tick paralysis can be fatal, with mortality rates of 10 to 12%.


Trichinosis

Trichinosis is caused by eating improperly cooked meat infected with the cysts of this parasite, the roundworm Trichinella spiralis. It is most common in pigs, bears (particularly polar bears), and some marine mammals. Nausea and diarrhea or intestinal cramping may appear within 1 to 2 days, but it generally takes 7 days after digestion. Swelling of the eyelids is very characteristic on the 11th day. After that, muscle soreness, fever, pain in the eyes, and subconjunctival hemorrhage (see page 49) develop. If enough contaminated food is ingested, this can be a fatal disease. Most symptoms disappear in 3 months.


Treatment is with pain medication (Percogesic from the Non-Rx Oral Medication Module, or Norco 10/325 from the Rx Oral Medication Module). The use of steroids such as Decadron (20 mg/day for 3 or 4 days, followed by reduced dosage over the next 10 days) is indicated in severe cases. Specific drugs are available for treatment of this disease (albendazole and, when available, mebendazole). The best prevention is cooking suspected meat at 150°F (66°C) for 30 minutes for each pound of meat.



Trypanosomiasis, African (African Sleeping Sickness)

While it is very likely that you are not leaving the grid for Africa, the African variety of trypanosomiasis is interesting as it is so different from the American variety, which you may encounter if you are heading to Central America or South America. Two species of trypanosomes cause African trypanosomiasis (African sleeping sickness), which is transmitted by the bite of the tsetse fly. The severity of the disease depends upon the species encountered. The infection zone is confined to the area of Africa between 15 degrees north and 20 degrees south of the equator—the exact distribution of the tsetse fly. Humans are the only reservoir of Trypanosoma gambiense found in west and central Africa, while wild game is the principal reservoir of the T. rhodesiense of east Africa.


T. gambiense infection starts with a nodule or a chancre that appears briefly at the site of a tsetse fly bite. Generalized illness appears months to years later and is characterized by lymph node enlargement at the back of the neck and intermittent fever. Months to years after this development, invasion of the central nervous system may occur, noted by behavioral changes, headache, loss of appetite, backache, hallucinations, delusions, and sleeping too much. In T. rhodesiense infection the generalized illness begins 5 to 14 days after the nodule or chancre develops. It is much more intense than the Gambian variety and may include acute central nervous system and cardiac symptoms, fever, and rapid weight loss. It has a high rate of mortality. If untreated, death usually occurs within 1 year. Specific, but frequently toxic, therapy is available.




Trypanosomiasis, American (Chagas Disease)

Chagas disease (American trypanosomiasis), caused by Trypanosoma cruzi, a protozoan hemoflagellate, is transmitted through the feces of a brown insect called the “kissing bug,” or the “assassin bug” in North America. This bug is a member of the family Reduviidae. The bug’s popular name in South America is vinchuca, derived from a word which means “one who lets himself fall down.” These bugs live in palm trees or the thatching in native huts and like to drop onto their sleeping victim’s face or exposed arms. When biting victims, the bug defecates. The itch of the wound causes bitten patients to scratch the wound, rubbing the feces into the bite site, thus causing the inoculation of the infectious agent. This disease is found in parts of South and Central America, but the vector for the disease (the kissing bug) is located in the southwestern United States. At first this disease may have no symptoms. A chagoma, or red nodule, develops at the site of the original infection. This area may then lose its pigmentation. After 1 to 2 weeks, a firm swelling of one eyelid occurs, known as Romana’s sign. The swelling becomes purplish in color, and lymph node swelling in front of the ear on the same side may occur. In a few days a fever develops, with generalized lymph node swelling. Rapid heart rate, spleen and liver enlargement, swelling of the legs, and meningitis or encephalitis may occur. Serious conditions also can include acute heart failure. In most cases, however, the illness subsides in about 3 months and the patient appears to live a normal life. The disease continues, however, slowly destroying the heart, until 10 to 20 years later, chronic congestive heart failure becomes apparent. The underlying cause may never be known, especially in a traveler who has left the endemic area. In some areas of Brazil, the disease attacks the colon, causing flaccid enlargement with profound constipation.


This disease is a leading cause of death in South America, generally due to heart failure. As many as 15 million people in South America may be infected.


Tuberculosis

Tuberculosis (TB) is caused by one of two bacteria, Mycobacterium tuberculosis or M. bovis. The infection results in a chronic illness that can reactivate many years after it apparently has been killed. In the United States there are 20,000 new cases, with 1,800 deaths, yearly. Worldwide there are 8 to 10 million new cases, with 2 to 3 million deaths annually. This disease is spread primarily by inhalation of infected droplets. The disease also spreads by drinking infected milk or eating infected dairy products such as butter. If milk cannot be pasteurized, the animals from which it is sourced (cows, goats, etc.) should be tuberculin-free. In my practice I once treated an elderly lady from southern Indiana who had widespread tuberculosis, which she had caught from drinking goat’s milk.


Active pulmonary disease usually develops within a year of contact. The early symptoms of fever, night sweats, lethargy, and weight loss can be so gradual that they are initially ignored.Tuberculosis usually infects the lungs, but it can spread throughout the body, causing neurological damage, bone infections, and overwhelming infection. Diagnosis is usually made with a chest X-ray.


Tularemia

Tularemia (rabbit fever, deerfly fever) can be contracted through exposure to ticks, deerflies, or mosquitoes. Cuts can be infected when working with rabbit pelts. Eating improperly cooked infected rabbits can result in onset. Similarly, muskrats, foxes, squirrels, mice, and rats can spread the disease via direct contact with their carcasses. Stream water may become contaminated by these animals.


An ulcer appears when a wound is involved, and lymph nodes become enlarged, first in nearby areas and then throughout the body. Pneumonia normally develops. The disease lasts 4 weeks in untreated cases. Mortality in treated cases is almost zero, while in untreated cases it ranges from 6 to 30%.


Treatment of choice is streptomycin, but the doxycycline suggested for the Rx Oral/Topical Medication Module works extremely well. The average adult would require an initial dose of 2 tablets, followed by 1 tablet every 12 hours. Continue therapy for 5 to 7 days after the fever has broken.




Typhoid Fever

Caused by the bacterium Salmonella typhi, typhoid fever is spread by contaminated food and dairy products. Prevention is proper food storage, the thorough cooking of food, and avoidance of unrefrigerated dairy products.


The disease is characterized by headache, chills, loss of appetite, backache, constipation, nosebleed, and tenderness of the abdomen to palpation. The temperature rises daily for 7 to 10 days. The fever is maintained at a high level for 7 to 19 more days, then drops over the next 10 days. With typhoid fever, a pulse rate of only 84 may occur with a temperature of 104°F (40°C), when one might otherwise expect a pulse rate of over 120. Between the 7th and 10th days of the illness, rose-colored splotches, which blanch when pressure is applied, appear in 10% of patients.


The drug of choice for treating this illness is Rocephin, given at 30 mg/kg of body weight/day IM in 2 divided doses per day for 2 weeks. An oral drug that can be used is Levaquin, 500 mg given once daily. Diarrhea may be severe in the latter stages of this illness. Replacement of fluids is especially important during the phases of high fever or diarrhea (see page 88). Patients with relapses should be given another 5-day course of the antibiotic. Immunization prior to departure to endemic areas is useful in preventing or curtailing the severity of this infection and should be taken by anyone traveling to an endemic area. This disease is very common after mass disaster situations, and while immunization is not usually indicated for living in the US, it is a disease to be aware of if the grid collapses.


Endemic Typhus, Flea-Borne

This disease is also known as murine typhus, rat-flea typhus, New World typhus, Malaya typhus, and urban typhus. It is one of several diseases caused by rickettsia, which resemble both viral and bacterial infections. Other diseases caused by this order are Rocky Mountain spotted fever, Q fever, trench fever, and the various typhus diseases. Endemic typhus is due to Rickettsia typhi, which is located worldwide, including the southern Atlantic and Gulf Coast states of the United States. It is spread to humans through infected rat flea feces.


After an incubation period of 6 to 18 days (mean 10 days), shaking chills, fever, and headache develop. A rash forms, primarily on the trunk, but fades fairly rapidly. The fever lasts about 12 days. This is a mild disease and fatalities are rare. Antibiotic treatment with doxycycline, 100 mg given twice daily, is very effective. Prevention is directed toward vector (rat and flea) control.


Epidemic Typhus, Louse-Borne

This malady is also called classic typhus, European typhus, and jail fever. It killed 3 million people during World War II. On the positive side, no American traveler has contracted this disease since 1950. It is most likely to be encountered in mountainous regions of Mexico, Central and South America, the Balkans, eastern Europe, Africa, and many countries of Asia. The causative agent is Rickettsia prowazekii, which is transmitted by infected lice.


Following a 7to 14-day incubation period, there is a sudden onset of high fever (104°F, or 40°C), which remains at a high level, with a usual morning decrease, for about 2 weeks. There is an intense headache. A light pink rash appears on the 4th to 6th day, soon becoming dark red. There is low blood pressure, pneumonia, mental confusion, and bruising in severe cases. Mortality is rare in children less than 10 years of age but may reach greater than 60% in those over 50. Antibiotics, such as doxycycline, 100 mg twice daily, are very effective if given early in the disease. Prevention is proper hygiene and delousing when needed. A vaccine was formerly made in the United States but is no longer available and is not needed due to the low incidence observed.


West Nile Virus

This is an arbovirus that primarily infects birds, especially crows, ravens, and robins. Mosquitoes then spread this virus to all mammals, which unfortunately includes humans. A sign of local West Nile virus activity can be dead birds, especially crows, ravens, and robins. In North America the mosquito vector is the culex, which is unfortunate as these mosquitoes do not usually announce their presence by buzzing in your ears or leaving welts when they bite. They are silent, stealth biters. If you are being buzzed and welt up, you don’t have to worry about it being from a culex mosquito.


West Nile virus was first identified in the United States in 1999 and has presented in all states and in all provinces of Canada (with rare exceptions). The disease is usually without symptoms, but when more severe it results in fever, headache, stiff neck, nausea or vomiting, muscle aches and weakness, and even coma and death. It does not spread from person to person, except via blood transfusion. Support is accomplished with adequate pain medication, evacuation if possible, and generally helping with normal body functions.


Yellow Fever

An arbovirus, yellow fever is found in tropical areas of South and Central America and Africa. This viral disease is contracted by the bite of the Aedes aegypti mosquito (and other species). Onset, about 2 weeks after the bite, is sudden, with a fever of 102 to 104°F (40°C). The pulse is usually rapid the first day, but becomes slow by the second day. In mild cases the fever falls suddenly 2 to 5 days after onset. This remission lasts for hours to several days. Next the fever returns, but the pulse remains slow. Jaundice, vomiting of black blood, and severe loss of protein in the urine (causing it to become foamy) occurs during this stage. Hemorrhages may be noted in the mouth and skin (petechiae). The patient is confused, and the senses are dulled. Delirium, convulsions, and coma occur before death in approximately 10% of cases. If the patient survives, this last febrile episode lasts from 3 to 9 days. With remission the patient is well, with no aftereffects from the disease.


Immunization is available and required or recommended for travel to many countries. It was once a common disease in the US, and we have the mosquito here that can spread it again.


Zika Virus

This is a viral disease spread by a daytime biting mosquito that frequently lives in human habitats, the Aedes alopictus. As the range of this beast is well into the northern areas of the United States, and it can also carry dengue, chikungunya, and West Nile virus, febrile illness associated with muscle and joint pain, and at times rash and/ or eye irritation, could be any one of these diseases. Avoid the use of aspirin or meloxicam, but treat instead with Tylenol or Ultram. Due to possible birth defects from this disease, pregnant women will need to have a careful specialist follow-up. Prevention is the use of mosquito protection as indicated on page 204, and since this disease can be spread sexually, use of condoms for at least 6 months after exposure or illness. Persons traveling into a Zika-infested area should continue to wear mosquito repellant at least 2 weeks after they leave to prevent a mosquito in a disease-free area from biting and spreading this illness into the community. Frequently the ache and other symptoms of Zika are very mild, and a person can contract it without even knowing they have had it or are carrying it.







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