Introduction

Salmonella infection (salmonellosis) is a common bacterial infection of the intestinal tract. Salmonella typically live in the intestines of animals and humans and are shed through feces, where the bacteria remain highly contagious. Humans become infected most frequently through contaminated food sources, such as poultry, meat and eggs.

Typically, people with salmonella infection develop diarrhea, fever and abdominal cramps within 12 to 72 hours. Signs and symptoms of salmonella infection generally last four to seven days. Most healthy people recover without specific treatment.

In some cases, diarrhea can be extremely dehydrating and require prompt medical attention. Life-threatening complications may also develop should the infection spread beyond your intestines.

Your risk of salmonella infection is higher if you travel to countries with poor sanitation. Preventive measures include proper cooking, good hygiene such as hand washing, and avoiding raw or undercooked eggs and meat.

Signs and symptoms

In general, salmonella symptoms begin with nausea and vomiting and progress to abdominal pains and diarrhea. Additional signs and symptoms include fever, chills and muscle pains, and can last anywhere from several days to two weeks.

There are more than 2,000 types of salmonella bacteria, although fewer than a dozen types are responsible for most illness in humans. Other symptoms may be present depending on the type of salmonella germ causing your infection. The most prevalent salmonella-related illnesses are:

• Gastroenteritis. This increasingly common salmonella-induced illness is caused by the S. enteritidis bacterium, which is most often ingested through raw or undercooked meat, poultry, eggs or egg products. The incubation period ranges from several hours to two days, and additional signs include blood in the stool.
• Enteric fever. Also known as typhoid fever, this illness is caused by the S. typhi bacterium and is most commonly contracted by drinking salmonella-contaminated water. The incubation period ranges from five to 21 days following infection. Additional signs and symptoms may include constipation, cough, sore throat, headache and mental confusion. Slightly raised, rose-colored spots on your upper chest also may appear. In addition, a slowing of your heartbeat (bradycardia) and enlargement of your liver and spleen (hepatosplenomegaly) may be present.
• Bacteremia. This condition results when salmonella bacteria enter and circulate throughout your bloodstream. Infants and people with compromised immune systems are at special risk of developing serious complications, including infection of tissues surrounding the brain and spinal cord (meningitis) and infection within the bloodstream (sepsis). People with salmonella-induced bacteremia may show few symptoms; however, fever can be present.

If you have intestinal salmonella and you have a healthy immune system, you may not seem ill or show signs or symptoms. However, you may continue to shed the bacteria in your feces and remain contagious for up to a year.

Causes

Salmonella infection begins when you ingest one of the various types of salmonella bacteria — with S. enteritidis, S. typhi and S. choleraesuis responsible for most salmonella-related illnesses. Those bacteria that survive the acidic environment of your stomach then travel to your small intestine and adhere to its lining, where they begin their life cycle. Fresh bacteria are shed in your feces, where they remain highly contagious.

You can contract salmonella infection by touching or ingesting anything contaminated with salmonella bacteria. Reservoirs for the microorganism include pet reptiles, dogs and cats, pigs and cattle, infected humans, contaminated water, raw dairy products and chicken eggs. Salmonella can survive for months in water, ice, sewage and frozen meat.

Most frequently, humans come in contact with salmonella through food sources such as contaminated poultry, meat, eggs and egg products.

Methods of salmonella infection include:

• Swallowing or putting something contaminated with salmonella into your mouth
• Drinking water contaminated with salmonella
• Touching contaminated reptiles, including iguanas, turtles or snakes — about 90 percent of reptiles carry salmonella
• Touching contaminated pet rodents
• Eating raw or undercooked food contaminated with salmonella
• Touching your hand to your mouth if your hand has been in contact with a contaminated surface or object
• Having close contact with other infected people or animals — especially their feces — allowing bacteria to be transmitted from your hands to your mouth

Risk factors

The risk factors for becoming infected with salmonella include:

• Being exposed to contaminated food or water
• Ingesting improperly cooked or stored food, especially poultry, meat or eggs
• Traveling internationally, especially to countries with poor sanitation
• Having infected family members
• Owning a pet reptile, such as an iguana, lizard or turtle
• Having an impaired immune system, such as people with AIDS and transplant recipients
• Having inflammatory bowel disease, in which damage to the lining of your gastrointestinal tract reduces barriers to salmonella entering your small intestine
• Having sickle cell disease, which lowers your immunity to infection
• Having a disease such as malaria or sickle cell anemia, which impairs phagocytes — cells in your body that attack pathogens
• Using corticosteroids, which suppress your immune system
• Using antacids, which lowers stomach acidity and reduces barriers to salmonella entering your small intestine

When to seek medical advice

Seek medical attention if you develop diarrhea that doesn’t clear within several days or is accompanied by blood in your stool. Also call a health care provider if you experience severe vomiting, abdominal pain or dehydration.

Screening and diagnosis

The simplest way to diagnose salmonella infection is to isolate the bacteria in a stool or other culture. Typically, your doctor will ask for a stool sample and send it to a laboratory, where a technician will try to grow and identify the infectious organism under a microscope.

Although salmonella infection elsewhere in your body isn’t always present in your bloodstream, a blood culture might help identify certain types of bacteria and rule out other pathogens.

Complications

Salmonella infection itself isn’t life-threatening. However, in certain people — especially children, older adults, transplant recipients and people with a weakened immune system — the development of complications can be dangerous.

Complications of salmonella infection may include:

• Reiter’s syndrome — an inflammatory condition characterized by eye irritation, painful urination and painful joints — which can lead to chronic arthritis
• Severe dehydration
• Infection of the tissues surrounding your brain and spinal cord (meningitis)
• Infection of your bloodstream (blood poisoning or septicemia)
• Inflammation of the lining of your heart or valves (endocarditis)
• Infection of your bones or bone marrow (osteomyelitis)
• Spread of infection to other parts of your body

Treatment

There’s no reliable treatment for salmonella intestinal infection, and recovery usually depends on the health of your immune system. In most otherwise healthy people, diarrhea and abdominal pains subside within several days to two weeks without specific treatment.

For people with weakened immune systems, the illness can endure and lead to severe diarrhea, fever and significant dehydration and malnutrition. The goal of salmonella treatment is to replace lost fluids, alleviate signs and symptoms, improve your immune response and destroy the invading pathogens. These options include:

• Fluid replacement. You’ll need to replace fluids and electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body — lost to persistent diarrhea. This can be done either by drinking lots of liquids, or in cases of serious fluid loss, receiving fluids intravenously. These precautions will help keep your body hydrated and functioning properly.
• Dietary modifications. Avoid milk products to help alleviate abdominal pains. Substitute stomach-soothing foods, including bananas, rice, apples and toast.
• Antibiotics. If infection has traveled outside your intestine, antibiotic medications can help destroy or inhibit the growth of salmonella bacteria. These drugs include ciprofloxacin (Cipro), a sulfamethoxazole and trimethoprim combination (Bactrim), ceftriaxone (Rocephin) and amoxicillin (Amoxil). Duration of treatment may vary depending on your illness, and range from 14 days for enteric fever to six weeks for bacteremia. Resistance to antibiotics is increasingly reported in various strains of salmonella.
• Antidiarrheals. These medications relieve diarrhea by slowing down intestinal movements and increasing fluid absorption. These drugs include loperamide (Anti-Diarrheal Formula, Imodium).

Prevention

Salmonella infection is contagious, so take precautions to avoid spreading bacteria to others.

Preventive methods are especially important when preparing food or providing care for infants, older adults and people with compromised immune systems.

Follow these suggestions:

• Keep eggs adequately refrigerated (lower than 41 F), and discard cracked or dirty eggs. Avoid keeping eggs unrefrigerated for more than two hours.
• Cook eggs for 15 seconds or more at 145 F. Eat eggs promptly after cooking.
• Avoid eating raw eggs, as in cookie dough, homemade ice cream or eggnog. If you must consume raw eggs, ensure that they have been pasteurized. Check the egg carton or package for labeling. 
• Separate uncooked meats from produce and cooked foods to prevent transfer of any bacteria.
• Wash your hands after handling uncooked foods. Also be sure to thoroughly wash cutting boards and utensils.
• Wash your hands after contact with animals, including reptiles, rodents and other pets.
• Wash your hands after handling human and animal feces, including those of household pets.

Salmonella infection is a post from: by the pines

Introduction

Smallpox is a contagious, disfiguring and often deadly disease caused by the variola virus. Few other illnesses have had such a profound effect on human health and history. In the 20th century alone, an estimated 300 million people died of smallpox.

The initial signs and symptoms of smallpox, which appear about two weeks after infection, resemble those of the flu — fever, fatigue and headache. Later, severe pus-filled blisters appear on the skin that eventually leave deep, pitted scars. Once symptoms develop, there’s no effective treatment for smallpox and no known cure.

Naturally occurring smallpox was finally eradicated worldwide by 1980 — the result of an unprecedented immunization campaign. But the virus didn’t disappear entirely. Stocks of smallpox virus, set aside for research purposes, are officially stored in two high-security labs — one in the United States and one in Siberia. This has lead to concerns that smallpox someday may be used as a biological warfare agent.

Signs and symptoms

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
• A feeling of bodily 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 the 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 way the lesions are distributed 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.

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 ever 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.

Causes

The variola virus causes smallpox. Once you’re infected, the virus immediately begins replicating 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 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.

Smallpox outbreaks typically occur in two- to three-week intervals. Initially, just a few people get sick. A couple weeks later, a larger number of people develop the disease, and in another two weeks, even more cases appear. This pattern reflects the incubation period of the virus as well as its ability to spread by orders of magnitude.

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.

There are also two rare forms of smallpox:

• Hemorrhagic smallpox. This 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 form is also often fatal. The early signs and symptoms are similar to other forms of the disease, but the lesions are velvety and never become filled with pus. Eventually, the skin takes on a rubbery appearance. Bleeding in the skin and intestinal tract also may occur.

Screening and diagnosis

Trained health workers can diagnose smallpox without the need for laboratory tests. The World Health Organization (WHO) provides training materials to help health staff recognize smallpox and distinguish it from chickenpox. Still, an initial case of smallpox is likely to be confirmed by laboratory testing.

Even a single confirmed case of smallpox would be considered an international health emergency to be reported immediately to local health authorities and national officials.

Complications

Historically, variola major is fatal in about 30 percent of people who contract it. Almost no one survives the hemorrhagic and malignant forms of the disease. People who recover from smallpox usually have severe scars, especially on the face, arms and legs. In many cases, smallpox may lead to blindness.

Treatment

No cure for smallpox exists. There is some evidence that cidofovir — an antiviral medication normally used to treat an infection known as cytomegalovirus (CMV) — might prevent smallpox if it’s given within a day or two of exposure. The smallpox vaccine itself can prevent or lessen the severity of the disease if given within four days of infection. But neither of these is useful once signs and symptoms develop. For now, the best that doctors can offer people with symptomatic smallpox is supportive therapy and antibiotics to prevent secondary infections.

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.

Prevention

Smallpox vaccine
In 1967, the WHO launched a global immunization campaign to eradicate smallpox. At that time, millions of people died of smallpox every year. 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 Centers for Disease Control and Prevention (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. Experts in virology say the vaccine causes a fatal complication in about one 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.

Evidence from the vaccination of some military personnel and health care professionals also suggests that the smallpox vaccine may cause inflammation of the heart (myocarditis), inflammation of the membrane covering the heart (pericarditis), or a combination of these two conditions (myopericarditis). Heart pain (angina) and heart attacks also have been reported in a small number of people who have been vaccinated, although it’s not entirely clear whether the vaccine caused these conditions.

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, smoking, or a parent or sibling with heart disease.

If you were vaccinated before 1972
Many people may have never been vaccinated against smallpox. Others received the vaccine 25 years ago or more. It’s not known how long immunity lasts, although it’s likely the vaccine is most effective for about five to 10 years. Partial immunity may last much longer. In addition, people who are revaccinated appear to have increased immunity.

Smallpox is a post from: by the pines

<h2>Overview</h2>
A child in a child care center develops severe diarrhea. Will the other children get sick, too? It’s entirely possible. Despite proper hand washing, viral diarrhea is highly contagious.

Rotavirus is the most common cause of severe diarrhea in infants and children worldwide, according to the Centers for Disease Control and Prevention (CDC). In fact, rotavirus infections are so common that most children have at least one bout with rotavirus by age 2 or 3.

However unpleasant, most rotavirus infections can be treated at home with extra fluids to prevent dehydration. Occasionally, severe dehydration requires intravenous fluids in the hospital. Sadly, dehydration related to rotavirus is a major cause of childhood deaths in developing countries.

Rotavirus infections are most common in the winter and spring. A new vaccine can help prevent rotavirus infections in infants. For older children and adults — who aren’t as likely to develop serious signs and symptoms of rotavirus — frequent hand washing is the best line of defense.
<h2>Signs and symptoms</h2>
A rotavirus infection usually starts with a fever, followed by three or more days of watery diarrhea and vomiting. The infection can cause abdominal pain as well. In adults who are otherwise healthy, a rotavirus infection may cause only mild signs and symptoms — or none at all.
<h2>Causes</h2>
Rotavirus is present in an infected person’s stool several days before symptoms appear through up to 10 days after symptoms subside. The virus spreads easily through hand-to-mouth contact throughout this time — even if the infected person doesn’t have symptoms.

If you have rotavirus and you don’t wash your hands after using the toilet — or your child has rotavirus and you don’t wash your hands after changing your child’s diaper or helping your child use the toilet — the virus can spread to anything you touch, including food, toys and utensils. If another person touches your unwashed hand or a contaminated object and then touches his or her mouth, an infection may follow.

Sometimes rotavirus spreads through contaminated water or infected respiratory droplets coughed or sneezed into the air.

Because there are many types of rotavirus, it’s possible to be infected more than once. However, repeat infections are typically less severe.
<h2>Risk factors</h2>
Rotavirus infections are most common in children ages 4 months to 24 months — particularly those who spend time in child care settings. Older adults and adults caring for young children have an increased risk of infection as well.
<h2>When to seek medical advice</h2>
Call your child’s doctor if your child:
<ul>
 <li>Has severe or bloody diarrhea</li>
 <li>Has frequent episodes of vomiting for more than three hours</li>
 <li>Has a temperature of 102 F or higher</li>
 <li>Seems lethargic, irritable or in pain</li>
 <li>Has signs or symptoms of dehydration — dry mouth, crying without tears, little or no urination, unusual sleepiness or unresponsiveness</li>
</ul>
Call your doctor if you:
<ul>
 <li>Aren’t able to keep liquids down for 24 hours</li>
 <li>Have frequent episodes of vomiting for more than two days</li>
 <li>Vomit blood</li>
 <li>Have blood in your bowel movements</li>
 <li>Have a temperature higher than 101 F</li>
 <li>Have signs or symptoms of dehydration — excessive thirst, dry mouth, little or no urination, severe weakness, dizziness or lightheadedness</li>
</ul>
<h2>Screening and diagnosis</h2>
Rotavirus is often diagnosed based on symptoms and a physical exam. A stool sample may be analyzed in a lab to confirm the diagnosis.
<h2>Complications</h2>
Severe diarrhea can lead to dehydration, particularly in young children. Left untreated, dehydration can become a life-threatening condition.
<h2>Treatment</h2>
There’s no specific treatment for a rotavirus infection. To prevent dehydration while the virus runs it course, drink plenty of fluids. If your child has severe diarrhea, offer an oral rehydration fluid such as Pedialyte — especially if the diarrhea lasts longer than a few days. For children, a rehydration fluid can replace lost minerals more effectively than can water or other liquids. Severe dehydration may require intravenous fluids in the hospital.
<h2>Prevention</h2>
To reduce the spread of rotavirus, wash your hands thoroughly and often — especially after you use the toilet, change your child’s diaper or help your child use the toilet. But even strict hand washing doesn’t offer any guarantees.

Enter the rotavirus vaccine. In early 2006, the Food and Drug Administration (FDA) approved a new vaccine (RotaTeq) to prevent rotavirus infections in infants. The vaccine is given by mouth in three doses, often at ages 2 months, 4 months and 6 months. Studies indicate that the vaccine prevents about 74 percent of all rotavirus cases, and about 98 percent of the most severe cases. The vaccine is not approved for use in older children or adults.

In 1998, the FDA approved the first vaccine for rotavirus (RotaShield). But RotaShield was withdrawn from the market in 1999 after reports linked it to an increased risk of intussusception — a rare but life-threatening form of intestinal blockage.
<h2>Self-care</h2>
If your baby is sick, offer small amounts of liquid. If you’re breast-feeding, let your baby nurse. If your baby drinks formula, offer a small amount of an oral rehydration fluid or regular formula. Don’t dilute your baby’s formula.

If your older child isn’t feeling well, encourage him or her to rest. Offer bland foods, such as soda crackers and toast. Plenty of liquids are important, too, including an oral rehydration fluid. Avoid apple juice, dairy products and sugary foods, which can make a child’s diarrhea worse.

If you’re struggling with diarrhea or vomiting, take it easy. Suck on ice chips or take small sips of water or clear sodas or broths. Eat bland foods. Avoid anything that may irritate your stomach, including dairy products, fatty or highly seasoned foods, caffeine, alcohol and nicotine.

Rotavirus is a post from: by the pines

Introduction

Plague is a life-threatening infection caused by the organism Yersinia pestis, the bacterium that caused the 14th-century Black Death plague pandemic.

Plague-causing bacteria still exist in the environment today, although their effect has abated dramatically. The major threat of plague these days comes not through natural transmission, but through intentional transmission, perhaps by terrorists as an agent of biological warfare.

In nature, infected fleas transmit Y. pestis primarily among rodents. When a plague outbreak among rodents kills many of them in short order, infected fleas that were feeding on the rodents’ blood jump to other animals and humans, spreading the infection.

During the Black Death, plague caused 20 million to 30 million deaths in Europe. More recent pandemics through the late 19th century killed millions of people worldwide. Improved living conditions and health services have made such large-scale outbreaks of natural plague unlikely, but occasional isolated plague cases continue.

These days, weapons may be more likely than rats to cause a plague pandemic. Plague bacteria could conceivably be put into a form that could be sprayed through the air, infecting anyone inhaling the bacteria and causing pneumonic plague. This form of plague affects your lungs and can spread from person to person. Fortunately, when given promptly, antibiotics can effectively treat plague most of the time.

Signs and symptoms

There are three types of plague: bubonic, septicemic and pneumonic. Signs and symptoms of plague vary depending on the type and on how you contract it. It’s possible to develop more than one type of plague.

Bubonic plague
This is the most common type of plague in humans, accounting for the majority of naturally occurring cases. Bubonic plague is caused by a bite from an infected flea and is characterized by an enlarged, infected lymph node called a bubo.

Signs and symptoms of bubonic plague generally appear within two to eight days after a plague-infected flea bites you. After you’re bitten, the bacteria travel through your lymphatic system, infecting the first lymph node they reach. The resulting bubo is usually 1 to 10 centimeters in diameter, swollen, painful and warm to the touch. It can cause so much pain that you can’t move the affected part of your body. The bubo usually develops in your groin, but may also appear in your armpit or neck, depending on where the flea bit you. More than one bubo can develop, but typically buboes affect only one area of your body.

Buboes may not be noticeable until a day or more after other symptoms appear. Other signs and symptoms of bubonic plague include:

• Sudden onset of fever and chills
• Headache
• Fatigue or malaise
• Muscle aches

Septicemic plague
Septicemic plague occurs when plague bacteria multiply in your bloodstream. You can contract this form of plague when bacteria transmitted by a fleabite enter directly into your bloodstream, or as a complication of bubonic or pneumonic plague. If septicemic plague occurs as a complication of bubonic plague, buboes may be present.

Signs and symptoms of septicemic plague include:

• Fever and chills
• Abdominal pain, diarrhea and vomiting
• Bleeding from your mouth, nose or rectum, or under your skin
• Shock
• Blackening and death of tissue (gangrene) in your extremities, most commonly your fingers, toes and nose

The gangrene associated with septicemic plague inspired the nickname Black Death for the 14th-century pandemic.

Pneumonic plague
Pneumonic plague is the least common form of plague — accounting for 12 percent of U.S. cases in the last 50 years — but the most rapidly fatal. Primary pneumonic plague can occur when you inhale infectious droplets coughed into the air by a person or animal with pneumonic plague. Early signs and symptoms, which generally occur about two days after inhaling contaminated droplets, include:

• High fever
• Weakness
• Signs of pneumonia, including chest pain, difficulty breathing and a cough with bloody sputum
• Nausea and vomiting

You can also develop pneumonic plague as a complication of bubonic or septicemic plague if the bacteria spread to your lungs. This is called secondary pneumonic plague.

Pneumonic plague progresses rapidly and may cause respiratory failure and shock within two days of infection. If antibiotic treatment isn’t initiated within a day after signs and symptoms first appear, the infection is likely to be fatal.

Plague resulting from a bioterrorist attack
It’s possible that plague bacteria could be turned into an aerosol and then might be spread over large populations as a bioterrorist weapon. An attack of this kind would cause pneumonic plague — the most deadly and most contagious type. In 1970, the World Health Organization estimated that if plague bacteria were sprayed over a city of 5 million people, up to 150,000 people could be infected and 36,000 might die.

According to a consensus statement by a group of scientists published in the Journal of the American Medical Association, the incubation period for pneumonic plague following a bioterrorist attack might last from one to six days, but more often from two to four days. Signs and symptoms would mirror those of naturally occurring pneumonic plague, but might also include nausea, vomiting, abdominal pain and diarrhea.

Other indications that a bioterrorist event or germ warfare is behind a pneumonic plague outbreak include a high incidence of pneumonic plague in humans in regions of the country that haven’t had outbreaks among animals or rodents, or when plague occurs in people without any known risk factors.

Causes

Plague has afflicted humans throughout history. The first recorded plague outbreak began in Egypt in A.D. 541.

The Black Death pandemic in the 14th century killed one-third of Europe’s population. Europeans living during early pandemics believed the disease was a punishment from the gods or an unlucky confluence of astrological or supernatural elements.

The most recent plague pandemic began in China in the late 1800s and, due to booming international trade and ships with high rat populations, spread quickly throughout Asia and other parts of the world. That outbreak caused more than 12 million deaths in India and China alone.

The cause of plague, the Yersinia pestis bacterium, was discovered in 1894 by Alexandre Yersin. Soon after, scientists realized that fleas transmitted the bacteria.

In World War II, the Japanese army released plague-carrying fleas over a part of China, causing outbreaks of the disease. After World War II, both the United States and the former Soviet Union pursued biological weapons programs that developed means of exposing large populations to plague bacteria. Today, plague is one of a number of feared potential agents of bioterrorism, along with anthrax, smallpox, botulism, tularemia and nerve gases.

Risk factors

Naturally occurring plague outbreaks are most common in rural areas and in urban areas characterized by overcrowding, poor sanitation and a high rat population. Outbreaks can happen at any time of year.

In the United States, plague outbreaks occur most often between April and November. Most U.S. cases occur in Western states, including New Mexico, Arizona, Colorado and California.

Rock squirrels and ground squirrels are the most common sources of infection in the United States. Other rodents, including chipmunks and prairie dogs, may host plague-carrying fleas. Animals that may be infected and pose a transmission risk to humans include wild rabbits and domestic cats that have contact with wild rodents.

The disease usually spreads through fleabites, but you can also contract plague after being exposed to an infected animal that may have coughed infectious droplets into the air or through a break in your skin after handling an animal with plague. Groups at increased risk include veterinarians, cat owners, hunters, campers and hikers in areas with recent plague outbreaks among animals.

When to seek medical advice

Call your doctor if you or someone close to you develops signs or symptoms of plague within a week of any of the following:

• Being exposed to a sick or dead animal
• Being bitten by a flea or by an unknown insect
• Spending time in an area with a known, recent plague outbreak or with a large number of dead or dying animals
• Having close contact — within three feet — with a person or animal with pneumonic plague
• Traveling to a high-risk region of the United States or another country with high plague rates

Screening and diagnosis

Your doctor may suspect plague if you live in a high-risk region. With the exception of a visible bubo, signs and symptoms often mimic other, more common infectious diseases.

You’ll likely be asked to describe the type and severity of your symptoms and tell your doctor about your recent history, including whether you’ve been exposed to sick animals or traveled to areas with plague outbreak.

If your doctor suspects plague, he or she may confirm the diagnosis through microscopic examination of fluid extracted from your bubo, bronchi or trachea. Needle aspiration is used to obtain fluid from your bubo. Fluid is extracted from your airways using endoscopy. In this procedure, a thin, flexible tube is inserted through your nose or mouth and down your throat. A suction device is sent down the tube to extract a fluid sample from your airways.

Your doctor may also test blood drawn from your veins to diagnose plague. Y. pestis bacteria generally are present in your bloodstream only if you have septicemic plague.

Complications

Complications of plague may include:

• Gangrene of your fingers and toes resulting from clots in the small blood vessels of your extremities
• Severe shock
• Sudden, severe lung failure (acute respiratory distress syndrome)
• Bloodstream infection (septicemia)
• Inflammation of the membranes and fluid surrounding your brain and spinal cord (meningitis)
• Death

With prompt treatment, the overall fatality rate from plague is between 5 percent and 14 percent in the United States. Without treatment, mortality rates can be as high as 60 percent for bubonic plague and 100 percent for pneumonic plague. Death can occur within days after symptoms first appear if treatment doesn’t begin promptly.

Treatment

As soon as your doctor suspects that you have plague, you’ll need to be admitted to an isolation room in a hospital. There, you’ll receive powerful antibiotics directly into your veins (intravenously) or your muscles (intramuscularly) for at least 10 days. Streptomycin and gentamicin are the most effective drugs against plague. Other alternatives include intravenous doxycycline (Vibramycin), ciprofloxacin (Cipro) and chloramphenicol (Chloromycetin).

If you have serious complications, such as bleeding abnormalities, organ failure and respiratory distress, then respiratory support, intravenous fluids and oxygen may be necessary. Your doctor is required by law to report documented plague infection to local health officials.

Even if you don’t have signs or symptoms, you’ll need treatment with preventive, oral antibiotics for seven days after direct exposure to a person with pneumonic plague.

Prevention

Previously, a vaccine was available for bubonic plague, but its efficacy was never well studied and the manufacturer stopped producing it in 1999. Clinical trials on a new plague vaccine are in the earliest stages.

Although no effective vaccine is available, antibiotics offer effective preventive therapy if you’re at risk or have been exposed to plague. Ask your doctor immediately about preventive antibiotics if you:

• Have had close contact with a person or animal with known or suspected pneumonic plague
• Have been bitten by a flea or unknown insect in an area known to have recent plague cases
• Are planning to spend time in a region with recent plague outbreak

Take the following precautions if you live or spend time in regions where plague outbreaks occur:

• Avoid contact with sick or dead animals. If you hunt, wear gloves when handling dead animals.
• Rodent-proof your home. Remove potential nesting areas, such as piles of brush, rock, firewood and junk. Don’t leave pet food or any other foods in areas that rodents can easily access.
• Prevent your pets from contracting fleas. Use flea-control products and don’t allow pets to wander unsupervised. Ask your veterinarian for recommended flea-control brands and guidelines.
• Take precautions when outdoors. Closely supervise your children and pets when spending time outside in areas with large rodent populations. Use insect repellent on your skin and clothing.

Know the risk factors and the symptoms of plague so that you can identify it early and contact your doctor immediately. If you know of recent plague cases in your area, report sick or dead animals to your local health department or to police.

Plague is a post from: by the pines

Introduction

Yellow fever is a hemorrhagic fever caused by a virus spread by a particular species of mosquito. It is 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 those with the more severe form of yellow fever die of the disease.

There is 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.

Signs and symptoms

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 three to four days.

Toxic phase
Although signs and symptoms may disappear for a day or two following the acute phase, 15 percent of those 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 the nose, mouth and eyes
• Heart dysfunction (arrhythmias)
• Liver and kidney failure
• Brain dysfunction including delirium, seizures and coma

About 20 percent to 50 percent of those who enter the toxic phase die of the disease. The rest usually recover without significant problems.

Causes

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 the serious 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 so 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.

When to seek medical advice

See your doctor at least 10 to 14 days before traveling to an area in which yellow fever is known to occur, to see if you need vaccination.

If you have any signs or symptoms of yellow fever, see your doctor, and tell him or her if you’ve recently traveled to a region in which the disease is known to occur.

Screening 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 test your blood for evidence of the virus.

Medical history
Your doctor will likely ask about your medical and travel history and any exposure to mosquitoes. Be sure to describe international trips in detail, including the countries you visited and the dates, as well as any contact you may have had with mosquitoes.

Blood tests
Laboratory tests, usually using a sample of your blood, are needed to confirm a diagnosis of yellow fever. 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. These tests may take several days.

Complications

Yellow fever results in death for 20 percent to 50 percent of those infected. This usually occurs within 10 to 14 days from the start of infection. Complications during the toxic phase of a yellow fever infection include kidney and liver failure, jaundice, delirium and coma.

Those 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.

Treatment

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.

Prevention

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.

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.
• Apply permethrin-containing mosquito repellent to your clothing, shoes and camping gear and bed-netting. Use repellent with a 10 percent to 30 percent concentration of DEET on your skin. Choose the concentration based on the hours of protection you need — a 10 percent concentration of DEET is effective for about two hours, whereas higher concentrations last longer. Keep in mind that chemical repellants 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.

Yellow fever is a post from: by the pines