Wednesday, December 09, 2015

Heart attacks and rabbit fever

cdc reports that one third of Americans should be treated for high cholesterol, but only half of them are taking medicines.

note the racial differences:

Prevalence of cholesterol-lowering medication use among adults eligible for treatment varied within sex and racial/ethnic subgroups, with the lowest prevalence (5.7%) among blacks who did not have a routine place for health care and the highest prevalence among persons who reported making lifestyle modifications (approximately 80% for a majority of subgroups) 

discussion of guidelines here (for later reading) 

and there has been an outbreak of Tularemia in the midwest.
It is commonly called "Rabbit fever", but you can catch it in other ways (including from your cat).

Clinical presentation and severity of tularemia depends on the strain, inoculation route, and infectious dose. Tularemia can be transmitted to humans by direct contact with infected animals (e.g., rabbits or cats); ingestion of contaminated food, water, or soil; inhalation from aerosolization (e.g., landscaping, mowing over voles, hares, and rodents, or other farming activities); or arthropod bites (e.g., ticks or deer flies) (1,3). Human-to-human transmission has never been demonstrated (1,3)

The disease is hard to diagnose, and one suspects there is a lot more out there than reported: indeed, there is a question if the disease rate is up lately, or if it is merely because it is now a reportable disease.

Alas, the early symptoms are not specific.

Infected persons can develop a range of symptoms that display several clinical forms. These include fever and chills with muscle and joint pain (typhoidal), cough or difficulty breathing (pneumonic), swollen lymph nodes with or without skin lesions (ulceroglandular or glandular), conjunctivitis (oculoglandular), pharyngitis (oropharyngeal), or abdominal pain with vomiting and diarrhea (intestinal) (2,3). Symptoms typically begin within 3–5 days of exposure, but can take up to 14 days to appear. Case fatality rates range from <2 depending="" on="" span="" strain="" the="">13). Streptomycin is considered the drug of choice on the basis of historical use and Food and Drug Administration approval; however, it sometimes can be difficult to obtain and is associated with frequent ototoxicity (3). Gentamicin, doxycycline, and ciprofloxacin are also used (2,3).

In Oklahoma, anyone with a fever and achiness (aka "flu symptoms) in our clinic was given Tetracycline for presumed Rocky Mountain Spotted fever, which will also treat Tularemia (albeit with a relapse rate).

RMSF does have a rash, but it appears after several days, and since the labratory diagnosis took two weeks,  so we tended to treat everyone.

but you only catch RMSF from tickbites: Tularemia can be caught via the airborne particles, and for this reason it is a potential bioterrorism organism.

the Soviets may have used it as a bioweapon in the battle of Stalingrad.
Alibek claims in his book that tularemia (caused by the bacterium Francisella tularensis) was deployed against Nazi troops during the battle for Stalingrad (August 1942 to February 1943). Alibek bases his allegation on the hundreds of thousands of tularemia infections that quickly arose at the beginning of the siege and the collaborative statements of an elderly lieutenant colonel in the Soviet Red Army. Alibek also reports a significantly high (70%) pulmonary involvement among those infected with tularemia from both sides, suggesting man-made air-borne dissemination.
Although no doubt exacerbated by wartime conditions at Stalingrad we believe that the tularemia epidemic of 1942-1943 was a natural outbreak. With regard to the high percentage of pleural involvement reported by Alibek (and others) one should note that even in the 1960s the mechanism of the disease process was not well understood nor was it certain if there was a primary pulmonary form of tularemia.[4] The fact that a large percentage of tularemia infections were associated with pleural involvement--an outcome that could have been induced via other portals of entry--may not he very helpful in identifying the route of the initial infection.
Second the Rostov region alone already had 14,000 tularemia cases in January 1942, several months before the major Panzer assault on the city. With the large epizootic pool of F. tularensis among mice and water rats (and a severely if not completely disrupted hygiene and sanitation system), it probably required no help from Soviet bioweaponeers to create the conditions for an epidemic

more general information about Tularemia HERE.
and HERE.

One problem: like RMSF, usually you diagnose it by increasing antibody titers: You measure them on the first visit and recheck them in two weeks to see if the titer goes higher.

and there is a vaccine, but rarely used except in laboratory workers.

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