diseas

WILD DISEASES By Carolee Boyles-Sprenkel

A few days after Patsy M. returned home from a trip to Hawaii, she came down with what she thought was intestinal flu. After a week of nausea and vile-smelling diarrhea she went to her doctor. He couldn't find anything wrong with her and put her on a liquid diet. Two weeks and ten pounds later she was becoming anemic.

Three stool samples, a sigmoidoscopy and a proctoscopy could not establish the cause of her illness. Finally she mentioned her symptoms to a colleague at work who recognized them as something he'd heard of before. A little research turned up information on an organism that parasitizes the human digestive tract, Giardia. After only 24 hours on the antibiotic Flagyl, Patsy knew she'd solved the problem. She recovered without further incident.

Patsy was only one of a number of people who bring back more from their outdoor experiences that they bargain for. Any time we go into the woods, we run the risk of encountering illnesses and discomforts our urban neighbors don't ever run into. Few physicians even think about testing for these "exotic" diseases. Untreated, some will run their course in a few days or a few weeks. But not all are so benign.

According to epidemiologist Dr. Lisa Conti, doctors term these diseases "zoonotic." That means they're caused by organisms that infect both animals and humans. Though most affect humans only rarely, a few are relatively common.

This is definitely not a case of "what you don't know won't hurt you." What you don't know about some of these ailments will, in some cases, kill you.

Lyme Disease

Lyme Disease may be the most visible of the little shop of horrors found in the woods. Unlike some other diseases, Lyme Disease is not rare. Dr. Robert Craven, a Centers for Disease Control researcher studying Lyme, says doctors reported more than 2400 cases during 1988. He believes it's spreading throughout the country.

A bacterium carried by deer mice and deer causes Lyme Disease. Ixodid ticks can pass the organism from infected animals to people.

The first symptom of the disease is a little red area where the tick attached itself to you. The spot grows. Then fever, headache, and muscle aches start. The spot increases in size until it become a red ring several inches across with a light-colored center. "It's kind of like a bull's-eye," says Craven.

If you don't get treatment, the effects can be severe. "It can eventually cause cardiac problems, usually rhythm disturbances," Craven says. "It can cause arthritis, which can be fairly severe and debilitating. It can cause a whole host of neurologic problems - encephalitis, meningitis type problems, paralyses, that sort of thing."

Lyme Disease is easy to treat with antibiotics. According to Craven, researchers are trying to produce a vaccine, but none is available at this time.

Rocky Mountain Spotted Fever

Another bacterium transmitted exclusively by tick bites is Rocky Mountain Spotted Fever. Infected ticks can pass the organism from generation to generation without feeding on a sick animal.

According to Dr. Michael Wilder, a state public health clinician, the first symptoms are fever, cramping stomach pain and rash. "Stomach-ache seems to be a common early symptom," he says. "There may be some vomiting, but no diarrhea." The rash looks like measles but it appears on the wrists and palms of the hand, which measles rarely does.

Antibiotics will cure Rocky Mountain Spotted Fever. Of the patients who are not treated, though, a few die from either shock or hemorrhaging. Encephalitis

Several different types of encephalitis cause problems from time to time. St. Louis Encephalitis follows a 10-year cycle in the Mississippi Valley, according to Craven. Eastern Equine Encephalitis and Western Equine Encephalitis appear in small scattered outbreaks each summer.

Birds carry the viruses that cause encephalitis, which mosquitoes spread from the birds to humans and other mammals. Early symptoms include confusion and fever. Some varieties of the ailment cause nausea and vomiting. Then, Craven says, convulsions, coma, and other neurologic involvement may occur.

"Eastern Equine is a particularly virulent form of encephalitis in humans," he says. "It frequently kills, and the people who do survive are usually brain damaged to a greater or lesser degree for life."

Antibiotics are useless against encephalitis, he says. Researchers have developed a vaccine against both Eastern and Western Equine, but officials recommend using it only during epidemic conditions. Tularemia

According to Dr. Thomas Quan with the CDC's Fort Collins, Colorado unit, most people acquire tularemia infections from rabbits and hares, and the ticks associated with them. He says people can pick up the versatile organism in a number of ways.

"Most human cases occur through the bite of a tick or through direct contact with rabbits that are infected," he says. "There are other modes of infection, such as deer fly bites and mosquito bites." Sheep-shearers have acquired it from working with infected sheep in Colorado. Some people have become ill from drinking contaminated water. Farm workers can inhale the organism from hay dust.

Early symptoms are fairly vague. You'll develop a bit of a fever, and generally not feel too good. If you've inhaled the organism, you'll have respiratory symptoms; if you've swallowed it, you'll think you'll have intestinal flu. Swelling of the armpits - called buboes - and other plague-like symptoms will follow a tick bite or infection through a cut. For untreated cases, the fatality rate is about 5 to 7 per cent. With antibiotic treatment, patients can expect complete recovery. "The people who get sick with it wish they'd die, but they usually don't," Quan says. "But eventually they overcome it." Giardia

CDC worker Dr. David Addiss says the biggest source of Giardia is contaminated water. Biologists have found the organism from many streams and rivers. "It's found fairly commonly throughout the United States in untreated surface water," he says. "You don't find it very much in wells or big lakes, but you do see it in streams."

A number of different animals, especially beavers, may carry the protozoan that causes the illness. Symptoms include loose stools or full-blown diarrhea, cramping, gas and burping, and rarely nausea and vomiting. The disease may be more chronic than acute. Giardia attaches itself to the wall of the small intestine, where it lives and reproduces. Untreated, the ailment may go away on its own. In many people, through, the infection persists until it's treated with a course of antibiotic.

Don't rely on iodine or chlorine tablets to treat stream water. They may work if the water is warm and only contains a few Giardia cysts. But in cold or heavily infested water, they're not particularly effective.

Relapsing Fever

Craven also works with relapsing fever another tick-borne disease related to Lyme Disease. He says it's fairly rare in the United States.

The last big epidemic of Relapsing Fever occurred in the Grand Canyon in the 1970s, and was related to squirrels nesting in cabins where Canyon staff people were living. Generally, though, the cases are fairly scattered.

The disease produces flu-like symptoms, including fever and muscle aches. If it's not treated, the symptoms subside, and patients think they're well. Then it comes back. This cycle continues until the disease is treated. Fortunately, it doesn't seem to produce any serious long-term effects like Lyme Disease does.

Brucellosis

Unless you hunt wild hogs in the southeastern United States, brucellosis is one problem you probably don't need to worry about. This is not to say the disease isn't found in other species; biologists have reported it in desert rats and other rodents, hares, foxes, goats, sheep, deer, elk and bison, and even dogs and cats. But Dr. Arnold Kaufmann, a physician with the CDC in Atlanta, says he's never heard of hunters contracting brucellosis from any animal except hogs.

The organisms which cause brucellosis are a group of bacteria that live in the blood, bone marrow and lymphatic system, including the liver and spleen. You can become infected in a couple of ways. If you clean a hog without wearing gloves, bacteria can enter through small cuts and scratches on your hands. As you cut into the carcass of the animal a number of the organisms are released into the air, where you can inhale them.

Heat kills the bacteria, so you're not at risk if you eat well-cooked meat from a sick animal. In fact, when domestic animals such as cattle are found to have brucellosis, one cure is to send the animals to the slaughterhouse.

In humans, brucellosis is a vague sort of illness, according to Kaufmann. It causes headache, fever, and exhaustion. You may have achy joints and in general feel like you have a severe case of the flu.

"It goes on and on and doesn't go away," says Kaufmann. "It's a very complex disease. It can involved a variety of organs." Untreated, most patients eventually recover; for a few, though, it continues as a chronic illness. Treatment is simply a course of antibiotics.

Q Fever

Q or Query Fever may be under reported, according to CDC microbiologist Russell Regnery. As a result, the CDC doesn't have any good data on how many cases occur in this country each year.

"I think it's an important disease, but one for which very little data can be found," says Regnery. In his opinion, hunters and fishermen in sheep country need to be aware of the disease as a potential long-shot ailment. "If, for example, you were to shoot a sheep that had Q Fever and you butchered it out, especially if that animal is a pregnant female, you would really be asking for the possibility of exposure," Regnery says. The organism reaches its highest concentration in amniotic fluid and fetal tissues.

The agent is a specialized bacterium. It can infect humans through cuts on the hand, but it's very infectious if inhaled. As a result, clothes and other items can become contaminated by the organism.

Symptoms include headache and fever, plus muscle pain. Pregnant women may suffer complications. Untreated, the disease usually resolves itself after a few days or a few weeks. A few people, though, develop Q Fever endocarditis, or inflammation of the heart. This can be a chronic problem, hard to treat, and sometimes leading to death. Q-fever has been associated with rabbit hunting in Canada. Rabies

Despite modern vaccinations, rabies is still a potential threat. Unlike most of the other diseases you can acquire in the woods, rabies has no treatment - if you get it, you die. It's that simple.

"Any warm-blooded animal can get rabies," says Wilder. "But certain animals seem to play a more important role as a reservoir. The main ones throughout most of the country are insectivorous bats, skunks, foxes, and of course raccoons." Even deer and antelope can become infected if a rabid animal bites them.

You're only at a slight risk to pick up rabies if you dress an infected deer or other ungulate without gloves on. Theoretically, though, it's possible for you to get it, especially if you skin out the head and get saliva on your hands.

Direct contact is not the only way you can acquire rabies. In rare cases, spelunkers have become infected from inhaling the virus in bat caves.

If you're bitten by a rabid animal, the first symptom of the disease is what Wilder terms "an unusual sensation" at the site of the bite. "It's an increased sensitivity, a feeling of prickliness, just an odd sensation arising from the healing wound." A fever and stiffening of the neck follow. Then you'll have convulsions. You'll salivate because you're unable to swallow. Death will follow in of days or weeks.

A post-exposure vaccine for people has been available for many years. Recently, scientists have developed a pre-exposure vaccine. Wilder says whether or not you need to get vaccinated depends on what you're hunting. Most people don't need to worry about it. But if you're a woodchuck or raccoon hunter, he recommends it. At a cost of about $100, it's cheap insurance.

Wilder also stresses that hunters need to have their dogs vaccinated against the disease. Some raccoon hunters in particular fear the inoculation will affect the dogs' ability to hunt, and so don't have them vaccinated.

Don't do the vaccination yourself. In Florida and perhaps a few other state, rabies vaccine is available over the counter at feed stores. "We've been most fortunate that no identified cases of rabies have occurred from this practice," Wilder says.

Plague Remember the bubonic plague, the disease that decimated Europe in the Middle Ages? It's still with us in the western US.

Any rodent in the west can harbor the plague organism. "Most people in the United States who acquire plague are getting it from ground squirrels," Quan says. "On the west coast, it's the California Ground Squirrel. In the Rocky Mountains it's the Rock Squirrel. Then you have other smaller squirrels and chipmunks." Even if you don't have direct contact with rodents, you're still not immune. Your dog and cat may catch a squirrel, pick up the fleas carrying the organism, and bring it home to you.

Plague is transmitted to humans through flea bites. Early symptoms are similar to those of tularemia: high fever, muscle aches, fatigue. You'll have pain, sometimes quite severe, in the area where the buboes, or swollen lymph glands, are going to develop.

Untreated, plague kills. The organism produces toxins that cause problems with blood clotting, and eventually gangrene. Fifty-five to sixty per cent of patients die. Even treated, plaque kills 15 to 20 per cent of patients.

As dreadful as plague is, it's easily treated. A variety of antibiotics, including Tetracycline and sulfa drugs, will knock it out.

"People who see a physician early on after symptoms, and who have the savvy to know they were possibly exposed tend to survive," Quan says. "A large percentage of those who die have septicemic plague, which does not have a bubo." These cases look like a lot of other diseases, are hard to diagnose, and as a result often don't get treated early enough.

Fortunately, plague is rare. Quan says in 1983 doctors reported a high of 40 cases, but in general the number is 10 to 20. This compares to 200-plus for tularemia each year.

Prevention

Most members of this hall of villains are easy to prevent with little effort. First, don't drink untreated water. Carry water or soft drinks with you.

Second, any time you dress game, don't do it bare-handed; wear gloves. "If you don't wear gloves, you're really taking your chances," Quan says.

Third, avoid contact with mosquitoes, ticks and fleas. "Most of these things can be prevented with repellents," Craven says. He notes especially Permanone, a permethrin compound that is both an insecticide and a repellent useful for ticks.

If, after being in the woods, you begin to show symptoms like any of the ones described here, go straight to the doctor. Don't wait to see if you get better on your own. And be sure you tell him or her what you suspect.

"Be sure you tell the physician you had the contact," Quan says. "It's one way we have of making an early, proper diagnosis. Tell the doctor you had contact with such-and-such an animal. Then the physician is at least alerted that tularemia is as possibility, or in the western states, plague."

These are only some of the weird and exotic diseases you may encounter on a hunting or fishing trip. Others include Leptospirosis, Anthrax, and a variety of fungal organisms. But by following some common-sense preventive techniques, you can avoid bringing home these unwanted freeloaders from the woods.

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