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This acute form of poisoning results from the ingestion of a toxin produced by Clostridium botulinum. Progressive paralysis descends from the brain stem to the skeletal muscles and is often fatal. This germ grows in improperly sealed non-acid canned foods, such as fish or beans, which have been cooked insufficiently to destroy all germs.

Outbreaks have been seen from commercially processed fish, tuna, peppers, and soups. It is impossible to tell that a food is infected by the taste. However, boiling a home-canned food for ten minutes will destroy the toxin completely. Because of the threat of respiratory failure, a person suspected of having botulism should be hospitalized. Artificial respiratory support may be required for a long time. Because of the current mortality rate of 25%, the primary prevention through proper canning procedures and food preservation is vital.

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This acute, often fatal disease is caused by a germ toxin (exotoxin) produced in any closed wound by the organism Clostridium tetani. Tetanus is characterized by sudden rigidity and convulsive spasms of the skeletal muscles. The tetanus bacillus grows anaerobically, that is, in a wound where oxygen is excluded. For this reason puncture wounds are often a source of tetanus infection. Gun shot wounds and animal bites also have been suspect, as well as lacerations that are sutured without adequate cleansing.

Supportive measures, usually in a hospital, are important to effect recovery from tetanus. Hot packs to relax the muscle spasm, adequate care of wounds and the simple but effective toxoid vaccination can give protection. Vaccinations should be boosted every 10 years. In cases of an acute open wound, which appears contaminated, the human tetanus antitoxin should be given along with a tetanus toxoid vaccination to passively protect the individual from illness during early convalescence.

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Cholera is an acute illness of the small intestine. Occurring in epidemic forms, a generally painless diarrhea follows the entrance of the germs by 6 -
48 hours. Several liters of fluid may be lost within hours, leading to profound shock. With prompt fluid and electrolyte replacement, dehydration can be combated, bringing a prompt physiologic recovery. Inadequately treated patients may die from shock, acidosis, or kidney failure (uremia). Therefore, prompt and massive fluid replacement is vital.

A satisfactory solution can be prepared by adding five grams of sodium chloride, four grams of sodium bicarbonate, one gram of potassium chloride to one liter of distilled water. Hydration must be maintained until the diarrhea subsides. Cholera prevention, for travelers, is available with a standard vaccination. In countries where cholera is epidemic, a single inoculation prior to departure is recommended.

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The Diphtheria bacteria that cause this acute infectious disease usually enter through the upper respiratory tract. During the incubation of one to seven days the germs make a toxin that is absorbed and carried through the
blood stream to all parts of the body. Then a fever begins, associated with a membrane on the throat, listlessness, pallor, weakness, and finally vascular
collapse. Although occasionally restricted to the nose, diphtheria usually involves the throat (the pharynx and larynx), and in tropical areas it is responsible for some cases of “jungle sore”. Complications may involve the
extension of the membrane, which obstructs the respiratory tract or equally serious a toxic myocarditis, a vascular collapse, or neuritis.

Patients with diphtheria should be isolated and kept on strict bed rest. Antitoxins should be obtained and given to the patient, while general supportive measures are carried out. Preventive immunization in infancy should be routine. The standard protocol of three initial DPT inoculations (or in the case of Pertussis sensitivity, a DT immunization is available) followed by booster doses at one and six years will usually confer lifelong protection.

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Various bacteria of the Pasteurella family have been associated with epidemics of plague around the world. About 200 species of rodents may harbor this organism. After an incubation period of 1-12 days a patient develops an acute severe illness. The more common bubonic plague develops abruptly with chills, headache, vomiting, rapid heart rate, prostration, and delirium. A flea bite at the portal of entry rarely can be seen. The “bubo” consists of a matted group of lymph glands, which usually develops pus and drains after 1-2 weeks. Plague may also take the form of pneumonia. Infection may localize in other regions of the body.

Although often misdiagnosed, plague should initially be treated with hot, moist applications. Specific therapy should await a bacteriologic diagnosis. A similar type of illness seen in animal bites with local cellulitis should be treated as most bacterial infections are. If plague is suspected, see a doctor immediately; this illness is extremely infectious.

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