If germs invade the soft tissues below the superficial level of the skin (the “epidermis”), they can rapidly infect the main layers of soft tissue below. These include the deep layer of the skin (the “dermis”), the subcutaneous fat, the muscle layers, and various blood vessels and nerves.
Cellulitis may be easy to deal with in normal times, but it will be an epidemic in the aftermath of a major disaster. This is not because it’s contagious; it isn’t unless you have an open wound yourself or exchange bodily fluids. Expect cases simply because of the sheer number of injuries incurred from performing activities of daily survival in less than sanitary conditions.
Without antibiotics, infections can spread to lymph nodes and the bloodstream, rapidly becoming life-threatening. The end result might affect the entire body, referred to as “sepsis.” Once sepsis develops, inflammation of deep structures like the spinal cord (“meningitis”) or bone marrow (“osteomyelitis”) can further complicate the situation. In the past, sepsis was usually fatal.
The bacteria that can cause cellulitis are on your skin right now. Normal inhabitants of the surface of your skin include Staphylococcus and Group A Streptococcus. They do no harm until the skin is broken and they enter deeper tissues where they don’t belong. In recent years, a resistant bacterium called MRSA (Methicillin-Resistant Staphylococcus Aureus) has arisen which causes cellulitis resistant to the usual antibiotics.
As an aside, Cellulitis has nothing to do with the dimpling on the skin called “cellulite”. The suffix “-itis” simply means “inflammation”, so cellul-itis simply means “inflammation of the cells.”
Heat in the area of the infection compared to non-affected areas
Redness, usually spreading towards torso
Swelling in the area of infection (often appearing shiny and causing a sensation of tightness)
Drainage of pus or cloudy fluid from the area of the infection
Foul odor coming from the area of infection
Hair loss at the site of infection (less common)
Joint stiffness caused by swelling of the tissue over it (less common)
Cellulitis commonly occurs in an extremity, such as a leg. In these cases, it’s helpful to keep the limb elevated. Other strategies include warm or cool compresses or soaks to the affected area, and the use of ibuprofen (Advil) or acetaminophen (Tylenol) to decrease pain, discomfort, and fever.
As most cases of cellulitis are caused by bacteria, they should improve and disappear during a 7-14-day course of therapy with medications in the Penicillin, Erythromycin, or Cephalosporin (Keflex) families. Amoxicillin and ampicillin are particularly popular. MRSA cellulitis can be treated with clindamycin and the sulfa drug combination of sulfamethoxazole/trimethoprim (SMX-TMP). It’s important to complete the full course of therapy.
Adult dosing:
-Penicillin, amoxicillin, cephalexin, or ampicillin 250-500 mg orally four times a day for 7-14 days (Amoxicillin also comes in 875 mg).
-Clindamycin 150-300 mg orally three times a day for 7-10 days.
-SMX 800 mg-TMX 160 mg orally twice a day for 7-10 days.
Those allergic to penicillins can still take clindamycin or SMX-TMP. It should be noted that not all sources will recommend the same dosage, frequency, and duration of therapy for a particular drug. In resistant infections like MRSA, combination therapy with SMX/TMP and Cephalexin 500 mg orally four times a day for 7-14 days may be necessary.
As with all medications, the longer the therapy and the higher the dose, the more likelihood that adverse reactions may occur. A much more comprehensive discussion of antibiotics can be found in Alton’s Antibiotics and Infectious Disease: The Layman’s Guide, or online at drugs.com and rxlist.com.
All the drugs mentioned above are available in veterinary equivalents (at least at present). In a survival situation, however, antibiotics will be precious commodities. You, as medic, should dispense them only when absolutely necessary. The misuse of antibiotics, along with their excessive use in livestock, is part of the reason that we’re seeing an epidemic of antibiotic resistance in this country.
The Altons at Doom and Bloom Medical have an article up on Cyclospora Infection.
Food contamination is a constant concern in the United States, especially from imported produce. In normal times, U.S. citizens take for granted the ability to buy bananas in Montana in February. As long as we import food, we must be especially careful to eliminate subtropical and tropical pathogens from our food.
A number of different disease-causing organisms especially put humans at risk; one of these is Cyclospora cayetanensis. From May to late August, 2020, more than 1100 laboratory-confirmed cases of food contamination due to Cyclospora (known as cyclosporiasis) were reported in 34 states. In most cases, fresh imported produce, especially greens and vegetables, were identified as likely origins.
Cyclospora is a one-celled parasite that is a natural inhabitant of the tropics and subtropics, where it seems to cause outbreaks that are seasonal in nature. The U.S. cases, however, occurred in people who had not recently visited the tropics before symptoms began.
THE LIFE CYCLE OF CYCLOSPORA
Cyclospora is spread by people ingesting food or water contaminated with feces containing Cyclospora oocysts (essentially a thick-walled fertilized ovum). Unlike some similar parasites, however, the oocyst needs time (usually, at least 1–2 weeks) after being passed in a bowel movement to become infectious. Therefore, it’s unlikely that Cyclospora can be passed directly from one person to another. More likely, the oocysts contaminate crops or water sources.
SYMPTOMS OF CYCLOSPORIASIS
Exactly how food and water becomes contaminated with Cyclospora oocysts isn’t fully understood but, once the oocysts “hatch” in the human body, the microbes enter the intestinal wall. Some symptoms then begin to manifest. They start an average of 7 days after ingestion of the infective version of the oocyst and can include the following:
Watery diarrhea (most common)
Loss of appetite
Low-grade fever
Weight loss
Cramping
Bloating, increased gas
Nausea and vomiting
Fatigue
A typical case would cause watery diarrhea, with frequent, sometimes explosive, bowel movements. Vomiting, body aches, headache, fever, and other flu-like symptoms may be noted. Interestingly, some people infected with Cyclospora have no symptoms at all.
If untreated, the illness endures for a few days, but some cases last a month. Some victims experience improvement and then relapse several times during the progress of the infection. Although not life-threatening, long-term fatigue and other problems are a possibility.
The Complex Life Cycle of Cyclospora
TREATMENT
Once the organism is identified in a stool sample, cyclosporiasis can be effectively treated with the combination sulfa drug trimethoprim-sulfamethoxazole (TMP-SMX). The usual regimen for adults is trimethoprim (TMP) 160 mg plus sulfamethoxazole (SMX) 800 mg (one double-strength tablet) twice daily for 7–10 days. The veterinary equivalent is FISH-SULFA FORTE. No effective alternatives have been identified yet for those allergic to sulfa drugs. In this case, most immune-competent people will recover without treatment and with good hydration.
PREVENTION
Avoiding any food or water that might be contaminated with feces is the best way to prevent infection. Routine chemical disinfection is less effective for Cyclospora than for most other bacteria or parasites.
1)Washing hands with soap and warm water after touching fruits and vegetables. Also, be sure to clean cutting boards, dishes, utensils, and counter tops between the preparation of meat, poultry, and seafood and fruits and vegetables.
2)Preparing all fruits and vegetables thoroughly under running water before eating, cutting, or cooking. Remove any damaged or bruised areas on fruits and vegetables. Firm items like cucumbers or melons should be scrubbed with a clean brush dedicated to the purpose.
3)Storing properly by refrigerating cut, peeled, or cooked fruits and vegetables within two hours (preferable sooner). Separate the storage of fruits and vegetables and raw meat, poultry, and seafood.
It should be noted that routine chemical disinfection is less effective for Cyclospora than for most other bacteria or parasites. No vaccine exists and immunity isn’t long-term: Recurrence of infection is not uncommon if re-exposed.
In any situation where modern medicine is not available, there will be a number of deaths that occur from injury and infection. These may occur as a result of contact with hostile neighbors or from epidemic diseases, but many will happen simply from the performance of activities related to survival. Many minor wounds will become contaminated, leading to infections that could easily have been treated with antibiotics.
Things don’t end well for this familyYears ago, I realized the importance of antibiotics in a family’s medical kit after watching a History Channel program called “After Armageddon”. In it, the Johnson family is caught in a long-term disaster and finds a community that will take them in. The father is a paramedic and has useful medical skills, but simple injuries associated with household chores lead to a soft tissue infection. Without antibiotics, the family is forced to watch their patriarch sicken and die as the infection spreads throughout his body.
In a major disaster, this and many other deaths might be avoided if antibiotics were available. You may be reluctant to treat yourself or family members with these potent drugs. This is understandable: Antibiotics aren’t candy and are best utilized by qualified medical professionals. If there are no trained personnel, however, a layman with a working knowledge of bacterial diseases and their treatments may have no choice but to use antibacterials to save a life.
There are many antibiotics, but which antibiotics accessible to the average person would be good additions to your medical storage? When do you use a particular drug? The wrong antibiotic at the wrong time can be as bad as doing nothing at all. You should have both quantity and variety to be effective as a medic in long-term survival settings.
Today we’ll take the example of a drug that is used in the aquarium industry that is identical to a medication used in humans: Clindamycin, aka “Fish-Cin”. It is also known as “Cleocin”.
Clindamycin is part of the Lincosamide family of drugs. It works by preventing the production of bacterial proteins necessary for growth. This particular medication has been used to treat everything from acne to anthrax.
Cute, ain’t it? Ouch!
Clindamycin works best on bacteria that are anaerobic, which means that they don’t require oxygen to multiply. A deep puncture wound like, for example, a cat bite would give rise to favorable environments for anaerobes. Clindamycin is versatile enough to treat or prevent certain bacterial or protozoal causes of:
Acne
Dental infections
Ear Infections
Tonsillitis
Soft tissue Infections (skin, etc.)
Peritonitis (inflammation of the abdomen seen in appendicitis and other medical issues)
Some pneumonias and lung abscesses
Uterine infections (such as after miscarriage or childbirth)
It should be noted that although a certain antibiotic may be effective against a certain infection, that it may not always be the most effective. The drug most in favor at the moment is called the “drug of choice”. The drug of choice may change as new antibiotics are developed or new research becomes available about existing medicines…
…We decided to educate the family medic about how to identify various infectious diseases and the medicines that cure them and their veterinary “equivalents”. We did this over the years in articles, videos, and podcasts.
In “Alton’s Antibiotics and Infectious Disease”, we discuss:
How bacteria cause disease
How the immune system works to fight infection
Many different disease-causing organisms
Telling bacterial vs. viral disease
Common infectious diseases
Epidemic and pandemic diseases
How antibiotics work
Different antibiotic families
How to use antibiotics wisely
Issues with antibiotic resistance
Individual antibiotics and the diseases each one treats
Dosing, side effects, allergies, pregnancy and pediatric considerations
Expiration Dates
Establishing an epidemic sick room
Dealing with wound infections
Wound care
Supplies for the effective austere medic
Much more
A non-medical person having antibiotics on hand in disaster settings is considered controversial by the conventional medical wisdom, and for good reason. Yet, if there is no ambulance coming to render aid or hospital to treat the sick, you may become the end of the line with regards to the well-being of loved ones. Just as learning how to stop bleeding is important, learning about infection and the medicines that treat it will save lives in difficult times…
The supplies section of the book includes lists of contents for various medical kits: individual first aid kit (IFAK), family kit, dental tray, natural remedy supplies, up to and including a field hospital.
Combined with chronic malnutrition, the report also points to the scale of the collapse of the country’s health system, with practically every major health condition ranging from tuberculosis to malaria reaching crisis levels. For example, the number of malaria cases has risen from 36,000 in 2009 to 406,000 in 2017, while 87 percent of HIV patients now do not receive their necessary drugs…Most of these conditions are going untreated, mainly due to a lack of necessary medical resources and trained specialists.
Chuck over at the Medic Shack has another good, informative article up, this time about salmonella – how to treat it, how to avoid it, what to watch for.
Outbreak of Multi drug-Resistant Salmonella Infections Linked to Raw Chicken Products
That is the title on the CDC page a couple of weeks ago. Salmonella is bad enough by itself, but a multi drug resistant variety is worse.
Salmonella is a bacteria that is common in poultry. Its why people recommend to cook it completely to kill the bacteria. Salmonella infection is usually caused by eating raw or undercooked meat, poultry, eggs or egg products. The incubation period ranges from several hours to two days. Most salmonella infections can be classified as stomach flu (gastroenteritis). Possible signs and symptoms include:
• Nausea
• Vomiting
• Abdominal cramps
• Diarrhea
• Fever
• Chills
• Headache
• Blood in the stool
A good portion of people generally have no symptoms from salmonella infections. Others develop diarrhea, fever and abdominal cramps within eight to 72 hours. Most healthy people recover within a few days without specific treatment.. However people younger than 5 and older than 70, people with depressed immune systems, or in a weakened state can get sicker or even die from it. As of October, Ninety-two people infected with the outbreak strain of Salmonella Infantis have been reported from 29 states.
So what does this have to do with prepping. Or with survival? Oh I forgot to mention this current strain is multi drug resistant?
The major reason I want to talk about this is a lot of us buy in bulk. Some of us can it, some freeze. And some even freeze dry it. Any mistake in any of these methods can pack away some real bad news when we are at our weakest. Proper processing is a news letter for a different day. But back to salmonella. Salmonella is a huge concern for preppers. And now with a multi drug variant in the wild we need to take extra care…
In the modern world salmonella is rarely fatal. The elderly. Compromised immune system. Under 1 year old. Those are the groups that normally have the worst outcomes. And even then it is rare. Now add in poor living conditions. Exhaustion. Poor nutrition. Poor food prep. Hostile environment. You now have the recipe for disaster…
Ceftriaxone, amoxicillin or cephalosporin are decent antibiotics for salmonella. But a caveat needs to be inserted. They are good if it is a COMPLICATED case. That means if it has entered the blood stream and is causing Septicemia. Or has passed the blood brain barrier and entered the central nervous system. This is getting way out of the realm of a ditch medic. A MD, PA or NP is needed here.
Do not administer antibiotics to people suffering from uncomplicated cases. What happens, is studies show that a large relapse rate occurs. It can lengthen the time of how long a person is infectious. And has caused the resistant forms of it to appear. Also anti diarrhea meds like Imodium while slowing down the diarrhea can actually extend the time of the illness.
That is the title on the CDC page a couple of weeks ago. Salmonella is bad enough by itself, but a multi drug resistant variety is worse.
Lower Valley Assembly 