(Continued from Part 1. This concludes the article.)
Rocky Mountain spotted fever (RMSF) and Lyme disease are two bacterial tick-borne infections of particular concern. The ticks that transmit both of these diseases are found all over the United States. The CDC states that RMSF is most common in Arizona, Missouri, Oklahoma, Arkansas, Tennessee, and North Carolina. After the three- to twelve-day incubation period, the early signs (days 1-4) of RMSF include a high fever, severe headache, gastrointestinal symptoms (nausea, vomiting, anorexia), and edema around the eyes and on the back of the hands. Two to five days after symptoms begin, the rash associated with RMSF first appears. This rash is diagnostic, but not essential. In other words, the small, flat, pink, non-itchy spots that first appear on the wrists, forearms, and ankles do not occur with other illnesses. This rash sometimes spreads to the trunk, palms of the hands, and soles of the feet, but keep in mind that 10% of patients never develop this rash. When the rash color turns from red to purple, it signals severe progression of the disease. Treatment should have begun long ago. Subsequently appearing are altered mental status, cerebral edema, pulmonary edema and respiratory distress, necrosis (tissue death requiring amputation), and kidney failure. If there is any suspicion of RMSF, begin treatment immediately. Delay may be fatal.
The CDC also indicates that Lyme disease occurs primarily in the New England states. However, there are numerous anecdotal reports of high numbers of people contracting Lyme disease in Utah and Idaho as well. Diagnosis of Lyme disease is difficult because the symptoms are similar to many other illnesses—rashes, headaches, and muscle and joint aches. An incubation period lasting up to thirty days only complicates matters. While recalling a tick bite would facilitate diagnosis, over 60% of patients don’t remember being bitten. The classic early sign is the characteristic bullseye rash around the site of the bite. Other early common signs are meningitis or inflammation of the heart muscle. Unfortunately, these won’t be easily identified outside a hospital setting. Symptoms of severe arthritis involving multiple joints and chronic meningitis—headaches, problems in thinking clearly, and sleepiness—appear later.
Options for treating Lyme disease include doxycycline (100 mg, 2 times per day, 10-14 days) and amoxicillin (500 mg, 3 times per day, 14-28 days).
The numerous viral tick-borne diseases are fortunately less common, as we likely won’t be able to identify them without a laboratory. Antibiotics will not work. Treatment for these diseases is supportive care based on the symptoms.
Unlike the other pests addressed in this article, bedbugs do not cause disease. But they are definitely demoralizing. Nobody wants them. The eggs are pearly-white and about the size of pinheads, while the adults look like apple seeds in size and appearance. Bedbugs tend to congregate in families and favor mattress seams, books, suitcases, wallpaper, and electrical outlets. A lot of them together may smell like rotting raspberries. They have a distinctive bite pattern, usually targeting exposed skin and biting in a rather straight line. It’s called the breakfast-lunch-dinner pattern, because that’s basically what they do—take a bite for breakfast, walk on a bit to digest, take a bite for lunch, walk, eat dinner. And maybe some dessert.
To prevent bringing bedbugs home from hotels, always check the mattresses and store bags and backpacks in the hotel bathtub.
If you have been invaded by bedbugs, permethrin may kill them, though some are becoming resistant. Laundry and hot or cold treatments mentioned at the beginning of this article may help. Diatomaceous earth may be sprinkled on mattresses and carpets. Several treatments may be necessary. Natural options for repelling bedbugs include juniper boughs, mint, black cohosh, and bay leaves. A repellent spray can be made using ten drops each of lavender, rosemary, and eucalyptus essential oils in a cup of water.
Benadryl and hydrocortisone cream may be used to relieve the itching and inflammation of the bites.
Scabies, eight-legged mites related to ticks, burrow into the skin and cause intense itching. While commonly found among the poor, they spread very quickly to all classes of people, even the very most hygienic. Indeed, they’re often transmitted to health care providers, and outbreaks frequently occur in rehab hospitals. But day-care centers, schools, public transportation, and prisons are also affected. And that’s because scabies is so highly contagious. It is transmitted by direct physical contact or through infested linens or clothing. Though not technically an STD, scabies is often found in sexually promiscuous teens and young adults. And because scabies is so contagious, when one individual is affected, the whole household gets treated.
And that’s because symptoms of a first-time infection take two to six weeks to appear. During the incubation period, the scabies are spreading to everyone else in the family. The scabies will then incubate in the new hosts and spread for two to six weeks without any symptoms, and so on. When the scabies mites burrow under the skin and bite, they cause itching. This itching is an allergic response to the bites, waste, and eggs being laid. In repeat infestations, because the patient has already been previously sensitized, the allergic reaction is faster, sometimes as little as one day.
The scabies’ rash looks like tiny bites, hives, or bumps under the skin. Occasionally, the burrows or tunnels of the mites can actually be observed, especially with a magnifying glass, which may even allow you to see the mites going in and out of their burrows in the skin. The most common areas for scabies to tunnel are where it’s warmer and wetter—the wrist, arm, genitals, armpits, elbows, waist, buttocks, and areas between the fingers.
One of the chief complaints of those afflicted with scabies is that physicians do not understand how intense the itching is and that a lot of treatments are ineffective. Basically, the itching is so intense that patients cannot sleep at night. Indeed, this is the number one clue that scabies is the culprit—the itching is worse at night. In addition, the intense scratching of the afflicted areas creates sores which can then become infected (impetigo) and require antibiotics to treat.
Pharmaceuticals often prescribed to kill scabies include:
- 5% permethrin cream;
- 25% benzyl benzoate lotion;
- 1% lindane lotion;
- 10% sulfur ointment;
- 10% crotamiton cream;
Sulfur in petroleum jelly is one of the earliest known treatments for scabies. It is not FDA- approved, but it is safe for pregnant women and children. It does not smell good.
Although the above treatments will kill the mites, the itching may continue for several weeks afterward. While the itching is due to biting, it is also an allergic reaction to eggs and waste, which do not magically disappear when the mites are killed. The itching often intensifies during the first week after treatment. It then tapers off to no itching within one month of treatment. Physicians prescribe antihistamines to reduce itching and help with sleep. Home remedies for reducing the itching include:
- a bath with cool water and oatmeal;
- calamine lotion;
- paper towels dipped in rubbing alcohol and applied to the skin;
- apple cider vinegar bath;
- horse ivermectin and 10% permethrin;
- diatomaceous earth and baking soda mixed with water into a liquid paste applied all over the body twice, one week between applications;
- neem oil bath daily for six weeks;
- full-strength apple cider vinegar and salt soak (will burn, but only for a little while)
- diatomaceous earth and olive oil paste;
- a hot bath with 1-2 cups of salt each night for a week;
- witch hazel and tea tree oil;
- rosemary essential oil and tea tree oil;
- 1:1 tea tree oil and olive oil to dab on affected areas;
- Japanese honeysuckle (Lonicera japonica) leaves prepared as an infusion and used as an external wash.
Any personal items that could harbor the mites need to be laundered in water as hot as possible but at least above 120 degrees. Items that cannot be washed need to be avoided for at least three days.
The statistics are that somewhere between forty and eighty million Americans are afflicted with intestinal worms. Not only are they much more common than head lice, one-third of people with worms are totally asymptomatic. So they spread the parasites without even knowing it. None of the medications we commonly stockpile have any efficacy against worms. Worms spread from contact with an infected person or through contaminated food or water.
Pinworms spread easily from person to person, especially among young children, and from those who do not wash their hands thoroughly after using the toilet. All close contacts of an infected individual should be treated, mainly because asymptomatic infection and re-infection are common. Pinworms cause anal itching, especially at night. To identify pinworms, wrap tape around a gloved finger. Insert the finger up the patient’s anus at night. The pinworms will adhere to the tape.
Roundworms come to us from contaminated food. They usually are not diagnosed until the adult roundworms emerge from the mouth, nose, or anus. Other symptoms of roundworms include abdominal pain, intestinal blockage, and malnutrition. And, just as with pinworms, roundworm infections may be asymptomatic. All close contacts with the patient must be treated.
Mebendazole is the drug of choice for eliminating worms. It is available by prescription only in the US; however, overseas pharmacies offer it at a very reasonable price. All Day Chemist sells a bottle of thirty tablets for less than ten dollars, enough for treating fifteen cases of worms. The veterinary option is called albendazole. Though a sheep and cattle dewormer not approved by the FDA for use in people, it appears many physicians wouldn’t hesitate to use it in a crisis.
Natural treatments asserted to be effective against worms include sagebrush, garlic, pumpkin seeds, turmeric, and tobacco.
Three general practices will significantly reduce the chances of getting bitten and developing vector-borne diseases.
The first is absolute cleanliness. Washing clothing, bed linens, and towels in very hot water of at least 140 degrees for 10 minutes will kill all lice, ticks, fleas, and related insect-like vermin. Items that cannot be washed need to be placed in plastic bags wrapped securely and placed in a hot car that reaches temperatures of at least 140 degrees. Bagging and sub-zero temperatures for at least four days will also work for bedbugs. Consider burning the infested items if the other measures are not an option.
Social distancing such as may occur when people voluntarily relocate far from society will completely prevent contracting scabies, bedbugs, or lice, assuming that nobody brings these pests with them, and assuming that nobody ventures out into society. Maintaining a distance of several miles from other people will reduce (not eliminate) the incidence of some mosquito-borne diseases and worms. Social distancing will not reduce the threats posed by ticks.
Permethrin kills and repels insects and ticks and does so for a long time. The spray can be applied to tents, shoes, clothing, and backpacks to repel insects and to kill those that dare land on you or your things. Permethrin doesn’t kill the eggs, but because it is long-lasting, it will kill the larvae after they hatch. Permethrin-treated clothing can be purchased from sporting goods stores, or you can mix up a permethrin solution to apply to your gear. Permethrin should not be applied to the skin except in extreme situations. While permethrin is available online through Amazon, consider supporting your local businesses and buying it at the feed store.
Preparing your defense strategy against these invaders who aren’t after your food or supplies, just you and your family, requires far less training and practice. It does require becoming aware, adopting and vigilantly maintaining strict protocols for water purification and food preparation, and keeping the property clean and free of standing water. It requires dressing well to avoid bites and practicing social distancing as much as possible to reduce contact with potential carriers of vermin and disease. It necessitates acquiring medications to treat possible infections, most of which cost far less than a box of ammo. Make sure you have the means to wash clothing and linens in hot water. Invest in a few bottles of permethrin and enough mosquito netting to cover beds. No, no one’s going to admire your pretty stash of doxycycline, or go ga-ga over your skill in using permethrin. These lethal weapons don’t make for exciting television fare or entertaining dinner discussion. But having several layers of protection and defense against silent and nearly invisible assassins bent on your destruction is always a good idea.