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Botulism is an intoxication caused by ingestion or other exposure to a neurotoxin produced by the anaerobic, Gram-positive, spore-forming bacterium Clostridium botulinum.

Botulism is characterized by neurologic symptoms that may cause dysphagia, dry mouth, diplopia and dysarthria. Ptosis and descending, symmetrical paralysis are characteristic. The patient is usually mentally alert. Neurologic symptoms may be preceded or accompanied by mild GI disturbance such as constipation, vomiting, or diarrhea. Respiratory distress may occur if respiratory muscles become compromised.

Arizona usually sees 1-5 cases of botulism a year. Risk factors for cases in Arizona include IV drug use, consumption of canned food or consumption of prison wine, also known as "pruno."

Arizona 5 year median: 1 case

Transmission

Because C. botulinum forms spores, it can survive indefinitely under essentially any environmental condition.

Foodborne Botulism - Caused by ingestion of preformed toxin. Commonly implicated foods have been low acid, home-canned foods.

Wound Botulism - The toxin is produced in situ and disseminated in the blood from devitalized tissue where semi-anaerobic conditions are obtained. Often reported in drug users, especially injectors of “black-tar” heroin.

Inhalational Botulism - To date, the only human cases have been the result of inadvertent inhalation of toxin by laboratory workers. Toxin can be absorbed through the lung and it is believed that if botulinum toxin were to be used as a bioweapon, it would be by this route.

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Bacillus anthracis and anthrax

Bacillus anthracis is a Gram-positive, rod-shaped, spore-forming bacterium, and is the causative agent of anthrax, an acute, rapidly progressing infectious disease that affects both animals and humans. B. anthracisforms spores after the death of infected hosts. The spores can remain dormant for many years in soil and begin to grow again and secrete toxins after gaining entry into susceptible hosts. The B. anthracis spore, the infectious form of the pathogen, has long been considered as a potential warfare agent and has been a top bioterrorism concern since the 2001 anthrax attacks in the USA   

A Lethal Combination

Anthrax is caused by an unusually large bacterium, Bacillus anthracis. Once its spores lodge in the skin or in the lungs, it rapidly begins growth and produces a deadly three-part toxin. These toxins are designed for maximum lethality, and are frighteningly effective. Part of the toxin is a delivery mechanism that seeks out cells; another part is a toxic enzyme that rapidly kills the cell. In anthrax toxin, there is one delivery molecule, termed "protective antigen" because of its use in anthrax vaccines.   

Keeping Deadly Company

These types of multiple-part toxins are quite common in the bacterial world because they are exquisitely effective. Many other examples, such as toxins from the bacteria that cause cholera and whooping cough, may be found in the PDB. The delivery component specifically seeks out cell surfaces and inserts the toxic component where it can do the most damage. The toxic component is far more effective than poisons like cyanide and arsenic. Those poisons attack one-on-one, with a single cyanide molecule poisoning a single protein molecule. But toxic enzymes are compact cell-killing machines. Once inside the cell, they hop from molecule to molecule, destroying each in turn. These molecules are so effective that in some cases a single molecule can kill an entire cell.

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NHS England has written to all GPs warning that the vaccine has ‘showed no significant effectiveness in this group over recent seasons’.

From next autumn, family doctors should instead adopt an injection used by other European countries for the last 20 years, but which will not be available in Britain until the 2018-19 flu season.

Until then the elderly will have to make do with the current vaccine – and experts last night stressed that they should carry on receiving it as it is the best defence available. Some 70 per cent of pensioners, who are eligible for the jab on the NHS, have already had the current vaccine so far this winter. The new jab, called Fluad, is particularly effective against a strain which is especially dangerous to the elderly called H3N2, also known as Aussie flu. 

Trials have shown the £9.79 vaccine triggers a 61 per cent bigger immune response to this strain in over-65s than other vaccines.

It is also more effective against the other common strain, H1N1, with a 40 per cent bigger immune response.

Fluad has been available in Europe since August 1997, but only received a UK licence in August after British regulators retested its safety.

In October the Joint Committee on Vaccination and Immunisation (JCVI), which advises the Government, recommended it replace the existing vaccine for the elderly. The minutes of its meeting said of Fluad: ‘In a study undertaken in an elderly population ... [it] showed a highly significant effectiveness and relative effectiveness compared with [the current vaccine] which showed no effectiveness.’

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Pancreatic cancer is one of the deadliest forms of cancer. Despite the broad range of treatment options available and all the recent advances in medical technology, the five year survival rate for those diagnosed early is only 8% and this drops to 3% for those diagnosed at an advanced stage. This type of cancer is difficult to diagnose and is often overlooked, usually discovered when it’s advanced to a virtually incurable stage.

So what is pancreatic cancer? Like all cancers, it begins when normal cells mutate and stop their normal functioning. They begin to grow at an uncontrollable rate and start taking nutrients and oxygen from the body, acting independently of the rest of the body and avoiding the usual mechanisms the body uses to maintain health. As the number of cancerous cells increase, they form tumors that can eventually spread to other parts of the body. When pancreatic tumors advance to a large enough size, they begin to impact the function of other organs. This can result in digestive problems as the stomach begins to produce too much acid, as well as issues with the liver and bile production.

Due to the fact that pancreatic cancer is so difficult to diagnose, it makes sense to know the signs and symptoms to help with early detection if you or your loved ones are unfortunate enough to encounter this severe disease. Remember, the key to maintaining a healthy body is not only exercise and nutrition, but making sure you pay attention to what your body is telling you on a day-to-day basis. If you experience any of these symptoms, consult with a physician. 

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Dengue is caused by the four serotypes of dengue virus (1-4). An infection with one of the serotypes does not protect an individual against the other serotypes and multiple infections of dengue virus can put individuals at greater risk for dengue hemorrhagic fever.

The symptoms of dengue fever are:

• high fever
• severe headache
• joint pain
• rash
• mild bleeding

Dengue hemorrhagic fever includes a fever for 2-7 days followed by the capillaries in the body being permeable and causing leakage. This can lead to shock and possibly death.

Dengue is endemic in 100 countries in Asia, the Pacific, the Americas, Africa, and the Caribbean including parts of Mexico. Arizona has only had travel-associated dengue cases.

Arizona 5 year median: 14 cases

Transmission

Transmission occurs when an infected Aedes aegypti or Aedes albopictus mosquito bites an individual. 

Transmission can also occur from blood transfusions or organ donation from an infected individual. 

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Ebola virus disease is a serious, often fatal condition in humans and nonhuman primates. Ebola is one of several viral hemorrhagic fevers, caused by infection with a virus of the Filoviridae family, genus Ebolavirus.

The fatality rates of Ebola vary depending on the strain. For example, Ebola-Zaire can have a fatality rate of up to 90 percent while Ebola-Reston has never caused a fatality in humans.

The infection is transmitted by direct contact with the blood, body fluids, and tissues of infected animals or people. Severely ill patients require intensive supportive care. Ebola virus disease (EVD) is often characterized by the abrupt onset of fever, intense weakness, muscle pain, headache and sore throat.  Ebola tends to spread quickly through families and friends as they are exposed to infectious secretions when caring for an ill individual. The time interval from infection with Ebola to the onset of symptoms ranges from 2-21 days. 

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Cytomegalovirus (CMV) is a common virus that can infect almost anyone. Once infected, your body retains the virus for life. Most people don't know they have CMV because it rarely causes problems in healthy people.

But if you're pregnant or have a weakened immune system, CMV is cause for concern. A woman who develops an active CMV infection during pregnancy can pass the virus to her baby, who might then experience signs and symptoms. For people with compromised immunity, especially due to organ transplantation, CMV infection can be fatal. CMV spreads from person to person through body fluids, such as blood, saliva, urine, semen and breast milk. There's no cure for the virus. However, medications can help treat newborns and people with weak immune systems.

Symptoms

Most people infected with CMV who are otherwise healthy experience few if any signs and symptoms. People at greater risk of signs and symptoms of CMV include:

• Newborns infected with CMV before birth (congenital CMV).
• Infants who become infected during birth or shortly afterward (perinatal CMV). This group includes babies infected through breast milk.
• People with weakened immune systems, for example due to organ transplant or HIV infection.

Babies

Most babies with congenital CMV appear healthy at birth.

A few babies with congenital CMV who appear healthy at birth can develop signs over time — sometimes not for months or years after birth. The most common of these late-occurring signs are hearing loss and developmental delay. A small number of babies may also develop vision problems.

Babies with congenital CMV who are sick at birth tend to have significant signs and symptoms, including:

• Premature birth
• Low birth weight
• Yellow skin and eyes (jaundice)
• Enlarged and poorly functioning liver
• Purple skin splotches or a rash or both
• Abnormally small head (microencephaly)
• Enlarged spleen
• Pneumonia
• Seizures

People with weakened immunity

If your immune system is weakened, you might experience more-serious signs and symptoms affecting your:

• Eyes
• Lungs
• Liver
• Esophagus
• Stomach
• Intestines
• Brain

Otherwise healthy adults

Most people infected with CMV who are otherwise healthy experience few if any signs or symptoms. When first infected, some adults may have symptoms similar to infectious mononucleosis, including:

• Fatigue
• Fever
• Sore throat
• Muscle aches

CMV mononucleosis is less likely than infectious mononucleosis to cause enlarged lymph nodes and spleen.