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IOS 10 Exam 3

Bioterrorism

QuestionAnswer
Category A agent rules High priority agents with greatest risk to public are Easily spread, high casulity, public panic, require special action
Category B agent rules Second highest priority considered moderately easy to spread, moderate virulent, require specific enhancement of CDC lab and monitoring
Category A agents Bacilus anthacis, Variola virus (small pox), botulinum toxin, francisella tularensis, hemorrhagic fever virsus (RNA)
Category B agents Brucella, croxielle, salmonella, E.coli, shiegella, clostridium, bulrkoderia pseudomelle, chlamydia, Staph enterotoxin B, Rikettsie proqazekii (typhus), Water thereats-vibrio cholerae, crptosporidium parvi,, viral encephalitis
Why biological as weapons Large casulity & area, cheap, easy to produce , dificult to detect, vulnerability or population aka no vaccine
Anthrax as a biological weapon Spores are durable, cutaneous, or aerosilized, 1g=100K deaths, incubation -1d-8weeks
Aerosol of anthrax Aim is to generate invisible particles 0.5-1 micron to suspend in are to allow good penetration to the alveoli
Anthrax defense mechanism anti-phagocytic capsule and toxin
Clinical forms of anthrax inhalation (5%) 1ng lethal-very virulent, Cutaneous anthrax- 95% of cases, GI and Oropharyngeal- rare zoonotic meat injestion incubaction 1-7day
Mortality of inhalation antrax exposure 95% in untreated patients 1-7 days incubation period is TREATABLE (fever, chills, malase, pleural effusions on CXR, Late symptoms are not treatable 1-5 days after early onset, 50% develop meningitis later mortality
Diagnosis of antrax CXR, Chest CI, Thoracentesis, gram stain, blood cluture, cutaneous culture
Anthrax Inhalation treatment-initial Ciprofloxacin 400mg Q12 or doxycycline 100mg IV Q12 plus and additional antibiotic intil the patient is clinically stable (vanco, imipenem, PCN, Amp, clarithromycin)
Inhalation treatment-prolonged Ciprofloxacin 400mg Q12 or doxycycline 100mg PO Q12
Anthrax Inhalation treatment duration 60days, 100 days or 100days + vaccine (3 doses)
Inhalation- Early symptoms 1-7 days Low grade fever, chills, =weakness, myalgia, dyspnea, cough, HA, maliase, fatigue, abdominal pain, plural effusion on CXR
Late symptoms of inhalation anthraz exposure 1-5 days after early symptoms High fever, dyspnea, diaphoresis, cyanosis, and stridor secondary to massive lymphadenopathy, 50% develop meningitis, 90-95% death
Prophylaxis of anthrax adult Cipro 500mg PO Q12h 30day w/vaccine or 60 days alone
Prophylaxis of anthrax child Amoxicillin 80mg/kg/day Q8hr
Prophylaxis of anthrax pregnancy Cipro or doxycycline
Vaccination for anthrax 0,2,4 weeks post exposure
Small Pox Incubation 7-17days
Clinical presentation of Chicken Pox Day 1-enter lymph nodes, day 3-4 asymptomatic viremia in bone marrow, day 8-secondary viremia localized to small blood vessels Day 12-14 High fever, malaise, HA Day 15-16 Rash, pustular, day 20 crust formation
Key differences Chicken pox verse small pox Chicken pox is slow to develop, found on sole of hand and foot, all pox same stage
Treatment of small pox Prepared from cald lymph use bifurcated needle 2 doses
Clinical Response to Vaccination 2-5 days papule, 7-10 days Pustule, 8-10 days maximum erythema, 14days scab, 21 days scap seperation
Side effects of small pox vaccine Eczema vaccinatum,generalized vaccinia
Treatment of small pox side effects vaccina IgG (CDC) or Cidofovir
Contrindication to small pox vaccine Bioterrist attack no containdeications, immune compromised, HIV, Skin disorders, Ocular or periorbital disease , pregnancy
Role of CDC in bioterrorism preparedness Metropolitan Medical Response System-National Pharmaceutical Stockpile 2 components Push package and Vendor managed inventory
Push package Emergency response of category A agent- 50 tons package enought for 250,000 people 7 days
Vendor managed inventory Delivery of anthrax drugs for 60day w/in 24-36 hours for 12 million people.
Created by: liza001
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