Microbio -3- Bioterrorism
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What are the A list biologic agents | Anthrax (bacillus anthracis), Smallpox (variola major), Tularemia (francisella tularensis), Plague (yersinia pestis), Botulism (clostridium botulinum toxin), Viral hemorrhagic agents
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Requirements to be an A list agents | easily transmitted or spread from person to person, has high mortality rates, might cause public panic and require special action for public health preparedness
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Requirements of a B list agents | moderately easy to disseminate, moderate morbidity, low mortality rates, require enhancement of CDC's diagnositc capacity and enhanced disease surveillance
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Requirements of a C list agents | emerging pathogens that could be engineered later to be disseminated, potential for high morbidity and mortality
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has two forms pulmonary and cutaneous is spore forming | anthrax
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what is the mortality rate for a full blown case of anthrax | 100%
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what are the starting s/sx like for anthrax | flu like
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What does the spore forming ability of anthrax allow it to do | survive for long periods and resist drying and sunlight,
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HOw is anthrax diagnosed | routine blood culture, sputum culture, direct fluorescent stain, chest x-ray with widened mediastinum.
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do you need to quarantine for anthrax | no, no patient to patient spread
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Treatment of anthrax | doxycycline, cipro or anthrax vaccine
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what form must anthrax be in to infect target | aerosolized
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what is the treatment for a person who opens an envelope with powder | prophylatic course of antibiotics
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what is the less deadly but uglier form of anthrax and what are its s/sx | cutaneous anthrax which starts with edema develops into pruritic macule or papule
enlarges and ulcerates
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When was small pox eradicated | 1970
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what is the incubation rate for small pox | 21 days allows health department to indentify and vaccinate and isolate contacts
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Where is the pustular/vesicular rash of small pox most prominant why is this important | face and extremities, allows for differentiation from chicken pox
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Do the lesions of small pox develop and heal in stages or all at once | all at once, chicken pox develops and heals in stages this is another way to differentiate between chicken pox and small pox
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How do you diagnose small pox and what course do you take with a patient you think is infected | requires specialty testing and put patient in quarantine no treatment on symptomatic care
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What is tularemia what types are there | gram negative coccobacillus
jellison type A (highly virulent)
Type B (mild disease)
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Who is the most common group infected with tularemia | people who work with rabbits
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How does tularemia normally infect us | passing through broken skin causing febrile condition with skin ulcers and tender lymphadenopathy
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What is the incubation for tularemia | 1-21 days
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What way would tularemia need to enter to infect people as an effective bioagent | via the lungs as a aerosol which causes acute onset
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what are the s/sx of acute onset tularemia via inhalation | non productive cough
substernal burning
chest x-ray may show patchy ill defined infiltrates
may develop toxicity
shock is common
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what are the major problems with inhaled tularemia | febrile condition, develop multiple necrotizing granulomata that destroy alveolar septa. can develop bronchopneumonia, bronchitis or tracheaitis. can also develop bacteremia
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How do you diagnose tularemia | sed rate and c reactive protein is elevated
smears of aspirates from lymph nodes have organism
pneumotic form harder to diagnose
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What is the treatment for tularemia | streptomycin
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what are the fatality rates for untreated tularemia skin and lung | skin 5%
pneumonic 30%
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What is the type of plauge found in the US | Yersenia pestis
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what is the initial s/sx of plague yersenia pestis | non specific viral syndrome, progresses to severe pneumonia, cough w/ muco-purulant sputum, hemoptysis, and chest pain
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How do you diagnose plague | gram's stain of blood or sputum
culture
direct fluoroscopy assay
serology
chest x ray with bronchopneumonia
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Treatment for plague | contagious need strict isolation, treat with streptomycin, gentamycin, doxycyline, chloramphenicol,
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What is botulism | a toxin produced by an organism
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what is the lethal concentration of botulism | extremely lethal in parts per billion 1ng/kg
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how do you get infected with botulism | direct ingestion or inhalation of the toxin
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How is botulism toxic and lethal | is a choinergic blocker, which causes muscle paralysis. Death usually from respiratory failure.
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What is treatment for botulism | intubation with respirator
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How do you diagnose Botulism poisoning | look for the D's dysarthia, diplopia, descending paralysis, dysphonia.
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WHat is the treatment of botulism | antitoxin most effective if used in first 48-72 hours if this doesn't work ventilator
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What is the incubation time for hemorrhagic fevers | 5-10 days
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what is the characteristic s/sx of onset of hemorrhagic fever | abrupt onset of fever myalgia and headache, w/ nausea and vomiting, abdominal pain, diarrhea, chest pain and cough.
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what occurs five days after infection with hemorrhagic fever | develop macular papular rash which in prominent on the trunk
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What are the last s/sx of hemorrhagic fever | petechiae, ecchymoses and hemorrhages occur as the disease progresses
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what type of virus are all the hemorrhagic fevers | RNA viruses
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all hemorrhagic fevers but dengue can be transmitted via what | aerosol or fomites
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what is the only hemorrhagic fever with a vaccine | yellow fever
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