4-Bioterrorism Agents Flashcards
This is a deliberate release of viruses, bacteria, or agents used to cause illness or death in people, animals, or plants.
Bioterrorism
Why are bioterrorism agents typically found in nature?
Cuz they could be mutated to increase their ability to cause disease
These are spore-forming, G+ rods that appear as long serpentine chains and clumps (medusa head) on microscopy.
Bacillus anthracis
How long can the anthrax spores survive in the soil?
Years
This is the virulence factor for anthax that is made of poly-D glutamic acid, is antiphagocytic, and only produced during infection.
Capsule
What are the 3 protein components of the anthrax toxin?
Protective antigen (PA) Edema factor (EF) Lethal factor (LF)
What is the role of PA?
Carries EF and LF and penetrates the cells
What happesn when PA combines with EF?
since EF is a cAMP-inducing toxin –> edema
What happens when PA+LF?
DEATH
Where is anthrax disease serious?
In coutnries where herd vaccination is not practiced
What are the 3 routes of human disease infection?
Inoculation, inhalation, and ingestion
What accounts for the 95% of transmission for anthrax?
inoculation of spores through exposed skin
Who is at risk for inhalation of anthrax?
Woolsorters
Who is at risk for ingestion of anthrax?
Herbivores
After inhalation of the spores or droplets of anthrax, which cells carry it from the lungs to the lympatic system?
Macrophages
During the first 5 days of anthrax infection, what are the Sx?
malaise, fever, non-productive cough
After traveling into the lymphatic system, where do the spores germinate and multiply to make more toxin?
Lymph nodes
Within what time do you see pulmonary necrosis, septicemia, progressive respiratory distress and cyanosis, massive edema of the neck and chest?
withing 24 hours
What % of mortality occurs with anthrax infection in within 48 hours?
95%
What is the appearance of anthrax on non-selective media?
non-hemolytic, grow rapidly, “gray ground glass” appearance
What do you see on CXR for anthrax infections?
Mediastinal widening
What are the 2 DOC for anthrax infection?
Ciprofloxacin and doxycycline
What is the form of the vaccine for anthrax?
Formalin-killed B. anthracis
Who gets the vaccine (6 doses over 18mo)?
Only military personnel
This is a G+ anaerobic rods, that infects adults that do home canning and infants that eat honey.
C. botulinum
What is the effect of the heat-labile neurotoxin to cause flaccid paralysis form C. botulinum?
inhibits the release of Ach
How many cases/year do we see classic or foodborne botulism?
< 30 cases/yr
So what form of botulism is bioterrorism related?
Inhalation botulism
potential for high mortality
After what time frame from ingestion botulism do you see blurred vision, dry mouth, dilated pupils, CONSTIPATION, abd pain, and no fever?
1-2 days
What do people die from in ingestion botulism?
respiratory paralysis
What % mortality is ingestion botulism?
10%
What si the treatment for ingestion botulism?
antitoxin
+ supportive, stomach lavage
Should you give antibiotics for botulism infections?
nah
This is the disease caused by an oxidase-neg, G- rod that causes hemorrhagic pneumonia
Pneumonic plague
yersinia pestis
When do you die form pneumonic plague?
2 days
What do you see on gram stain of LN aspirate for Y. pestis?
safety pins
Is the inactivated vaccine still available?
Nah
Is pneumonic plague, anthrax, or both spread person-person?
Pneumonic plague
How do you get smallpox (variola)?
via respiratory droplets
How does person-person transmission occur for smallpox?
Fomites
What is the % mortality occur in outbreaks for smallpox?
30%
What do you see on the skin for smallpox?
Small pox. lol. jk. but not really.
they’re papules that become pustules that crust and scab
There was a vaccine for smallpox but in what year did they stop making it?
1980
When i say “bunny” you think of what bug?
Fanciesella tularensis
Story time!
my parents got a rabbit when i was like 5 and at the time i was really into teenage mutant ninja turtles (obviously). so we were deciding to name this rabbit and i came up with the awesome suggestion of “Shredder ball”, as Shredder is the villian in TMNT and “ball” cuz it was fluffy. my parents disagreed with my choice and in turn named it “Lilly” which makes no fuckin sense cuz it was brown and white and didnt look like a lilly pad at all. i cried about that one for a little while. if i ever get a rabbit again i will name it Shredderball.
What is the gram stain/shape of F. tularensis?
Aerobic G- bacillus
Though there are sever hundred cases of Shredderball infections/yr, what is the mortality rate?
~8%
How many F. tularensis do you need for infection?
10-50
What are the clinical manifestations for F. tularensis?
dry cough, dyspnea, chest pain, lobar PNA may develop, ARDS in some, may lead to Typhoidal (septicemic) tularemia
Though the gram stain is usually negative, what agar does F. tularensis grow on?
BCYE
(remember all the “-ellas” grow on BCYE??”
What are the 4 brucella spp to cause brucellosis?
B. abortis, suis, melentensis, and canis
Aborted fetuses can transmit brucellosis by what method into humans?
Inhalation of aerosols (10-100 organisms)
What are the Sx of acute disease?
fever, weakness, fatigue, malaise, depression, anorexia, profuse sweats, chills
What is the 2 antibiotics you give for 6 weeks for the brucellosis?
Doxycycline + rifampin
or doxycycline for 6 wks + streptomycin for 2-3 wks
This is the bug that causes Q fever from the placenta of infected livestock.
Coxiella burnetti
What are the 2 manifestatons of coxiella burnetii?
PNA and hepatitis
Serology of what 2 antigens are used for the Dx of C. burnetii?
Phase I and II antigens
What is the DOC for C. burnetii?
Doxycycline
What is the bug that causes glanders and meliodosis?
Bulkhoderia spp
What are the lab characteristics of Bulkhoderia spp?
nonmotile, nonsporulating, obligate aerobic, G- rods, nonfermenters
Which Bulkhoderia spp causes glanders?
B. mallei
Which Bulkhoderia spp causes melioidosis?
B. pseudomallei
whitmore disease
B. mallei (glanders) is a primary disease of what?
Horses, mules, and DONKEYS
So how do people get B. mallei?
direct contact with secretions from infected animal
B. pseudomallei is endemic in which areas?
SE asia and australia
How do humans get B. pseudomallei?
direct contact from contaminated source
What is the typical clinical manifestion of glanders and meliodosis?
local manifestations with ulceration
What happens in the pulmonary form of glanders and meliodosis?
PNA, pulmonary abscesses, and pleural effusions
The septicemia form of glanders is usually fatal withing what time frame?
7-10 days
Which pts are susceptible to the septicemia form of melioidosis?
chronically ill pts (HIV, DM)
What are the Sx tothe septicemic form of melioidosis?
resp distress, headache, fever, diarrhea, pus-filled lesions on skin, and systemic abscesses
What is the fatality rate of septicemic melioidosis within 24-48 hrs?
90%
What shows up on gram stain of sputum, urine, and skin lesions for glanders and meliodosis?
small, G- bacilli
may have safety pin bipolar appearance like Y. pestis
What are the 3 drugs of choice for glanders and meliodosis?
Amoxicillin and clavulanate
Doxy
TMP-SMZ
