Agents of Biologic Terrorism

Question 1

What are the three categories of biologic threats?

Answer 1

A- Greatest negative impact on Public Health
B- Some potential for negative impact
C- Little to no potential for negative impact

Question 2

What are some category A agents?

Answer 2

Anthrax 8 to 50 spores
F. Tularensis- 10 to 50
Yersinia Pestis- 100 to 500
Variola- 10 to 100
Hemorrhagic Fevers- 1 to 10
Botulinum Toxin .001  ug/kg

Question 3

What are some category B agents ?

Answer 3

Burkholderia Mallet
Brucella10 to 100
Coxiella Bunetti- 1 to 10
Food and Water Pathogens
EEV, WEE,VEE 10 to 100
Ricin Toxin

Question 4

What are some category C agents?

Answer 4

MDR TB

Encephalomyelitis

Question 5

What are some other rapidly fatal infections?

Answer 5

Meningococcemia
Bacterial Meningitis
Toxic Shock Syndrome
Staph Pneumonia
Viral Encephalitis
SARS
Avian Flu

Question 6

What is the definition of an influenza line illness (ILI) vs a common cold??

Answer 6

Abrupt onset of: Abrupt onset of:
Fever Nasal Discharge
HA Nasal Obstruction
Chills Scratchy Throat
Arthralgia Sneezing
Eye Pain Cough
Nasal Discharge Low Grade Fever
Sore throat

Question 7

What biologic agents present like the flu?

Answer 7

Small Pox- Cutaneous
Plague- Cutaneous and Respiratory. Hemoptysis with septic shock. CAts like strept pneumonia
VHF-Cutaneous
Anthrax- Respiratory with wide mediastinsum, flu sx x 3days followed by sepsis
Tularemia- Respiratory and Cutaneous

Question 8

What agent presents with neurologic sx?

Answer 8

Botulism. This is an acute DESCENDING motor paralysis without sensory findings after an incubation period of 2 to 72 hours.

Question 9

What are some treatments for these biologic agents?

Answer 9

Anthrax- Cipro/Doxy/ AMpicillin
Plague- Gentamicin/Cipro
Smallpox- Cidofovir
VHF- Ribovirin
Tularemia- Patchy infiltrates with mediastinal nodes on CXR- Cipro/Gent/Doxy/Chloramphenicol
use contact and airborne precautions

Question 10

What is the infective form of Anthrax?

Answer 10

The Spore which survives for decades. The spore gives rise to a gram + bacillus

Question 11

What are the virulence factors of Anthrax?

Answer 11

Edema Toxin (ET)- inhibits neutrophil toxin, interferes with cytokine
Lethal Toxin (LT)- results in Myolysis with hypoxic injury, liver failure and toxic shock
Polyglutamic Acid Capsule- it protects against macrophage phagocytosis

Question 12

Where are the virulence factors encoded?

Answer 12

Plasmids- PXO1- ET/LT; PXO2- capsule

Question 13

What are the three forms of Anthrax?

Answer 13

Cutaneous- direct contact, 20% mortality without abx, looks like a spider bite, most common, dx’ed with gram stain or MALDi Factor, or sera
GI- eating meat, incubation period 1 to 6 day, sx of sore throat and neck swelling, dx’ed with cultures
Inhalation- processing of wool and hides

Question 14

What is the incubation period of cutaneous anthrax?

Answer 14

1 to 12 days

Question 15

What is the incubation period of Inhalational Anthrax?

Answer 15

1 to 60 days

Question 16

What is the typical course of inhalational anthrax?

Answer 16

Biphasic- initially seems like a virus then 2 to 3 days later, sx of dyspnea and hypoxia

Question 17

What are some complications of inhalational Anthrax?

Answer 17

Meningitis
Hemorrhagic Mediastinitis
Lymph node necrosis. It is diagnosed with

Question 18

What is the treatment of Anthrax>

Answer 18

GI- IV Cipro with 2 of the following: Imipenem, Rifampin, Clindamycin ( to reduce production of exotoxin), Macrolides
Inhalational- same as above
Cutaneous- oral Cipro or Doxy
Anthrax Immune Globulin for severe cases
Drain effusions

Question 19

What is used for post exposure prophylaxis?

Answer 19

Cutaneous- Cipro or Doxy for 7 to 10 days

If Head and Neck Lesions- IV abx for 7 days

Question 20

What is the Anthrax Vaccine?

Answer 20

3 doses given at day 0, 2 weeks and 4 weeks