Bioterrorism Flashcards
the release, or the threat of a release, of a biologic agent among a civilian population for the purpose of causing illness or death in humans, animals, or agriculture that results in the spread of fear and disruption of daily life
Bioterrorism
Biological agents with the potential to be used for bioterrorism are classified into two groups:
biologically produced toxins and infectious organisms
have properties similar to chemical agents. The health impact does not depend upon an incubation period to manifest disease in humans
Biologic toxins
Infectious organisms are further subdivided into two categories:
contagious (propagating person to person) and noncontagious
True or false
 The contagious agents of greatest concern, such as smallpox, plague (pneumonic), and certain viral hemorrhagic fevers, are infectious from person-to-person through airborne or droplet transmission
True
Centers for Disease Control and Prevention has further characterized certain select agents based on four general criteria:
- Potential for public health IMPACT
- DELIVERY potential (an estimation of the ease for development and dissemination, including the potential for person-to-person transmission of infection)
- Public PERCEPTION (fear) of the agent
- Special requirements for public health PREPAREDNESS (diagnostic, logistic, etc.)
agents have the most severe potential and include viruses and bacteria such as variola major (smallpox), B. anthracis (anthrax), and Yersinia pestis (plague)
Class A
considered to have less potential for causing widespread illness and death or are more difficult to disseminate
Class B
as technology improves, could emerge as future threats
Class C
Initially fever, severe myalgias, delirium, prostration; followed within 2 d by papular rash on the face spreading to extremities (affecting palms and soles) and then to trunk (lesser extent than chickenpox); lesions progress at same rate, becoming vesicular and then pustular with subsequent scab formation
Smallpox
Small painless or pruritic papule enlarging into eschar with surrounding vesicles and edema; sepsis possible, less common
Cutaneous anthrax
Sore throat, ulcers on base of tongue, marked unilateral neck swelling, dysphagia, abdominal pain, vomiting, GI bleeding progressing to sepsis if untreated; mesenteric adenopathy on CT
Oropharyngeal/GI anthrax
Fever and chills, groups of small blisters or papules that may itch at the injection site, followed by a painless skin sore with black center and subsequent deep abscess formation
Injection anthrax
First stage is nonspecific (fever, cough, headache, malaise, fatigue); second stage (severe dyspnea, chest pain, shock) with rapid progression to death within 24 h after respiratory symp- toms develop; hemorrhagic mediastinitis with widened mediastinum on radiograph. Progres- sion to CNS involvement can occur after systemic spread. If suspected as a diagnosis, consider threat of intentional release of anthrax spores.
Inhalational anthrax
Initially fever, chills, painful swollen lymph node(s); node progresses to bubo (sometimes suppurative)
Bubonic plague
Fever, chills, cough, dyspnea, nausea, vomiting, abdominal pain; clinical condition consistent with gram-negative sepsis
Pneumonic plague
The clinical condition is consistent with gram-negative sepsis, disseminated intravascular coagulation (secondary septicemic plague may occur after bubo formation)
Primary septicemic plague
GI symptoms followed by symmetric cranial neuropathies, blurred vision, progressing to descending paralysis and respiratory dysfunction
Foodborne botulism
Symmetric cranial nerve palsies followed by descending paralysis; death occurs from upper airway obstruction and diaphragmatic respiratory failure
Inhalational botulism
Depends on route of exposure: all usually involve abrupt nonspecific febrile illness; inhalation exposure progressing to pleuropneumonitis; cutaneous exposure developing glandular or ulceroglandular lesions; ingestion developing oropharyngeal lesions/tonsillitis
Tularemia
Initial nonspecific febrile illness, sometimes with rash; progresses to bloody vomiting, diarrhea, shock
Viral hemorrhagic fevers
Fever, myalgias, headache, 30% develop pneumonia, rarely lethal (2%)
Q fever
Fever, myalgias, back pain; CNS infections and endocarditis possible
Brucellosis
Local infection: ulcers, suppurative; pneumonia, pulmonic abscesses, sepsis possible
Glanders
Local infection: nodule; pneumonia, pulmonic abscesses, sepsis
Melioidosis
Fever, headache, aseptic meningitis, encephalitis, focal paralysis, seizures
Encephalitis
Fever, headache, rash
Typhus fever
Fever, headache, dry cough, pneumonia, endocarditis
Psittacosis
What class?
Emerging threat agents (Nipah virus, hantavirus)
Class C
What class?
Alpha viruses (Venezuelan equine encephalitis, Eastern equine encephalitis, Western equine encephalitis)
Class B
What class?
Food safety threats (Salmonella species, Escherichia coli O157:H7)
Class B
What class?
Water safety threats (Vibrio cholera, Cryptospo- ridium parvum)
Class B
What class?
Rickettsia prowazekii
Chlamydia psittaci
Burkholderia pseudomallei
Brucella species
Coxiella burnetii
Class B
What class?
Filoviruses and arenaviruses (Ebola virus)
Class A
What class?
Francisella tularensis
Clostridium botulinum
Variola major
Class A
True or false
 Early symptoms of most agents of concern are not readily distinguished from more common, less threatening infectious diseases.
True
Bacillus anthracis Vaccination
Anthrax vaccination: Three-part series vaccination at 0, 2 wk, and 4 wk. Annual boosters may be required
Filoviruses Vaccination
Ebola trials with rVSV-ZEBOV
Prophylaxis for Variola major
Vaccinia immune globulin: best given within 2–3 d of exposure; limited supplies are available, and it is available through the CDC as an IND; consider giving to those exposed who have contraindications to vaccine. Cidofovir and brincidofovir are available for postexposure prophylaxis.
Bacillus anthracis Prophylaxis
Vaccinia immune globulin: best given within 2–3 d of exposure; limited supplies are available, and it is available through the CDC as an IND; consider giving to those exposed who have contraindications to vaccine. Cidofovir and brincidofovir are available for postexposure prophylaxis.
Bacillus anthracis Prophylaxis
Ciprofloxacin or doxycycline for 60 d is preferred, but alternatives exist. In addition, amoxicillin and penicillin V potassium for penicillin-susceptible strains; anthrax vaccine adsorbed BioThrax is now approved for both preexposure prophylaxis and postexposure prophylaxis.
Yersinia pestis Prophylaxis
Ciprofloxacin or doxycycline; alternative: chloramphenicol; prophylaxis for 10 d. Recommended for close contacts within 2 m.
Francisella tularensis Prophylaxis
Ciprofloxacin or doxycycline for 14 d
Unknown biological hazard
Class A Agents: Guidelines for Personal Protective Equipment for Clinical Care in the ED
until the pathogen is under- stood and its transmission pattern defined, employ standard, contact, and airborne precautions
Anthrax: Cutaneous infection:
Class A Agents: Guidelines for Personal Protective Equipment for Clinical Care in the ED
standard precautions. However, contact precautions are recommended for uncontained copious drainage. Respiratory tract and GI tract infec- tions: standard precautions
Ebola:
Class A Agents: Guidelines for Personal Protective Equipment for Clinical Care in the ED
If the epidemiology of transmission is consistent with natural disease, droplet precautions can be substituted for airborne precautions. Otherwise, consider Ebola a potential airborne pathogen during a bioterrorism event
Smallpox
Class A Agents: Guidelines for Personal Protective Equipment for Clinical Care in the ED
Combined use of standard, contact, and airborne precautions for initial care and for up to 3–4 wk until scabs heal over. Airborne precautions are recommended when possible, but in the event of mass exposures, barrier precautions and contain- ment within a designated area are paramount. When possible, only immune health- care workers should care for smallpox patients.
Pneumonic plague:
Class A Agents: Guidelines for Personal Protective Equipment for Clinical Care in the ED
Standard precautions. However, droplet precautions are needed until patients have received 48 h of antibiotic therapy.
Botulinum toxin
Class A Agents: Guidelines for Personal Protective Equipment for Clinical Care in the ED
Standard precaution.
Tularemia
Class A Agents: Guidelines for Personal Protective Equipment for Clinical Care in the ED
Standard precautions. Although person-to-person spread is rare, laboratory workers are at high risk of infection if exposed during specimen handling.
True or False
Decontamination is a consideration only if a patient presents shortly after acute exposure to a substance (toxin or organism) suspected or confirmed as a biologic agent, in contrast to the presentation of the patient who has already developed symptoms of an infectious disease.
True
refers to the ability to manage patients requiring unusual or very specialized medical evaluation and care.
It is intuitively obvious, for example, that even one patient presenting with signs and symptoms of smallpox would present highly unusual challenges affecting any hospital’s continuity of operations.
Medical surge capability
The most important assistance public health can provide to all clinicians is
in the development of a community-wide patient evaluation and treatment protocol.
