Bioterrorism

Question 1

What bacteria are priority biological agents?

Answer 1

anthrax, plague, tularemia, brucellosis, Q fever, food borne or water borne pathogens

Question 2

What viruses are priority biological agents?

Answer 2

smallpox, viral hemorrhagic fevers, viral encephalitis

Question 3

What toxins are priority biological agents?

Answer 3

botulism, staph enterotoxin B, ricin toxin, tricothecene mycotoxins

Question 4

What is anthrax?

Answer 4

Gram positive spore forming bacterium Bacillus anthracis. Primarily disease of herbivores which are infected by ingesting spores in soil. Natural transmission to humans by contact with infected animals or contaminated animal products

Question 5

What are the forms of anthrax?

Answer 5

cutaneous, ingestion, inhalation (most deadly)

Question 6

Describe characteristics of inhalation anthrax?

Answer 6

spores engulfed by macrophages and transported to mediastinal and peribronchial lymph nodes. malaise, low fever, nonproductive cough. Sudden respiratory distress, hemorrhagic mediastinitis.

Question 7

How is anthrax diagnosed?

Answer 7

Mediastinal widening on CXR, peripheral blood smear/culture w/gram + bacilli.

Question 8

What is the treatment for inhalational anthrax?

Answer 8

cipro 400mg IV every 12hrs or doxy 100mg IV every 12 hrs. plus one or two additional agent effective against anthrax (imipenem, clindamycin, macrolides)

Question 9

What are the symptoms of GI anthrax?

Answer 9

Nausea, Loss of appetite, Bloody diarrhea, Fever followed by abdominal pain. Invades the bowel wall then spreads through the bloodstream

Question 10

What is the epidemiology of smallpox?

Answer 10

caused by variola virus. transmitted by contact w/ppl, body fluids, fomites. person is most contagious w/onset of rash

Question 11

What is the medical management of smallpox?

Answer 11

Strict respiratory/contact isolation of patient. Patient infectious until all scabs have separated. Treatment is supportive care only. Decontaminate clothing. Pre & post exposure: Vaccine

Question 12

What is the epidemiology of the plague?

Answer 12

caused by Yersinia Pestis, gram (-) bacillus. transmitted by contact w/infected animals or their fleas, cat bite or scratch, airborne.

Question 13

Describe the pneumonic plague

Answer 13

Transmission is by breathing in Y. pestis particles. Respiratory spread by coughing or sneezing. Usually requires close contact within 6 feet.

Question 14

Describe the bubonic plague

Answer 14

Transmission through the bite of an infected flea or exposure to infected material through a break in the skin. can spread through the blood stream to the lungs causing a secondary pneumonic plague.

Question 15

Describe the septicemic plague

Answer 15

deadly blood infection. Rarest of the thee plagues. Almost always fatal.

Question 16

What are the symptoms of the plague?

Answer 16

Sudden onset of fever, SOB, Hemoptysis, Chest pain, N, V & diarrhea

Question 17

What are clinical signs of the plague?

Answer 17

Tachypnea, dyspnea, cyanosis, Rapidly developing pneumonia, Cervical bubo, Sepsis, shock and organ failure, Purpuric skin lesions and necrotic digits in advanced disease

Question 18

What is diagnostic testing for the plague?

Answer 18

CDC/military: Antigen detection, IgM EIA, PCR. Gram stain sputum or blood (or aspirate of bubo). Blood cultures. Pulmonary infiltrates or consolidation on chest xray

Question 19

What is the preferred treatment in adults for the plague?

Answer 19

Streptomycin 1g bid IM. Gentamicin 5mg/kg once daily IM or IV.

Question 20

What is the preferred treatment in kids for the plague?

Answer 20

Streptomycin 15mg/kg bid (maximum daily dose 2gm) IM. Gentamicin 2.5mg/kg every 8 hrs IM or IV

Question 21

What is prophylactic treatment for the plague?

Answer 21

Oral Doxycycline or Ciprofloxacin for 7 days after last exposure

Question 22

What is the epidemiology of botulism?

Answer 22

Caused by toxin from Clostridium botulinum. Colorless, odorless and tasteless. most lethal neurotoxin known to man

Question 23

What is the clinical presentation of botulism?

Answer 23

Cranial nerves III, IV, VI, VII, IX- blurry vision, diplopia, ptosis, expressionless facies, regurgitation, dysphagia, symmetric paralysis of voluntary muscles

Question 24

How is botulism treated?

Answer 24

administration of antitoxin within 24 hours. Type of antitoxin based on type of botulism (7 types). Doesn’t reverse paralysis present. Supportive care- Monitoring respiratory function, mechanical ventilation may be needed for weeks or months

Question 25

What is the epidemiology of tularemia?

Answer 25

caused by fransiscella tularensis. Humans become infected through several routes: Tick and deer fly bites, Skin contact with infected animals (rabbits), contaminated water, Laboratory exposure

Question 26

What is the most serious form of tularemia?

Answer 26

Pneumonic. Spread airborne. life-threatening pneumonia that can lead to systemic infection, Fever of 104 degrees

Question 27

What is the most common form of tularemia?

Answer 27

Ulceroglandular. following a tick or deer fly bite.

A skin ulcer appears at the site where organism entered the body then swelling of regional lymph glands.

Question 28

What are the 5 forms of tularemia?

Answer 28

pneumonic, ulceroglandular, glandular, oculoglandular, oropharngeal

Question 29

How is tularemia diagnosed?

Answer 29

Culture of F. tularensis in culture of skin lesions, lymph node aspirates or biopsies, sputum specimens or gastric aspirates depending on the form. CXR

Question 30

What is treatement of tularemia?

Answer 30

Streptomycin is the drug of choice. Gentamicin is acceptable alternative. Tetracyclines may be suitable alternative to aminoglycosides who are less severely ill. Is static agent so give for at least 14 days