Bioterrorism Flashcards
What bacteria are priority biological agents?
anthrax, plague, tularemia, brucellosis, Q fever, food borne or water borne pathogens
What viruses are priority biological agents?
smallpox, viral hemorrhagic fevers, viral encephalitis
What toxins are priority biological agents?
botulism, staph enterotoxin B, ricin toxin, tricothecene mycotoxins
What is anthrax?
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
What are the forms of anthrax?
cutaneous, ingestion, inhalation (most deadly)
Describe characteristics of inhalation anthrax?
spores engulfed by macrophages and transported to mediastinal and peribronchial lymph nodes. malaise, low fever, nonproductive cough. Sudden respiratory distress, hemorrhagic mediastinitis.
How is anthrax diagnosed?
Mediastinal widening on CXR, peripheral blood smear/culture w/gram + bacilli.
What is the treatment for inhalational anthrax?
cipro 400mg IV every 12hrs or doxy 100mg IV every 12 hrs. plus one or two additional agent effective against anthrax (imipenem, clindamycin, macrolides)
What are the symptoms of GI anthrax?
Nausea, Loss of appetite, Bloody diarrhea, Fever followed by abdominal pain. Invades the bowel wall then spreads through the bloodstream
What is the epidemiology of smallpox?
caused by variola virus. transmitted by contact w/ppl, body fluids, fomites. person is most contagious w/onset of rash
What is the medical management of smallpox?
Strict respiratory/contact isolation of patient. Patient infectious until all scabs have separated. Treatment is supportive care only. Decontaminate clothing. Pre & post exposure: Vaccine
What is the epidemiology of the plague?
caused by Yersinia Pestis, gram (-) bacillus. transmitted by contact w/infected animals or their fleas, cat bite or scratch, airborne.
Describe the pneumonic plague
Transmission is by breathing in Y. pestis particles. Respiratory spread by coughing or sneezing. Usually requires close contact within 6 feet.
Describe the bubonic plague
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.
Describe the septicemic plague
deadly blood infection. Rarest of the thee plagues. Almost always fatal.
What are the symptoms of the plague?
Sudden onset of fever, SOB, Hemoptysis, Chest pain, N, V & diarrhea
What are clinical signs of the plague?
Tachypnea, dyspnea, cyanosis, Rapidly developing pneumonia, Cervical bubo, Sepsis, shock and organ failure, Purpuric skin lesions and necrotic digits in advanced disease
What is diagnostic testing for the plague?
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
What is the preferred treatment in adults for the plague?
Streptomycin 1g bid IM. Gentamicin 5mg/kg once daily IM or IV.
What is the preferred treatment in kids for the plague?
Streptomycin 15mg/kg bid (maximum daily dose 2gm) IM. Gentamicin 2.5mg/kg every 8 hrs IM or IV
What is prophylactic treatment for the plague?
Oral Doxycycline or Ciprofloxacin for 7 days after last exposure
What is the epidemiology of botulism?
Caused by toxin from Clostridium botulinum. Colorless, odorless and tasteless. most lethal neurotoxin known to man
What is the clinical presentation of botulism?
Cranial nerves III, IV, VI, VII, IX- blurry vision, diplopia, ptosis, expressionless facies, regurgitation, dysphagia, symmetric paralysis of voluntary muscles
How is botulism treated?
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
What is the epidemiology of tularemia?
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
What is the most serious form of tularemia?
Pneumonic. Spread airborne. life-threatening pneumonia that can lead to systemic infection, Fever of 104 degrees
What is the most common form of tularemia?
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.
What are the 5 forms of tularemia?
pneumonic, ulceroglandular, glandular, oculoglandular, oropharngeal
How is tularemia diagnosed?
Culture of F. tularensis in culture of skin lesions, lymph node aspirates or biopsies, sputum specimens or gastric aspirates depending on the form. CXR
What is treatement of tularemia?
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
