bioterrorism Flashcards
BIOCHEMICAL TERRORISM
DEFINITION:
Using bacteria, viruses, toxins, or chemicals as possible biological warfare agents.
Historically Biological weapons have been used at least since 6 BC
Assyrians poisoned enemy wells with rye ergot
Bacteria (Anthrax, Q and the plague have bruce and tula)
Anthrax
Brucellosis
Plague
Tularemia
Q-Fever
Viruses
(small, hemorrhagic viruses)
Smallpox
Viral Hemorrhagic Fever
Toxins
Botulinum
Chemical Agents - Nerve:
Nerve:
Sarin Gas
Sarin Nerve Gas
Undetectable, colorless, odorless liquid Symptoms: AMS (altered mental status), fasciculations, seizures, muscle paralysis, apnea
ANTHRAX
Known as the wool sorter’s disease in the industrial mills.
Caused by Bacillus Anthracis
Spore forming gram + bacillus
Anthrax spores can survive for yrs
When spores find host they become active and cause disease
In nature human infection is rare and is usually limited to people who work with hoofed animals.
Three forms of contracting Anthrax
Cutaneous
1944 – 1994 total 224 cases of cutaneous Anthrax in the U.S. Mostly from working with hoofed animals.
Gastro-intestinal
Extremely rare
Inhalation (most deadly)
1900 – 1970’s 18 cases total (two from lab exposure)
1970’s to 9-11 terrorist attack there were 0 cases.
Symptoms of Anthrax
(anthrax is wide now)
Widened Mediastinum, Incubation 7 days
Inhalation Anthrax
Initial symptoms resembles the common cold
Sx’s progress to severe dyspnea and shock
Cutaneous Anthrax
Begins as papules followed by blister formation
Vesicles form an ulcer
Ulcer becomes painless and form black eschar that dries and falls off in a couple of weeks.
TREATMENT OF ANTHRAX
(anthrax needs to take cipro)
Postexposure prophylaxis for Anthrax
Cipro or doxy po for 60 days
Presumptive (definite) diagnosis of Anthrax
Cipro or Doxycycline intravenously for at least 60 days AND
One or more antimicrobials such as: Rifampin, Vancomycin, or Clindamycin
SMALLPOX - test question - when was global erradication?
Caused by the Variola Virus
Most deaths of any infectious disease
Millions of deaths from smallpox
2 million in 1967
HIGHLY CONTAGIOUS
Last Cases
Last US case in 1949
Last International case 1978
Global eradication 1980 (TEST QUESTION)
1971 smallpox vaccines stopped in the US
Vaccine immunity may last 5 -20 years.
80% of adults and 100% of kids are presumed susceptible to the virus now.
stages OF SMALLPOX - test question
Incubation Stage:
Prodrome Stage:
Eruptive Stage of Smallpox: how long after exposure?
(erupting at 21)
(Total 21+/- days since exposure)
Heralded by mucosal lesions
HIGHLY CONTAGIOUS
TREATMENT OF SMALLPOX
Prevention is the best treatment
Pros and Cons of Smallpox Vaccination
Must weigh likelihood of a smallpox attack versus the costs and dangers of receiving the live vaccine.
Present Emergent plan if smallpox outbreak
RING’ Vaccination
Vaccinate all those in contact with a person who is contagious with smallpox within 4 days.
And then vaccinate all those in contact with them… thus forming a ‘ring’ of immunization.
Smallpox Vaccine
Vaccinia (live virus vaccine)
95% effective in preventing smallpox
High level immunity for 3 – 5 years
Moderate level 5 to 10 years
Vaccination within 3 days of exposure prevents or greatly lessens symptoms.
Vaccination in 4 to 7 days of exposure will offer some protection
Live virus is present at vaccination site until scabs fall off.
Can be transmitted to other parts of the body or to other people.
Contraindications to Smallpox Vaccination - what about heart?
Persons with acute or chronic skin conditions (eczema, dermatitis, herpes, acne, psoriasis…)
Immunocompromised (HIV, CA…)
Pregnant, breastfeeding
Present short term illness
Cardiac hx. (CAD, HTN)
Normal Systemic Symptoms to the Smallpox Vaccine
30% of recipients will feel too sick to participate in ADL’s.
smallpox - how is it spread?
Can be produced in large quantities
Stable for storage and transport
Stable as aerosol
High Mortality (20 to 40% fatal)
Highly infectious
Person-to-person spread
Most of the world has no immunity
No specific treatment
Leaves survivors with disfiguring scars
chemical agents = Blood:
(bloody cyanide)
Blood:
Cyanide
chemical agents - Pulmonary
(gene in the pulmonary)
Pulmonary:
Phosgene
Chlorine
chemical agents - skin
Skin (blister…):
Mustard gas…
small pox - Incubation Stage (test question)
(Incubate until 7)
Incubation Stage: (7 to 17 days)
Person feels fine and is not contagious.
small pox - Prodrome Stage (test question)
you know this - the same as other virsuses
Prodrome Stage: (2 to 4 days)
Flu like symptoms: Fever, Prostration (weak), Arthralgia, Myalgias, HA, N/V, delirium, oral lesions…
small pox - when does a person become contagious? (test question)
At onset of mucosal lesion pt is contagious
eruptive stage of smallpox - symptoms
CHARACTERISTIC RASH:
Centrifugal: more concentrated on extremities and face – less on trunk
Macular-papular-pustular-umbilicated- scabs/crusting-falls off.
Contagious until ALL the scabs fall off
Permanent scarring especially on the face
