bioterrorism

Question 1

Biowarfare

Answer 1

offensive use of biological agents by nations to harm the military of the enemy.

Question 2

Bioterrorism

Answer 2

Induces widespread fear of infection and death in a civilian population leading to disruption of society, economic losses, etc. for political or social objectives. Bioterrorism can also target crops, domestic animals, water supply. Bioterrorism can be sponsored either by nations, cults or other extremist organizations.

Question 3

biocrimes

Answer 3

use microbes to attack individuals as in assassination or murder

Question 4

2 kinds of biothreat agents

Answer 4

1. Transmissible infectious agents that spread among people, animals or plants. 2. Toxins that affect exposed people, but do not make them contagious

Question 5

characteristics of microbes/toxins likely to be used as biothreat

Answer 5

High morbidity/ mortality, person-to-person spread, Low infectious dose, spread by aerosol, Lack of widespread rapid diagnostic tests, Lack of stockpiles of effective drugs, Lack of an vaccine, Lack of widespread immunity, Ability to obtain pathogen and cultivate it in large amounts, Stability of infectious organism in the environment, Potential to be weaponized, Mass casualties that could overwhelm the health care system

Question 6

describe properties of category A agents that could be used as bioweapons

Answer 6

Highly lethal, easily transmissible, high mortality rates, public panic/ social disruption, require special action for public health preparedness

Question 7

List category A agents

Answer 7

Bacillus anthracis (anthrax), Clostridium botulinum toxin (botulism), Yersinia pestis (plague), Variola major (smallpox) and other related pox viruses, Francisella tularensis (tularemia) and Viral hemorrhagic fevers like: Arenaviruses (LCMV, Junin, Machupo, Lassa Fever, Bunyaviruses (Rift Valley fever virus), Flaviviruses (Dengue), Filoviruses (Ebola, Marburg)

Question 8

describeproperties of category B agents that could be used as bioweapons

Answer 8

moderately easy to disseminate, cause moderate morbidity rates and low mortality rates, require enhanced diagnostic capacity, could be genetically enhanced for use as a weapon

Question 9

List Category B agents- bacteria

Answer 9

Burkholderia pseudomallei (meliodosis), Burkholderia mallei (glanders), Coxiella burnetii (Q fever), Brucella species (brucellosis), Chlamydia psittaci (psittacosis) Rickettsia prowazekii (typhus fever). Foodborne and waterborne pathogens -Vibrio cholerae, Diarrheagenic E. coli, Pathogenic vibrios, Shigella species, Salmonella, Listeria monocytogenes, Campylobacter jejuni, Yersinia enterolitica

Question 10

List category B agents- toxins

Answer 10

Ricin toxin (Ricinus communis), Epsilon toxin of Clostridium perfringens, Staphylococcus enterotoxin B, Mycotoxins (fungal toxins)

Question 11

yellow rain

Answer 11

think mycotoxins from fungi. Causes skin damage

Question 12

List Category B agents- viruses

Answer 12

caliciviruses including noroviruses, hepatitis A, Viral encephalitides (West Nile virus, LaCrosse, California encephalitis, VEE, EEE, WEE, Japanese B encephalitis virus

Question 13

describe properties of category C agents that could be used as bioweapons

Answer 13

New emerging pathogens that could be engineered for mass dissemination, cause highly virulent infectious diseases, population lacks immunity, potential for high morbidity and mortality, major public health impact

Question 14

List category C agents

Answer 14

emerging diseases such as SARS, Nipah, hantaviruses, highly pathogenic avian influenza

Question 15

Signs that a bioweapons incident has occurred

Answer 15

Unusual clinical presentations, clusters of cases of a previously rare disease, or appearance of a previously agriculture-associated disease in urban areas. Report to CDC

Question 16

How is the health care system prepared to respond to bioweapons incident

Answer 16

1. surveillance networks- timely reporting, rapid testing, control spread, isolation and quarantine. 2. stockpiles of equipment, drugs, vaccines, etc have been assembled and can be mobilized anywhere in US within 12 hrs. 3. providing accurate public information. 4. distinguish btw bioweapons event and emerging dz outbreak

Question 17

How can microbes be genetically engineered to be bioweapons

Answer 17

1. enhance virulence- Abx resistant genes, change antigenicity so nobody has protectve Abs, tissue tropism. 2. Construct chimeric microbes by recombinant DNA technology- genes from one organism recombined with genome of another. 3. de novo construction of pathogens - using oligonucleotides.

Question 18

Smallpox structure

Answer 18

virus- large, enveloped DNA virus in the orthopox family that replicates in the cytoplasm of infected cells, unlike other DNA viruses. Smallpox virions are highly resistant to inactivation by drying.

Question 19

smallpox clinical features

Answer 19

Fever,headache, limb and back pain, vomiting, apprehension for 3-4 days. Maculopapular rash (mucosa, head, forearms) > vesicles > pustules (firm, tense) > crust > scar. Hemorrhagic smallpox has rapid evolution of localized petechiae and hemorrhages (pregnant women and immunodeficient prone to this malignant form of the disease), bleeding from orifices, DIC and death. Typical rash may not develop.

Question 20

smallpox transmission

Answer 20

Incubation period 2 to 3 weeks. Virus shed from the pustules and scabs as well as by respiratory secretions from infected patients enters the body by inhalation and/or inoculation through scratches in the skin

Question 21

smallpox pathophys

Answer 21

During incubation the smallpox virus first replicates locally at the site of inoculation, then is spread by primary viremia to central organs such as spleen and liver, where it is amplified. Secondary viremia spreads virus to many tissues including the skin, where pustules are formed, most intensively in the face and torso. The incubation period ends when symptoms develop.

Question 22

Immune responses to smallpox

Answer 22

Innate immune responses cause the fever and systemic symptoms, and the pustular rash is the result of a combination of direct virus damage to infected cells in the skin and acquired immunie responses causing inflammation and cell mediated immunity to the infected cells.

Question 23

smallpox vaccine

Answer 23

live attenuated virus called vaccinia- antigenically related to smallpox virus and propagated in cow skin. Due to smallpox long incubation period, vaccination can be used after exposure.

Question 24

smallpox variolation

Answer 24

Pus from a lesion from a mild case of smallpox
was scratched into the skin. One local lesion developed, and most vaccinees were then resistant to virulent smallpox. 2% diedPus from a lesion from a mild case of smallpox
was scratched into the skin. One local lesion developed, and most vaccinees were then resistant to virulent smallpox. 2% died

Question 25

smallpox vaccine side effects

Answer 25

mild side effects such as a sore are, and vaccine virus could spread to other parts of the body (eczema vaccinatum) in patients with skin conditions. Vaccine virus could also be transmitted from the vaccine to contacts, causing local lesions in unexpected places. Vaccination of an immunocompromised person with vaccinia could cause progressive vaccinia with widespread symptoms, leading to death

Question 26

Who still gets smallpox vaccine

Answer 26

military and first responders in the USA

Question 27

drugs used against smallpox

Answer 27

IV -vaccinia Ig from sera of vaccinees can be used to treat smallpox or rxns to vaccination. Also Cidofivir (nucleoside analog used for CMV) and ST246 (Tecovirimat- inhibits release of extracellular virus).

Question 28

Anthrax structure

Answer 28

Caused by Bacillus anthracis, a gram-positive, non-motile soil bacterium, which expresses very potent toxins and produces spores that can survive for decades. Note: There are strains of Bacillus cereus, which carry anthrax toxin gene, produce capsules and have caused illnesses resembling inhalation anthrax.

Question 29

Anthrax presentation

Answer 29

cutaneous, GI (rare), inhalation (bioterrorism), injection (street drug contamination)

Question 30

Anthrax as bioweapon

Answer 30

The spores are the infectious form. They are relatively easily aerosolized.Infected persons are NOT contagious (i.e. infection is NOT transmitted person-to-person)

Question 31

anthrax vaccine

Answer 31

Not available for the public- Anthrax Vaccine Adsorbed (AVA) protects against cutaneous and inhalation anthrax. The vaccine is approved by the FDA for at-risk adults (e.g. some military personnel, veterinarians, those who work with anthrax) before exposure to anthrax.

Question 32

anthrax treatment

Answer 32

ciprofloxacin or doxycycline for prophylaxis or therapy

Question 33

anthrax diagnosis

Answer 33

culture, PCR of two virulence plasmids, wrights stain or organism in blood

Question 34

plague- cause/structure

Answer 34

Yersinia pestis, a gram-negative bacillus that infects prairie dogs and rats and is most commonly transmitted to humans by the bite of infected fleas

Question 35

plague clinical presentations

Answer 35

1. bubonic- , from insect bite

Question 36

plague vaccines

Answer 36

currently vaccine contains killed whole bacterial cells treated withformaldehyde & 0.5% phenol, only for laboratory personnel working with Y. pestis

Question 37

plague treatment

Answer 37

tetracycline, chloramphenicol or streptomycin. 1 week before and after exposure

Question 38

Tularemia - cause/ structure

Answer 38

Francisella tularensis, a small gram-negative coccobacillus, which can survive for weeks in soil or water.

Question 39

Tularemia transmission

Answer 39

Tularemia CANNOT spread from person to person, like pneumonic plague, and typically infects from insect bites or direct contact with infected small mammals. Can cause waterborne outbreaks, and has been delivered as an aerosol for bioterrorism. Infectious dose can be, as few as, 10 organisms

Question 40

tularemia presentation

Answer 40

fever, lymphadenopathy from aerosol, direct contact if from an insect bite, also gets a necrotic spot at site of bite. Oropharyngeal form from contaminated water, case fatality rate of untreated pneumonic tularemia can be 30-60%.

Question 41

Tularemia treatment

Answer 41

doxycycline or ciprofloxacin orally. Streptomycin or gentamicin are given IV

Question 42

Botulism- cause/ structure

Answer 42

Clostridium botulinum is an anaerobic, gram positive, spore-forming soil bacterium that produces one of the most potent toxins known, botulism toxin. There are 7 antigenic variants of this toxin

Question 43

botulism presentaion

Answer 43

The toxin is a protease that blocks release of acetyl choline from the motor neurons, causing flaccid paralysis that has a 60-100% fatality rate

Question 44

botulism treatment

Answer 44

Equine anti-toxins against types A, B and E are available in limited quantities to bind any circulating toxin, which has not yet reached the nerves. Can cause serum sickness

Question 45

Botulism vaccine

Answer 45

A botulism toxoid is used to immunize people who work with C. botulinum or the toxin, but it is not available in large amounts

Question 46

what is ricin

Answer 46

The residue remaining after caster beans are boiled down to produce castor oil.