Bioterrorism

Question 1

Definition of CDC category A agents

Answer 1

Agents that are highly lethal AND

Are easily transmissible
Have large public health systems impact
Cause social panic / disruption
Require special preparedness

Question 2

CDC Category A Agents

Answer 2

Anthrax (Bacillus Anthracis)

Smallpox (Variola major)

Question 3

Bacillus Anthracis - Bacteriology

Answer 3

Gram positive, spore-forming rod found in soil

Produces edema factor (adenylate cyclase mimic) which increases levels of intracellular cAMP

Question 4

Anthrax - Clinical Presentations

Answer 4

1. Cutaneous - Ulcer with black eschar
2. Inhalational - spores germinate in lungs, invade lymphatics and blood causing pulmonary edema / hemorrhage, mediastinitis, septicemia, shock, death
3. GI

Question 5

Anthrax - Diagnosis

Answer 5

Wright stain of peripheral blood smear

Question 6

Anthrax - Prevention

Answer 6

Vaccine available for at-risk individuals only (military, veterinarians, researchers); protects against cutaneous and inhalational disease

Question 7

Anthrax - Treatment

Answer 7

Ciprofloxacin or Doxycycline

Question 8

Variola Major - Virology

Answer 8

Poxvirus family - enveloped, linear DNA virus

Question 9

Smallpox - Pathogenesis

Answer 9

Virus is shed from pustules and enters the body by inhalation or innoculation; primary replication occurs in the oropharynx followed by primary viremia to liver and spleen; secondary replication occurs in reticuloendothelial organs and seeds virus via secondary viremia to many organs including skin

Question 10

Smallpox - Epidemiology

Answer 10

Eradicated 1976, last known fatal case occurred 1978; widespread vaccination ceased 1980

Official stocks exist only at US CDC and RUssian Lab

Question 11

Smallpox - Prevention

Answer 11

Live-attenuated vaccine exists for military / first responders only

Risk of skin lesions (eczema vaccinatum) or progressive vaccinia in immunocompromised pts (treat with vaccinia-IVIG)

Question 12

Clostridium botulinum - Bacteriology

Answer 12

Gram positive anaerobe

Produces botulinum toxin, a protease that cleaves SNARE proteins required for ACh release at the neuromuscular junction, causing flaccid paralysis

Question 13

Botulism - Prevention

Answer 13

Toxoid - immunizes high risk individuals (researchers)

Equine antitoxin can be given as post-exposure prophylaxis

Question 14

Yersinia Pestis - Bacteriology

Answer 14

Gram negative, facultative intracellular bacterium

Question 15

Plague - Pathogenesis

Answer 15

Y. pestis infects prarie dogs and rats; transmitted to humans by flea vector

Question 16

Plague - Clinical Presentation

Answer 16

Bubonic - from insect bite

Pneumonic - from inhalation

Septicemic - from ingestion of contaminated food / water

Question 17

Plague - Prevention

Answer 17

Vaccine exists for at-risk lab personnel only

Question 18

Plague - Treatment

Answer 18

Tetracyclines
Chloramphenicol
Streptomycin

Question 19

Francisella tularensis

Answer 19

Gram negative soil / water bacterium

Question 20

Tularemia - Clinical Presentation

Answer 20

Fever, lymphadenopathy

30 - 60% fatality

Question 21

Tularemia - Treatment

Answer 21

Doxycycline
Ciprofloxacin
Aminoglycosides