ID Prevention and Immunoprophylaxis- Exam 2 Flashcards
_____ A biological attack, or bioterrorism, is the intentional release of viruses, bacteria, or other germs that can sicken or kill people, livestock, or crops
bioterrorism
_____ the processing of microbes or toxins in a manner that would ensure a devastating effect following release
weaponization
What are the categories of bioterrorism agents?
Category A-C
What is a category A bioterrorism mean? B? C?
Easily spread person - person
High mortality and morbidity
Requires special action for public health preparedness
Potential for public panic and social disruption
Moderately easy to spread
Low to moderate morbidity and mortality
Readily available
Could be engineered for mass spread in the future
Potential for major health impact
Anthrax -(Bacillus anthracis)
Botulism - (Clostridium botulinum toxin)
Plague - (Yersinia pestis)
Smallpox - (Variola major)
Tularemia - (Francisella tularensis)
What category?
Category A
Brucellosis (Brucella spp.)
Epsilon toxin of Clostridium perfringens
Food safety threats (e.g., Salmonella spp., Escherichia coli 0157:H7, Shigella)
Glanders (Burkholderia mallei)
Melioidosis (Burkholderia pseudomallei)
Psittacosis (Chlamydophila psittaci)
Q fever (Coxiella burnetii)
Ricin toxin from Ricinus communis (castor beans)
Staphylococcal enterotoxin B
Typhus fever (Rickettsia prowazekii)
Viral encephalitis (alphaviruses [e.g., Venezuelan, eastern, and western equine encephalitis])
Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)
What category?
B
Nipah
hantavirus
SARS
MERS coronavirus
pandemic influenza
What category?
C
____ is the worst form in term of mass spread for bioterrorism agents
anything aerosol
Gram + rod
Spore-forming
Found in soil
Can form painless vesicle that turns into necrotic eschar
Fever, fatigue, malaise, N/V, cough, SOB ⇾ pneumonia ⇾ pleural effusions ⇾ death
What am I?
What form is most likely used in bioterrorism?
Anthrax
respiratory (aka inhaled) is most common
What is the treatment for Anthrax? What about post-exposure? For how long?
antitoxin
cipro or clindamycin
vaccination
cipro or doxy
lasts up to 60 days due to persistent spores
_____ is the only bioterrorism agent that is non-living. Can it spread person to person?
Botulism
does NOT spread person to person
T/F: The botulism antitoxin does not work on all the 7 distinct forms
False, DOES work on all the different forms
What is the pathophys behind botulism?
Toxin prevents the release of acetylcholine = flaccid paralysis of muscles
Multiple cranial nerve palsies leading to descending flaccid paralysis
Diplopia
dysphagia
dysarthria
dry mouth
ptosis
dilated pupils
fatigue
extreme weakness
What am I?
How do you dx?
Botulism
toxin immunoassay
What is the treatment for botulism?
Intubation, mechanical ventilation, parenteral nutrition
Equine antitoxin if dx early in disease
Weeks to months of regeneration of new motor neuron synapses w/in the muscle cell
T/F: There is a good botulism vaccine on the market, recommended for ages 18+
FALSE! no approved FDA vaccine
Gram - bacillus
Painful LAD w/ necrosis, fever, bacteremia ⇾ septicemia ⇾ death
Nodes called buboes
Extensive ecchymosis and necrosis of digits and nose
either can be from a bite of an infected rat flea or inhalation of the bacteria
Fever, cough, hemoptysis, and GI Sx
What am I?
Bubonic plague
How do you dx bubonic plague? What is the treatment?
Blood cultures and / or cultures of buboes, sputum
Antibodies
gentamicin, streptomycin, doxycycline, fluoroquinolone
What is the prophylaxis treatment for bubonic plague? What is the prevention?
Doxycycline and ciprofloxacin X 7 day
No vaccine available
_____ has been eradication globally. What is the virus called?
smallpox
Variola major
_____ is a double-stranded DNA virus from Poxviridae family. Virus infects host ⇾ spreads to lymphoid tissue ⇾ localized infection of skin dermis ⇾ 2-14 days later ⇾ fever, malaise, HA, N/V, back pain, rash (maculopapular to face and extreme ⇾ spreading to trunk ⇾ turn to vesicles, then pustules, then scabs), mouth ulcers
Smallpox
How do you dx smallpox? What is the treatment?
Culture, PCR
Antibodies
Strict isolation
Supportive measures only
Antivirals have not really been studied
Small, non-motile, gram - coccobacillus
NOT spread person to person
Non-spore forming
rabbit fever or deer fly fever
spread through ticks and fleas that bite an infected host and pass to humans
What am I?
Tularemia
Pharyngitis, pleuritis, bronchopneumonia
Fever, HA, chills, fatigue, malaise
Conjunctivitis and exanthems also possible
50% will have an infiltrate on CXR; hilar adenopathy w/o infiltrate also possible
What am I?
How do you dx?
Tularemia
Gram stain or cultures of infected tissues or blood
What is the treatment for tularemia?
Streptomycin, doxycycline, gentamicin, fluoroquinolones
What is a very deadly viral hemorrhagic fever used for bioterrorism?
Ebola virus
All are enveloped, single-stranded RNA viruses that require a host. Human’s contract ____ by being in direct contact with body fluids
viral hemorrhagic fevers
Fever, myalgia, prostration, DIC w/ thrombocytopenia and capillary hemorrhage
Viral hemorrhagic fevers
When should you suspect a viral hemorrhagic fever?
Should be suspected in any person w/ temp >38.3 ℃ (or 101 ℉) for <3 weeks with at least 2 of the following (in the absence of another cause):
Hemorrhagic or purpuric rash
Epistaxis
Hematemesis
Hemoptysis
Hematochezia
What is the dx testing for Viral Hemorrhagic Fevers? What is the treatment?
Serological testing for antigen and antibody; PCR - sent to the CDC
No approved treatment or vaccine
Experimental - antibody cocktails and ribavirin
In September 2001 ____ was released through USPS, with 22 infections and 5 fatalities
anthrax
____ was the main focus of the pre-1991 Iraqi bioweapons program. Japan produced it in 1930 and used it to poison prisoners
Japanese cult successfully infected civilians in Tokyo on 3 separate occasions
Botulism
_____ WWII - Japanese dropped _____ over China causing an outbreak in areas of target
Yersinia pestis aka the plague
plague-infested fleas
smallpox has a ____ mortality rate when infected
10-30%
____ was possibly used to infect sheep and sent into enemy lines by the Hittites in the 14th century. There was an outbreak among German and Soviet soldiers on the frontline in WWII
Tularemia
1992 - a Japanese cult travelled to Africa under false assumptions to aid _____ in an effort to obtain the virus for bioterrorism use. What dz?
Ebola victims
Viral hemorrhagic fever
What is the short version of the Universal Precautions?
Treat all human body fluids as if they are infected
Includes hand hygiene; PPE based on certain types of exposure; safe injection practices; and safe management of contaminated equipment and other items in the environment. Applies to all patients and all bodily secretions (urine, feces, nasal secretions, sputum, vomit)
Standard Precautions
Gown and gloves required for pt or environment contact
Sometimes above needed to even enter patient room
What kind of precautions?
Contact precautions
Surgical mask required w/in 3 feet of patient
What kind of precaution?
Droplet precaution
Negative pressure isolation room
Respirator must be worn
What kind of precaution?
Airborne infection isolation
When in contact w/ blood, body fluids, secretions, excretions, mucous membranes, non-intact skin, or contaminated equipment
What types of PPE?
Gloves
During procedures when contact of clothing, exposed skin w/ blood/body fluids, secretions, excretions, or body fluid is anticipated
What type of PPE?
Gowns
Any activity which may result in splashes or sprays of blood, body fluids, secretions, or excretions
What type of PPE?
Mask/Goggles or Face shield
_____ induced by vaccines prepared from bacteria or their products
active immunity
_____ administration of preformed antibodies in preparations called immunoglobulins
passive immunity
An _____ vaccine is a vaccine created by reducing the virulence of a pathogen, but still keeping it viable. _____ takes an infectious agent and alters it so that it becomes harmless or less virulent.
attenuated
Attenuation
More stable
Safest form
Weaker immune response
often requires multiple doses/boosters
What type of vaccine?
Give some examples
inactivated/dead virus
seasonal influenza, polio
Does not cause active disease (typically)
Provides greatest immunity
What type of vaccine?
Give some examples
Live, attenuated - live but weakened virus
MMR
Contain only antigens
Less risk of adverse reactions
Very time-consuming to make
What type of vaccine?
Give some examples
Subunit vaccines
Hep B
For bacterial infections that secrete toxoids
Inactivated toxoids
What type of vaccine?
Give some examples
toxoid vaccines
tetanus, diphtheria, pertussis
Works against bacteria w/ a cell wall
Produce synthetic product containing cell wall similar to the bacteria
What type of vaccine?
Give some examples
conjugate vaccine
HIB type B vaccines, Pneumococcal
______ use a live bacteria as a vector
Recombinant vector vaccines
**What is the CI for all vaccines? What is a precaution?
Severe allergic reaction - anaphylaxis
Pregnancy and severe immunosuppression - no LIVE vaccines, including live-attenuated vaccines
Acute illness that is moderate to severe - with or without fever
_____ is approved for ages 6 weeks ⇾ 7 years of age
Made up of inactivated forms of the toxins produced by these bacteria, as well as acellular antigens of pertussis
DTaP
____ lower dose of the toxin components used for booster doses only
Indicated for those 7 years of age and older
What is it called w/o the pertussis component
Tdap
Td