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Microbiology Part 2 > Lec50 Bioterrorism > Flashcards

Lec50 Bioterrorism Flashcards

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1
Q

What should you think when you see widened mediastinum with fever and sepsis?

A

inhalational anthrax

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2
Q

what should you think when you see localized skin lesion with depressed black eschar?

A

cutaneous anthrax

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3
Q

what should you think when you see vesicular/pustular rash starting on face and hands with all lesions same stage of development?

A

smallpox

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4
Q

What properties make agents of bioterorrism dangerous?

A
  • readily available
  • easy to weaponize
  • easy to disperse/transmit [aerosol or P2P]
  • cause severe illness
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5
Q

What is definition category A agents of bioterrorism?

A
  • high priority agents
  • easily disseminated or transmitted person to person
  • high mortality/public panic/social disruption
  • need special action for public health preparedness
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6
Q

What are the four main category A agents of bioterrorism?

A
  • anthrax [bacillus anthracis]
  • tularemia [ francisella tularensis]
  • plague [yersinia pestis]
  • botulism [clostridium botulinum toxin]
  • smallpox [variola major]
  • filoviruses, viral hemorrhagic fever
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7
Q

What are characteristics of bacillus anthracis?

A
  • large gram pos bacilli
  • spore forming
  • facultative anaerobe
  • non-motile
  • sticky –> adheres to agar surface
  • catalase positive
  • boxcar morphology
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8
Q

How do you get infection of bacillus anthracis?

A
  • inhaled, ingested, inoculated through exposed skin
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9
Q

What are the virulence factors of bacillus anthracis?

A
  • capsule
  • protective antigen [PA]
  • edema factor [ EF]
  • lethal factor [LF]
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10
Q

What is anthrax edema toxin?

A

PA [protective antigen] + EF [edema factor]

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11
Q

What is anthrax lethal toxin?

A

PA [protective antigen] + LF [lethal factor]

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12
Q

What is anthrax lethal factor function?

A

zinc metalloprotease, stimulates inflammatory cytokine production and cell death

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13
Q

What is anthrax edema factor function?

A

adenylate cyclase, increased cAMP intracellular levels

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14
Q

What happens in cutaneous anthrax?

A
  • direct contact organism and non-intact skin
  • within 1/2 wks have local edema –> macule or papule –> ulcer –> vesicles –> black depressed exchar
  • mortality in 20% without antibiotics
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15
Q

What happens in GI anthrax?

A
  • spores ingested
  • edematous response
  • huge mesenteric lymph node
  • lots of tissue necrosis –> can see eschar
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16
Q

What happens in inhalational anthrax?

A
  • responsible for most anthrax related deaths
  • inhale spore-bearing partiles
  • spores phagocytosed by macrophages to mediastinal lymph node
  • up to 60 days later have clinical disease
  • get widened mediastinal lymph nodes and widened mediastinum
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17
Q

What are symptoms of pt with inhalational anthrax?

A
  • fever, nigh sweats, fatigue, respiratory

- enlarged mediastinal lymph node, widened mediastinum

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18
Q

What makes anthrax a good weapon? limitations?

A
  • aerosol is odorless/colorless
  • spores highly stable
  • disease has high case fatality rate

limitations: little [cutaneous] or no [inhalational] person to person spread

19
Q

How do you treat anthrax?

A
  • penicillin, ciproflaxicin

- anthrax vaccine by military

20
Q

What is responsible for the plague?

A

yersinia pestis

21
Q

What are characteristics of yersinia pestis?

A
  • biopolar “safety pin” gram neg bacilli
  • slow growing
  • member of etnerobacteriaceae
22
Q

What is reservoir of yersinia pestis?

A
  • wild rodents
23
Q

How is yersinia pestis transmitted?

A
  • via fleas or direct exposure to infect tissue or resp droplets
24
Q

What are diseases of yersinia pestis?

A
  • bubonic plague [regional lymphadenitis]
  • septicemia without bubo
  • pharyngitis and cervical lymphadenitis
  • pneumonic plague
25
Q

What are characteristics of variola virus?

A
  • large DNA virus
  • genus orthopoxvirus
  • brick shaped viral structure
  • low infectious dose [just a few virions]
26
Q

How is variola virus transmitted?

A

person to person

  • via droplet nuclei or aerosols
  • by direct contact
  • by fomites
27
Q

What is pathogenesis of variola? symptoms?

A
  • implants on respiratory mucosa
  • migrates and multiplies in regional lymph nodes
  • day 3/4: asymptomatic viremia w/ spread to spleen, bone marrow, lymph
  • day 8: secondary viremia w/ fever, toxemia, organisms in small blood vessels of dermis/oropharynx leading to pox
  • fever/malaise/headache/backache/delerium
28
Q

How do you differentiate chickenpox from smallpox?

A

chickenpox

  • palms and soles rarely involved
  • lesions apepar first on face or trunk
  • lesions in crops of different stages
  • no or mild prodrome
  • dewdrop on rose petal lesions
29
Q

How do you prevent smallpox?

A
  • vaccination with vaccinia virus [cowpox]
  • can use for pre and post exposure prevention
  • -> pre-exposure protection wanes over time
  • -> post exposure w/4 das
30
Q

What is treatment for smallvox?

A
  • vaccinia virus within 4 days of exposure
  • supportive care
  • can give cidofovir
31
Q

What makes smallpox a good agent of bioterrorism? limitation?

A
  • highly susceptible population
  • efficient P2P spread
  • high case fatality
  • limited treatment options

limitations: not in nature, only 2 known repositories [WHO labs]

32
Q

Who gets monkey pox?

A
  • owners of prairie dogs due to cross contamination with gambian rats
33
Q

What are characteristics of clostridium botulinum?

A
  • spore forming obligate anaerobic bacillus

- found in soil

34
Q

What is pathogenesis of clostridium botulinum? How do you get it?

A

AB toxin –> flaccid paralysis

  • food born from canned foods
  • infant from spores in honey
  • rarely wound botulism
  • inhalational botulism = terrorism agent
35
Q

What makes botulinim a good terrorism agent? limitations?

A

good:

  • found in nature
  • multiple routes of exposure
  • toxic lethal dose –> 1gm could kill 1 million

limitations

  • hard to concentrate
  • commercially available produts have very low conc of it
  • not spread P2P
36
Q

What are signs of inhalational botulsim?

A
  • blurred vision
  • drooping eyelids
  • slurred speach
  • descending paralysis
  • respiratory paralysis
37
Q

How do you treat inhalational botulism?

A

supportive

antitoxin

38
Q

What are properties of trancicella tularensis?

A
  • poorly staining

- tiny gram neg coccobacilli

39
Q

How is tularemia transmitted?

A
  • by ticks, handling animal carcasses

- can be aerosolized

40
Q

What are the 3 viral hemorrhagic fevers?

A
  • ebola
  • marburg
  • lassa fever
41
Q

What is definition category B agents of bioterrorism?

A
  • second highest priority agents

- moderately easy to disseminate and have morbidity but usally low mortality

42
Q

What are some examples of category B agents of bioterrorism?

A
  • brucella
43
Q

What is definition category C agents of bioterrorism?

A
  • third highest priority agents

- include emerging pathogens that have ease of production or potential for high morbidity/mortality

44
Q

What are examples of category C agents?

A
  • nipah virus
  • hantavirus
  • MDRTB
  • yellow fever

Microbiology Part 2 (30 decks)

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