Lecture 6 - Bioterror Flashcards
Public Health works to highlight what four key areas of public health action
- Preventing disease and promoting health
- Improving medical care
- Promoting health-enhancing behavior
- Modifying the environment
Routine passive surveillance
- Refers to data supplied to a health dept based on a set of rules that require reporting.
- Cheaper
- Multiple sources
Active surveillance
- Health agency solicit reports
- Reporting is incentivized
- Usually occurs during an epidemic
Purpose of surveillance
- Accurately assess health of population
- Early warning system to alert of disease
- Implement control measures
- Define specific protocols
- Measure and evaluate programs
The objectives of Preventing Emerging Infectious Diseases: A Strategy for the 21st Century are organized under four goals:
- Surveillance and response
- Applied research
- Infrastructure and training
- Prevention and control
Bioterrorism CDC Definition
The deliberate release of viruses, fungi, bacteria and other agents to cause disability, illness or death in people, animals, or plants.
Reasons weapons programs were started
– Relatively cheaper than other weapons programs
– Could have longer lasting effects
– Exceptionally good at disrupting society
– Can be difficult to detect
CDC Category A examples
- Anthrax
- Smallpox
- Plague
- Toxin C botulinum
- Tularemia
- Clostridium botulium
CDC Category B examples
- Brucellosis
- Q fever
- Glanders
- Burkholderia
- Alphaviruses
- Ricin
- Staphylococcus enterotoxin B
CDC Category C examples
- Hantavirus
- Nipah virus
- Tick-borne hemorrhagic
- Yellow fever
- Influenze
- Rabies
Bacillus Anthracis
- Gram +
- Spore forming rod
- Can survive suspended animatoin for years
What are the three toxins Anthrax has?
- Protective Antigen (PA)
- Edema Factor (EF)
- Lethal Factor (LF)
What is the purpose of the capsule in anthrax?
- Protects B anthrax from phagocytosis
What plasmid is the capsule of B. Anthrax carried on?
Plasmid pXO2
Which combination of toxins in B. Antrax lead to edema toxin?
PA + EF
Which combination of toxins in B. Antrax lead to lethal toxin?
PA + LF
Protective antigen (PA) binds receptors on host cell surfaces that are common to many tissues and forms a ______
prepore
this facilitates LF and EF entry into cells
LF cleaves __________ leading to cell death by an unknown mechanism
MAP kinase
EF increases __________ levels resulting in cellular edema at infection site
cAMP
X ray from anthrax patient shows what?
- Bibasilar infiltrates
- Negative CT head
What are the three types of bacteria we can see in meningitidis?
Haemophilus influenzae (-) Neisseria Meningitidis (-) Streptococcus Pnuemoniae (+)
3 important factors for weaponized spores:
- Dispersibility
- Floatability
- Inhalability
Use of _______ which is hydrophobi facilitiates drying process with spore powder
Exosorium
Use of _______ nanoparticles prevent spore clumping which keeps them airborne longer
Silica
Adding __________________ to the spores makes them more likely to stick to alveoli
Negative Charge
The bacteria Bacillus Anthracis produces dormant spores that can live in environments like _______
soil for a long time
Three ways anthrax can get into the body?
- Cutaneous
- Inhalational
- Gastrointestinal
(New - injection)
Clinical manifestations of injection anthrax
- Absence of typical eschar
- Painless sore with black center
- Swelling around the sore
- More edema than cutaneous anthrax
- Spreads faster and harder to recognize
Clinical manifestations of cutaneous anthrax
- Small blisters/bumps that itch
- Swelling around sore
- Painless sore/ulcer with a black center/eschar
- Edema
(Papule –> Vesicular –> Necrotic ulcer)
Case fatality for cutaneous Anthrax
Without antibiotic treatment
With antibiotic treatment
Without - 20% (not very fatal)
With - 1%
Clinical manifestations of inhalational anthrax
- Viral like illness
- With or without respiratory symptoms
- Wool sorter’s disease
- Meningtis
Case fatality for inhalational Anthrax
Without antibiotic treatment
With antibiotic treatment
Without - 97%
With - 75%
Deadliest
Inhalational anthrax is assocaited with what X-ray finding?
Mediastinal widening
Pleural Effusion
Clinical manifestations of gastrointestinal anthrax
- Mouth/stomach symptoms
- Undercooked anthrax infected meat
- Ulcers in GI
Diagnosis for general anthrax
- Present in high concentration in microscope
- Gram + non-motile rods
- PCR
Diagnosis for Inhalational Anthrax
- Chest x-ray: Widened mediastinum, pleural effusion
- Biopsy
- Fluid for gram stain
General Anthrax treatment
- IV antibiotic + antitoxin
- Most in nature susceptible to penicillin
- Ciprofloxacin or Doxy
Anthrax antitoxin
- Raxibacumab
- Anthrax immunoglobulin
