M21: Disease Transmission IV: Biodefense Flashcards
Policies Against Bioweapons
- _ (1925): Prohibiting use of biological weapons in war
- _ (BWC, 1972): prevents development, production and stockpile of biological weapons
The Geneva Convention
The Biological Weapons Convention
Differences between biological agents vs. conventional weapons (5)
- Cheaper
- Ubiquitous
- Hard to detect
- Dual-use technology
- Potentially self-perpetuating
Components of the US plan include:
_ which capture particles from the air and are analyzed for the presence of bioagents
the strategic national stockpile of _
_ teams
Biowatch detectors
vaccines/antimicrobials
national disaster medical system
Epidemiologic clues:
The most likely scenario would be _ among people who are _.
The likely presenting symptoms would be _ because most infectious agents are distributed in _ form, but _ outbreaks through _ could also occur.
Another clue would be if an organism was identified that _.
Also _ around the country or organisms with an unusual pattern of _ would be suspicious.
a large epidemic with severe illness and high death rate
otherwise fairly healthy
respiratory
aerosolized
food borne
ingestion
wasn’t normally present in that part of the country or the world
multiple, simultaneous outbreaks
antibiotic resistance
Natural Events
There have been several natural events which would be managed in a fashion similar to an act of bioterrorism. This is an example of an “_” approach to preparedness. Because the principles are the same, these natural events are often discussed along with bioterrorism.
These include such diseases as (4)
The strengths needed to respond to natural outbreaks would be harnessed in the response to an unnatural outbreak.
all hazards
pandemic influenza
SARS
monkeypox
West Nile Virus.
Components
The first part of managing an outbreak is _. This can be done through laboratory and/or clinical reporting. This is important for containment but, most importantly, for better outcomes.
We generally rely on _ confirmation of the disease after which we focus on containing it through infection control measures.
This may involve (3) while monitoring for signs of infection.
early identification of it through surveillance
laboratory
isolating infected and contagious patients
finding close contacts
observing/quarantining individuals
Category A Agents
- _ (anthrax)
- _ (tularemia)
- _ (plague)
- _ (smallpox)
- _ and _ (Viral hemorrhagic fevers)
- _ (botulism)
- Bacillus anthracis (anthrax)
- Francisella tularensis (tularemia)
- Yersinia pestis (plague)
- Variola major (smallpox)
- Arenaviruses and filoviruses (Viral hemorrhagic fevers)
- Clostridium botulinum toxin (botulism)
Category A Agents
- Bacillus anthracis (_)
- Francisella tularensis (_)
- Yersinia pestis (_)
- Variola major (_)
- Arenaviruses and filoviruses (_)
- Clostridium botulinum toxin (_)
- Bacillus anthracis (anthrax)
- Francisella tularensis (tularemia)
- Yersinia pestis (plague)
- Variola major (smallpox)
- Arenaviruses and filoviruses (Viral hemorrhagic fevers)
- Clostridium botulinum toxin (botulism)
Category A Agents are considered to be high priority agents because (5)
– They can be easily spread from one person to another
– High mortality rates
– Major public health impact
– Public panic & social disruption
– Special action required for public health preparedness
Category B Agents
These are the 2nd highest priority. They are less likely to cause _ but they may be easier to _ and they are fairly easy to _.
fatal disease
obtain
disseminate
Category B Agents (7)
E. coli Salmonella Burkholderia mallei (glanders) Burkholderia pseaudomallei (melioidosis) Rickettsia prowazekii (typhus fever) ricin toxin
Category C Agents
These are the third highest priority. This group includes pathogens that could be _ because of availability and ease of production and dissemination.
These agents have the potential for high _ and _ and major health impact
engineered for mass dissemination
morbidity and mortality rates
Category C Agents (3)
Nipah virus
avian influenza virus
hantavirus
Category A Agents:
Anthrax:
Bacillus anthracis
- Gram (positive / negative) _
- Readily forms _ –> Can persist in the soil for years
- Non-_, _ colonies on blood agar
- Anthrax occurs worldwide
- Reservoirs (3)
- Gram positive rod
- spores
- Non-hemolytic, medusa’s head/comet’s tail colonies on blood agar
- Anthrax occurs worldwide
- Reservoirs: cattle, sheep, goats
Category A Agents:
Anthrax:
Naturally occurring anthrax is generally a disease of the _
Breakdown (? > ? >?): inhalational, gastrointestinal, cutaneous
skin
cutaneous > inhalational > gastrointestinal
Category A Agents:
Anthrax:
Anthrax Infection
In humans, anthrax is fairly (common / rare).
It usually occurs after exposure to _ or _.
In 2001, it was also associated with _ exposure.
Other recent outbreaks of note include cases in _ in Scotland through contaminated _ and people handling _.
rare
infected animals or animal products
intentional
injection drug users
heroin
drums made with animal skins
Category A Agents:
Anthrax:
Anthrax Infection
The infection begins with _ when it is in an environment conducive to vegetative growth.
It then _ and produces a _.
The organisms may stay contained in the _ or spread through both the _ and the _.
It causes severe inflammation of the _.
germination of the spore
multiplies
toxin
skin
bloodstream
lymphatics
lymph nodes
Category A Agents:
Anthrax:
Virulence Factors
- Capsule: The organism is protected from the immune system by an _ capsule (a _ capsule) encoded on a plasmid.
- Exotoxins (2) encoded on a plasmid
antiphagocytic polyglutamic acid (PGA)
Edema Toxin (protectiv eantigen + edema factor)
Lethal Toxin (protective antigen + lethal factor)
Category A Agents:
Anthrax:
Virulence Factors
a. Edema Toxin
i) an _ that increases intracellular _ concentrations and interferes with _
b. Lethal Toxin
i) _ that cleaves and inactivates multiple _ and interferes with _
adenylate cyclase
cyclic AMP
cell function
calmodulin-dependent zinc metalloprotease
mitogen-activated protein kinases
signal transduction
Category A Agents:
Anthrax in 2001
There were 22 cases diagnosed between October and November 2001. Eleven of these were _ infections and all survived. The others were _ anthrax and among these 11 cases; 7 were postal workers, 2 had known exposure to contaminated mail and 2 had presumed exposure to contaminated mail. These infections were all limited _ to Florida, Washington DC, New York, New Jersey and Connecticut. This was consistent with an intentional release in certain geographic areas. However the fear was widespread.
cutaneous
inhalational
geographically
Category A Agents:
Cutaneous (skin) anthrax
- Exposure _ to _ of anthrax
- Incubation period of _ days
- _ at site
- Vesicles –> _
- Lesion is usually (painful / painless)
- Enlarged _ in the region of the infection
- Exposure abraded/lacerated skin to spores of anthrax
- Incubation period of 1-7 days
- Pruritic papule at site
- VesiclesàBlack eschar
- Lesion is usually painless
- Enlarged lymph nodes in the region of the infection
Category A Agents:
Gastrointestinal Anthrax
- From _
- 40% mortality
- _ day incubation period
- _, _, and _, followed by severe _. Many cases will be associated with _, massive _, and _.
- From uncooked meat
- 40% mortality
- 1-5 day incubation period
- Nausea, vomiting, and fever, followed by severe abdominal pain. Many cases will be associated with hematemesis, massive ascites, and bloody diarrhea.
Category A Agents: Inhalational Anthrax (“_ Disease”)
- 45% mortality in 2001; Patients who survived were recognized and treated early in their course
- Incubation period of _ days
- _ illness (but no _)
- Does not cause _ but does cause _
- _ widening on chest x-ray (_)
- Dissemination from inhalational or GI anthrax can result in _ (“cardinal’s cap”)
Woolsorter’s
- 45% mortality in 2001; Patients who survived were recognized and treated early in their course
- Incubation period of 4-6 days
- Flu-like illness (but no rhinorrhea)
- Does not cause pneumonia but does cause bloody pleural effusions
- Mediastinal widening on chest x-ray (hemorrhagic mediastinitis)
- Dissemination from inhalational or GI anthrax can result in hemorrhagic meningitis (“cardinal’s cap”)
Category A Agents:
Anthrax:
Diagnosis
The easiest way to make the diagnosis is by _
– _ cultures turn positive in 6-24 hours
– _ cultures may be used for epidemiologic purposes to see if someone has been exposed
Other diagnostic tests include:
– _
– stains
– Anthrax _ test
– Looking for a 4-fold increase in _ antibody level—this requires follow up antibody levels ( diagnosis)
culture of blood, CSF, effusion
Blood
Nasal swab
– PCR
– Immunohistochemical stains
– Anthrax IgM test
– Looking for a 4-fold increase in IgG antibody level—this requires follow up antibody levels (retrospective diagnosis)
Category A Agents:
Anthrax:
Transmission-Isolation
There is no _-to-_transmission of inhalational anthrax.
It can be spread by _.
No _ is required: “standard precautions”
There is no person-to-person transmission of inhalational anthrax.
It can be spread by contact with an open, infected wound.
No special isolation is required: “standard precautions”
Category A Agents:
Anthrax:
Treatment
The standard treatment was increased in duration in 2001 because of concerns that someone could have been exposed to a “weaponized” form of anthrax which could be easily aerosolized. So the current treatment recommendations are based on the assumption that _ in the lungs could be germinating long after inhalation exposure. Since manufactured anthrax may contain _, multiple antibiotics are recommended.
Cutaneous anthrax:
_ x 60 days or _ x 60 days
Inhalational or gastrointestinal:
_ or _ and 1-2 additional antibiotics x 60 days (7)
Post-exposure prophylaxis:
3 doses of vaccine and _ x 60 days or _ x 60 days
Monoclonal Antibody:
• _: targeted toward protective antigen
• To be used as an adjunct to antimicrobial treatment
spores
antibiotic resistance genes
doxycycline
ciprofloxacin
doxycycline
ciprofloxacin
- rifampin
- vancomycin
- penicillin/ampicillin
- chloramphenicol
- imipenem
- clindamycin
- clarithromycin
doxycycline
ciprofloxacin
Raxibacumab
Category A Agents:
Anthrax:
Vaccination
The anthrax vaccine is called the _. It has historically been given with a series of 5 doses plus annual boosters.
It results in antibodies against the “_” which is a component of both of the toxins produced by this organism.
It is generally well tolerated but there are mild _ reactions in 30% of people and _ reactions in 0.2% of people.
Other treatments:
• _ (not FDA approved)
Anthrax Vaccine Adsorbed (AVA)
protective antigen
local
systemic
Anthrax Immune Globulin
Category A Agents:
Tularemia:
Francisella tularensis
- Gram-(positive / negative) _
- (Obligate / Facultative) (intracellular / extracellular) pathogen
- Why category A: (#) organisms to cause disease, variety of _, substantial _ if untreated
- _ experimented with it in WWII-era
- Gram-negative coccobacillus
- Facultative intracellular pathogen
- Why category A: 10 organisms to cause disease, variety of sources, substantial mortality if untreated
- Japanese experimented with it in WWII-era
Category A Agents:
Tularemia:
Epidemiology
- (Common / rare) in the USA before 1950
- Now (more / less) common
- Disease of the (northern / southern) hemisphere
- Primarily a disease of _
- Peaks in the (summer / winter) (_)
- Small peak in the (summer / winter) (_)
- Common in the USA before 1950
- Now less common
- Disease of the northern hemisphere
- Primarily a disease of animals
- Peaks in the summer (ticks)
- Small peak in the winter (hunters)
Category A Agents:
Tularemia:
Naturally occurring infection
This is a naturally occurring infection in the USA. It generally begins after the bite of an infected _.
It is generally found in _ or _ and it may be inoculated directly into the wound.
It can also be seen after contact with contaminated _ and it can be aerosolized (rarely) from contaminated _.
Laboratory workers are at risk if it is in their laboratory so they should be notified if you suspect this infection.
tick
tick saliva or feces
animal products (e.g. skinning, dressing or eating infected animals) water, dust, or hay
Category A Agents:
Tularemia:
Clinical Presentations
- Average incubation period of _ days
- Abrupt onset of _
• Syndromes
o _: most common; lesion + lymphadenopathy
o _
o _
o _: lymphadenopathy
o _
o _: disseminated infection that does not fall into other categories; hardest to diagnose
• In antibiotic era, death rate 4%
3-5
fever, chills, headache, malaise, anorexia, and fatigue
o Ulceroglandular: most common; lesion + lymphadenopathy
o Oculoglandular
o Pharyngeal
o Glandular: lymphadenopathy
o Pneumonic
o Typhoidal: disseminated infection that does not fall into other categories; hardest to diagnose
Category A Agents:
Tularemia:
Diagnosis
- Alert microbiology lab!!!
- _ culture - (large / small), gram-(positiv e/ negative) _
- _ cultures (rarely positive)
- Antibodies – _, confirm the diagnosis
- _: inflammation, pleural effusion and enlarged hilar lymph nodes
Transmission-Isolation
- No _-to-_transmission
- No _: “standard precautions”
- Sputum culture - small, gram-negative coccobacilli
- Blood cultures (rarely positive)
- Antibodies – retrospective, confirm the diagnosis
- Chest x-ray: inflammation, pleural effusion and enlarged hilar lymph nodes
- No person-to-person transmission
- No special isolation: “standard precautions”
Category A Agents:
Tularemia:
Treatment
Preferred: _ or _ (intramuscular, intravenous) for 10 days
Alternatives: _, _, or _ (all oral) for 10 days
Prevention
- _ no longer available
- _ or _ for 14 days as post-exposure prophylaxis
streptomycin or gentamicin
doxycycline, ciprofloxacin, or chloramphenicol
Vaccine
Ciprofloxacin or doxycycline
Category A Agents:
Plague:
Yersinia pestis
- Cause of “_” - 14th Century Europe
- 3 world _
- 3,000 cases worldwide in 1994
- Naturally occurring disease in the _ USA
- Gram-(positive / negative) _
- _ staining, “safety pin”
- Cause of “Black Death” - 14th Century Europe
- 3 world pandemics
- 3,000 cases worldwide in 1994
- Naturally occurring disease in the southwestern USA
- Gram-negative bacillus
- Bipolar staining, “safety pin”
Category A Agents:
Plague:
Virulence Factors (some of many):
- _: acts as a protease, promotes adhesion, and coagulase (flea mid-gut)
- _: Type III secretion system
- _
Naturally occurring infection
This is a disease of _.
Fleas obtain a blood meal from an infected _.
_ multiplies and blocks digestive system of flea.
Flea takes another blood meal from _ and regurgitates bacteria into _.
- Plasminogen activator
- Yersinia outer protein virulon
- LPS
rodents
rodent
Y. pestis
human
human
Category A Agents:
Plague:
Symptoms (3)
- Acute febrile lymphadenitis – “bubonic plague”
- Pneumonic
- Septicemic
Category A Agents:
Plague:
Symptoms
- Acute febrile lymphadenitis – “bubonic plague”
a. Most (common / rare) form
b. Sudden onset of _
c. Intense pain and swelling in _
- Pneumonic
a. Infection of the _
b. Incubation: 2-4 days
c. _, _, and _
d. Bloody _
e. _: pneumonia
f. Mortality – 50%
- Septicemic
a. Generalized infection (_)
b. Presumably after escape from the _
a. Most (common / rare) form
b. Sudden onset of fevers, chills, weakness, headache
c. Intense pain and swelling in lymph nodes
a. Infection of the lungs
b. Incubation: 2-4 days
c. Fever, cough and difficulty breathing
d. Bloody sputum
e. Chest x-ray: pneumonia
f. Mortality – 50%
a. Generalized infection (blood stream)
b. Presumably after escape from the lymph nodes
Category A Agents:
Plague:
Transmission (pneumonic plague)-Isolation
• (Contagious / Not contagious)
• _ – gowns and gloves
• _ precautions for 72 hours while on appropriate antibiotics
Treatment
Preferred: _ or _ (intramuscular, intravenous) x 10 days
Alternatives: _, _ or _(oral) x 10 days
Prevention:
Mass casualty setting or post-exposure _
Preferred antibiotics: _ or _ (oral) for 7 days
Vaccine: _
Transmission (pneumonic plague)-Isolation
• Contagious
• Isolation – gowns and gloves
• Droplet precautions for 72 hours while on appropriate antibiotics
Treatment
Preferred: streptomycin or gentamicin (intramuscular, intravenous) x 10 days
Alternatives: doxycycline, ciprofloxacin or chloramphenicol (oral) x 10 days
Prevention:
Mass casualty setting or post-exposure prophylaxis
Preferred antibiotics: doxycycline or ciprofloxacin (oral) for 7 days
Vaccine: No longer available
Category A Agents:
Smallpox:
Variola major/Variola minor
• (DNA / RNA) virus
• Only human disease _
o _ as only host
Clinical Presentation
- _ day incubation period
- _ followed 5 days later by _
- Severe subtypes: _ smallpox, _ smallpox
• DNA virus
• Only human disease eradicated from the planet (Rinderpest is an animal disease that has been eradicated)
o Humans as only host
- 10-14 day incubation period
- Prodrome followed 5 days later by rash
- Severe subtypes: hemorrhagic smallpox, flat smallpox
Category A Agents:
Smallpox:
Evolution of rash
- _ -_ and _
- _ – filled with _
- _ – filled with _
- _
- _
- all lesions _
- Maculopapular -flat and raised (macular = flat, papular = raised)
- Vesicles – filled with clear fluid
- Pustules – filled with pus
- crusts
- scarring
- all lesions of same form
Category A Agents:
Smallpox:
Transmission
- most contagious from the onset of the rash through the first _ of rash
- _ or _ (small particles that can be spread in the air, e.g. from coughing)
- _
- _ – objects which the infection can live on for limited periods of time (e.g. contaminated clothing or bed linens)
- infectious until _
Isolation
• All individuals with possible smallpox should be isolated immediately
1. _ room
2. _ – masks to filter out infection - used for other infections in the hospital, such as patients with tuberculosis
3. _ and _
• _ and _ should be vaccinated and placed under surveillance
- 7-10 days
- droplet nuclei or aerosols
- direct contact
- fomites
- the scabs have healed
- Negative pressure
- N95 respirators
hospital, such as patients with tuberculosis - Gowns and gloves
• Household and other close contacts
Category A Agents:
Smallpox:
Variola vs. Varicella (_ vs. _)
Variola (_) • Rash most dense on _ and _ (_) • Lesions appear over _ days and evolve _ • Rash occurs on _ • Pruritic (itchy) / Doesn’t itch
Varicella (_) • Greater concentration of lesions on _ (_) • Lesions appear in _, _ • Rarely seen on _ or _ • Pruritic (itchy) / Doesn’t itch
smallpox vs. chickenpox
(smallpox) • face and extremities (centrifugal) • 1-2 days, at the same rate • palms • Doesn’t itch
(chickenpox) • the trunk (centripetal) • crops, different stages of maturation in adjacent areas • palms or soles • Pruritic (itchy)
Category A Agents:
Smallpox:
Vaccine
The smallpox vaccine comes from the observation that milkmaids who had developed _ never got smallpox.
Historically this has been a _ vaccine. These vaccines have been 95% effective in preventing disease (historically) and are useful even if given 4 days after exposure.
Before 2001 – _
This vaccine is grown on calf skin and contains _, _, _, and _.
It is a _ vaccinia virus so there is a risk of dissemination in someone who is immunocompromised.
It can also lead to complications in people with _ and it can be spread to close contacts.
Current vaccine – _ 2000
This is similar to the previous vaccine but it has been modified to grow in _ cells and it does not contain any _.
There are still the same contraindications as the previous vaccine except for _. This is in the Strategic National Stockpile
Future vaccines
Vaccines that would be safe in _ and _ patients.
cowpox
live cowpox (vaccinia virus)
Dryvax
polymyxin B, streptomycin, tetracycline and neomycin
live, replicating vaccinia
atopic skin disease
ACAM
vero
antibiotics
antibiotic allergies. This is in the Strategic National Stockpile
immunosuppressed and atopic
Category A Agents:
Smallpox:
Vaccine Contraindications:
– _ (HIV; corticosteroid use or chemotherapy; organ transplant; leukemia or lymphoma)
– _ – e.g. eczema
– _
Normal, mild adverse reactions • _ and _ • Swollen regional _ • Low grade _ • _, _, _ • _ • 1 out of 3 people may feel badly enough to miss work, school or recreational activities
Serious adverse reactions
• _ – spreading the vaccinia virus by sexual/skin contact
• _ – a widespread vaccinia rash after hematogenous dissemination
• _ reaction
Life-threatening adverse reactions
• Seen in 14-52/million vaccinations
• Mortality 1-2/million vaccinations
• _ – widespread infection of the skin in people with skin conditions
• _ – progressive infection at the vaccination site with tissue destruction
• Post-vaccinia _
Treatment:
_ (antiviral)-no established efficacy
_
Vaccine Contraindications
– Immunodeficiency
– Chronic skin condition
– Pregnancy
Normal, mild adverse reactions • Sore and red • Swollen regional lymph nodes • Low grade fever • Fatigue, headache, muscle aches • Itching • 1 out of 3 people may feel badly enough to miss work, school or recreational activities
Serious adverse reactions
• Inadvertent inoculation – spreading the vaccinia virus by sexual/skin contact
• Generalized vaccinia – a widespread vaccinia rash after hematogenous dissemination
• Allergic reaction
Life-threatening adverse reactions
• Seen in 14-52/million vaccinations
• Mortality 1-2/million vaccinations
• Eczema vaccinatum – widespread infection of the skin in people with skin conditions
• Progressive vaccinia – progressive infection at the vaccination site with tissue destruction
• Post-vaccinia encephalitis
Treatment:
Cidofovir (antiviral)-no established efficacy
ST-246
Category A Agents:
Viral Hemorrhagic Fevers
Diverse viruses from different families that cause _ manifestations
o Filoviridae: Ebola, Marburg
o Arenaviridae: Lassa Fever, Machupo
- (DNA / RNA) viruses causing _ and generalized _ damage
- In animals - may be spread by _, _, _, _, _, and _
• Human infections - contact with _ and _
o exposure to reservoir: _ - _ viruses
high lethality hemorrhagic
o Filoviridae
o Arenaviridae
- RNA viruses causing high fevers and generalized vascular damage
- In animals - may be spread by aerosol, urine, feces, fomites (objects), saliva and ocular exposure
• Human infections - contact with blood and body fluids
o exposure to reservoir: rodents-arenaviruses
Category A Agents:
Viral Hemorrhagic Fevers:
Clinical manifestations
- _, _, _, _
- Contagious: _, _, _; some are vector borne (e.g. Crimean Congo Hemorrhagic Fever)
- Generally no treatment (supportive) EXCEPT
a. _ respond to _ (IV form not FDA approved)
• Outbreaks controlled with _ and the use of protective clothing; in the US setting, patients to be placed in negative isolation room with _ precautions.
- Fever, severe illness, petechiae, unexplained bleeding
- Ebola, Marburg, Lassa
a. Arenaviruses respond to ribavirin
• barrier-nursing protocols, airborne
Category A Agents:
Botulism
Botulism is a toxin-mediated disease caused by _, a gram (positive / negative) _ forming _.
There are several forms of botulism that occur, but in a bioterrorism situation the presumed route of exposure would be _.
Botulism is (contagious / not contagious) and (does / does not) require isolation of patients.
Inhalational exposure would most closely mimic _ botulism.
Toxin Characteristics
The toxin of botulism is an (endotoxin / exotoxin) that is secreted by the bacteria.
The toxin targets the nerve synapse preventing the release of _ (neurotransmission)
Clostdium botulinum
gram positive spore
anaerobic bacillus
inhalational
not contagious
does not
gastrointestinal
exotoxin
acetylcholine
Category A Agents:
Botulism
Clinical Features
Botulism causes a _ that is characterized by cranial nerve dysfunction without sensory symptoms.
There is no _, _, or _.
Diagnosis
The diagnosis of botulism is made _, but culture, PCR, antibody testing, and assays in mice can be used for confirmation.
Treatment
The treatment includes both _, which can include prolonged mechanical ventilation, as well as administration of an _ obtained from the CDC. (FDA approved).
bilateral symmetric descending acute paralysis
fever, tachycardia, or mental status changes
clinically
supportive care
heptavalent anti-toxin
Anthrax
1) Microbiology
2) Vector
3) Virulence Factors
4) Treatment
5) Vaccine
6) Clinical Features
7) Other
1) Gram positive, spore-forming bacilli
2) Livestock
3) Capsule, Edema toxin, Lethal toxin
4) Penicillin, Ciprofloxacin, Doxycycline, Raxibacumab
5) 5 doses + yearly booster
6) Cutaneous, GI, Inhalational
7) Amerithrax 2001 attacks
Tularemia
1) Microbiology
2) Vector
4) Treatment
5) Vaccine
6) Clinical Features
7) Other
1) Gram negative cocco-bacillus
2) Rabbits, Ticks, Flies
4) Streptomycin
5) N/A
6) Ulceroglandular, Pneumonic, Oculoglandular, Typhoidal, Glandular
7) Martha’s Vineyard
Plague
1) Microbiology
2) Vector
3) Virulence Factors
4) Treatment
5) Vaccine
6) Clinical Features
7) Other
1) Gram negative bacillus
2) Rodents, Fleas
3) LPS, Type III secretion system, Plasminogen activator
4) Streptomycin
5) N/A
6) Bubonic, Pneumonic, Septicemic
7) SW US
Smallpox
1) Microbiology
2) Vector
4) Treatment
5) Vaccine
6) Clinical Features
1) Orthopox virus
2) Eradicated
4) cidofovir?
5) +++
6) Centrifungal rash, Lesions of same age, Contagious after rash appears
Viral Hemorrhagic Fevers
1) Microbiology
2) Vector
4) Treatment
5) Vaccine
6) Clinical Features
7) Other
1) RNA viruses
2) Rodents for arena viruses
4) None
5) None in US
6) Bleeding, shock
7) Africa
