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Bioterrorism
bioterrorism lecture
22
Medical
Graduate
10/02/2008

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Cards

Term
What are the 3 CDC categories of bioterrorism agents and what do they mean?
Definition
  • category A: easily transmitted person to person, requires special tx,high mortality.
  • category B: moderately easy to dissiminate, low mortality, moderate morbid.
  • category C: emerging pathogens, potential for future use.
Term
What is Anthrax?
Definition

gram postive bacillus that forms spores & is found in soil worlwide. Human usually infected by contact wit infected animals or animal products.

There is NO person to person transmission of Anthrax.

Term

Concerning Cutaneous Anthrax (most common form-95%), what would the progression of the papule be?

Definition
  • small papule
  • ulcer surrounded by vessicles
  • painless eschar with edema.
Term
When testing for Anthrax, a nasal swab is used. What would a positive result of the nasal swab indicate to the NP?
Definition

A positive test indicates exposure only, it does not dx infection. It is a tool for epidemiology only.

Term
What is the very unique Tx for Anthrax with systemic involvement?
Definition

For inhalation or cutaneous Anthrax with systemic involvement:

  • cipro 400mg iv q 12h or doxy 100 mg PO IV q 12h.  combine with one:  rifampin, vanco, PCN, clinida
  • TREAT FOR 60 DAYS
Term

What is the treatment for uncomplicated cutaneous Anthrax?

Definition
Cipro 500mg PO BID or Doxy 100 mg PO BID x 60 days
Term
What is the prophylaxis for exposure to Anthrax?
Definition

Cipro 500mg PO Bid, or Doxy 100mg BID

kids or breastfeeding Moms: amoxicillin

levoquin OK of 18y or >

 

Treat for 60 days

Term
What are the 2 major forms of the the plague?
Definition
  • Bubonic: cutaneous form, flea bite, flu like s/s, buboes, andenopathy.
  • Pneumonic (most likely bio weapon): flu like s/s pneumonia progresses to hypoxemia, cyanossis & hemoptysis.
Term
What is the progression of the plague?
Definition
  1. pt inhales organisms
  2. 2-3d later sudden onset of flu like s/s
  3. 24h later.......pneumonia w/productive cough, bilat. infiltrates, cyanosis.
  4. ARDS, DIC
  5. endotoxemia
  6. respiratory failure, circulatory collapse.
Term
How do we Tx the plague?
Definition

IV aminio glycoside and IV Doxy

or

Cipro

Term

True or False

No diagnostic rapid test exists for the plague.

Definition

True

gram stain of body fluids may reveal gram negative organism & BC should be + in 48h.

Term
Concerning viral hemorrhagic fevers such as Ebola, what is its pathology?
Definition
  • variable incubation 2-21d
  • flu like s/s with high fever
  • increased vascular permeabilty causes hemorrhage in GI tract & mucous membrane.
  • petechia or ecchymotic rash
  • edema, hypotension.
Term
What is the tx for viral hemorrhagic fevers?
Definition
  • supportive tx
  • IV ribabirin used for Lassa
  • vaccines under development
  • prophylaxix with ribabirin may be useful
  • contact and respiratory precautions
  • mortality rate 90% for Ebola.
Term
What is Smallpox?
Definition
  • caused by variola virus
  • has characteristic skin legionns
  • about 30% mortality in unvaccinated
  • last known natural case Somolia 1977
  • any Dx will be considered bioterrorism
Term
What does smallpox look like?
Definition

[image]

Maclular (flat, red) rash 2-3d after flu s/s. starts on face, forearms, hands and palms and soles. evolves into tense vesicles.

Term
How can Smallpox be used as a Bio weapon?
Definition
  • can be aerosolized
  • highly contageous
  • no effective tx
  • vaccination ceased 1972
  • remains stable in the envirnment
Term
What is the Patho of Smallpox?
Definition
  • virus inhaled or deposited on membranes
  • goes to lymph nodes & incubates 7-17d
  • release into blood stream: flu like s/s
  • rash begins 2-3d later
  • death due to toxemia of viral antigens and circulating immune complexes.
Term
Compare chicken pox to the smallpox.
Definition

In Smallpox illness develops before the rash, in chickenpox it occurs after the rash.

 

Smallpox

Chickenpox

Prodromal S/S

YesMinimal or none

Distribution

Out to inIn to out

Lesions

Painful, deepPruritic, superficial 

Progression

SynchronousAsynchronous

Palms/Soles ?

YESNo
Term
What is the key to diagnosis in Smallpox?
Definition
Clinical presentation
Term
What is the Tx for smallpox?
Definition

No effective tx.

Vaccinate all potential contacts within 3-4d

Term

What are some facts about the Smallpox vaccine?

Definition
  • Virus sheds from vaccine site for up to 6w.
  • Shedding can infect household contacts.
  • encephalitis, severe vaccinia, anaphylaxis, Stevens-Johnson have been reported S/E.
  • Auto innoculation.
Term

True or False

Sarin gas is used for mass infection while Ricin (a derivative of the castor been plant) is used for infecting one individual at a time.

Definition
True.
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