Biological Diseases


Agent & Incubation Period
Signs, Symptoms, Sequelae and
Mode of Acquisition
Source
Vaccine available
Contagious between humans
Treatment
Comments

Anthrax
(inhalation)

Bacillus anthracis

7 days post exposure

*Resembles a common cold (fever, cough, malaise) which progresses to severe dyspnea, diaphoresis, stridor, cyanosis and shock
* Chest xray shows a mediastinal widening.
* Gram positive bacilli seen on blood smear and culture.
* Hemorrhagic mediastinitis, thoracic
lymphadenitis, and/or meningitis.
* Inhalation of spores from contaminated
animal products
* Infected animal
tissue
* Spores can live in the soil for years
* Biological
warfare agent
* Yes … approved for ages 18-65
* 3 injections given 2 weeks apart, followed
by 3 more injections at
6, 12, & 18 months
extremely unlikely * Early treatment is
essential
* Penicillin
* Doxycycline
* Fluoroquinolones
(Cipro)
* Special considerations for
treatment of children, elderly, & pregnant women
90-100% of cases are fatal

Anthrax
(cutaneous)

Bacillus anthracis

7 days post exposure

Spores enter the skin
* Infection more likely with a cut or abrasion on the skin
* Infection begins with a raised, itchy
bump that resembles a bug bite
* Within 1-2 days, a vesicle develops,
followed by a painless ulcer 1-3 cm in diameter with a black necrotic center
* Lymph glands in the adjacent area may
swell

Infected
animal tissue,
hair, fur, hides, leather
* Spores can live
in the soil for years
* Biological
warfare agent

Yes … approved for ages 18-65
* 3 injections given 2 weeks apart, followed
by 3 more injections at
6, 12, & 18 months
rare, but can occur Early treatment is
essential
* Penicillin
* Doxycycline
* Fluoroquinolones
(Cipro)
* Special considerations for treatment of children, elderly, & pregnant women
Death rare
if treated
* 20% of
untreated
cases are
fatal

Anthrax
(intestinal)

Bacillus anthracis

7 days post exposure

Early symptoms : nausea, vomiting, malaise, anorexia, fever, acute inflammation of the GI tract
* Advanced symptoms: abdominal pain, vomiting blood, severe diarrhea
* Illness progresses rapidly
* Eating undercooked contaminated food
Infected animal tissue
* Spores can live in the soil for years
* Biological warfare agent
Yes … approved for ages 18-65
* 3 injections given 2 weeks apart, followed
by 3 more injections at
6, 12, & 18 months
extremely unlikely Early treatment is
essential
* Penicillin
* Doxycycline
* Fluoroquinolones
(Cipro)
* Special
considerations for
treatment of
children, elderly,
and pregnant
women
25-75% of cases are fatal

Botulism (foodborne)
Clostridium botulinum

Incubation depends on amount and rate of toxin absorption
(2 hours to 8 days)

Early symptoms: abdominal cramps, nausea, vomiting, diarrhea, difficulty seeing, speaking, swallowing.
* Double or blurred vision, drooping eyelids, slurred speech, dry mouth,
* Progresses to an acute, afebrile, symmetric, descending flaccid paralysis with multiple cranial nerve palsies, coma
* The most poisonous substance known, a major bioweapon threat due to its extreme potency, lethality, ease of production, transport, and misuse.

Contaminated food from restaurants or home canned sources

Bacteria commonly found in the soil

Botulinum toxoid is available but supplies are scarce and mass outbreaks of disease are rare No * Antitoxin available from CDC; must be administered early in course of disease
* Supportive care
* Presents public health emergency
* Mortality rate = 8%

Botulism
(inhaled)

Clostridium botulinum

Incubation depends on amount and rate of toxin absorption
12 to 80 hours

* Ptosis, diplopia, blurred vision, dysarthria,
dysphonia, dysphagia
* Progresses to an acute, afebrile, symmetric, descending flaccid paralysis with multiple cranial nerve palsies, coma
* The most poisonous substance known, a major bioweapon threat due to its extreme potency, lethality, ease of production, transport, and misuse.
Man-made aerosolized form of the infection, created for use in bioterrorism
Botulinum toxoid is available but supplies are scarce and mass outbreaks of disease are rare No * Supportive care As above

Botulism
(wound)

Clostridium botulinum

Incubation depends on amount and rate of toxin absorption

* Double or blurred vision, drooping eyelids, slurred speech, dry mouth,
* Progresses to an acute, afebrile, symmetric, descending flaccid paralysis with multiple cranial nerve palsies, coma
* Will NOT penetrate intact skin
Bacteria found in soil … in recent years black tar heroin from California is a prime source
as above No * Antitoxin available from CDC; must be administered early in course of disease
* Supportive care
Infectious disease that would NOT result from bioterrorism
Botulism
(intestinal)

Clostridium botulinum
Lethargy, feeds poorly, constipation, weak
cry, and poor muscle tone
* Occasionally susceptible patients may harbor
C. botulinum in their intestinal tract (most often occurs in infants)
Bacteria commonly found in the soil as above No

*Supportive care

*Antitoxin is not routinely given for infant botulism

Infectious disease that would NOT result from bioterrorism
Brucellosis
(foodborne)

Brucella species

Incubation is variable

* Flu-like symptoms such as fever, sweats, headache, back pain, and physical weakness.
* In severe cases, the patient may develop hepatitis, arthritis, spondylitis, anemia, leukopenia, thrombocytopenia, meningitis, uveitis, optic neuritis, papilledema, and endocarditis
* Chronic symptoms may include recurrent fevers, joint pain, and fatigue.
Ingesting contaminated milk, dairy, or animal products
* High risk in unpasteurized milk, ice cream and cheeses
None available for humans Extremely rare … although may possibly be transmitted through breast milk, sexual contact, or tissue transplantation Doxycycline and rifampin used in combination for 6 weeks
* Recovery takes a few weeks to several months
Mortality <2%
Brucellosis
(inhaled
)

Brucella species
As above Inhaling aerosolized Brucella None available for humans As above As above As above
Brucellosis
(wound)

Brucella species
As above Transmitted via skin abrasions while handling infected animals. None available for humans As above As above As above

Pneumonic Plague
Yersinia pestis

Incubation is
1 - 6 days
post exposure

Early signs are fever, headache, weakness, dyspnea and productive cough (bloody or watery sputum)
* May see nausea, vomiting, abdominal pain, or diarrhea
* Acutely swollen and painful lymph nodes appear on the 2nd day of the infection, and the overlying skin is erythematous
* Pneumonia progresses over 2-4 days followed by septic shock and death

Bacteria carried by rodents and their fleas

Bioweapon usage would occur after aerosolization of the bacteria

None at this time, however research is underway Occurs through respiratory droplets during face-to-face contact Early treatment is important
* Streptomycin
* Tetracycline
* Chloramphenicol
* Doxycycline
* Special considerations for
treatment of children, elderly, and pregnant women
* Resp. isolation precautions, prophylactic antibiotic for close contacts of patient
Death can occur in as little as 2-4 days
Smallpox
Variola virus


Incubation is
7 - 17 days
post exposure

Initial symptoms are high fever, fatigue, head and back aches.
* 2-3 days later, a rash appears in the mouth, on the face, arms, and legs. The rash begin as flat red lesions that evolve at the same rate … after a day or two the lesions become pus-filled and begin to crust early in the second week. Scabs fall off after 3-4 weeks
* Patients with smallpox are most infectious during the first week of illness, although are contagious until all skin scabs are healed
* In people exposed to smallpox, the vaccine can be given w/I 4 days to lessen or prevent the illness
*Infected saliva droplets The U.S. has an emergency supply available
(has not been routinely used since 1972)
Occurs through respiratory droplets during face-to-face contact
* Can also be
transmitted by
contaminated clothing or bedding
No proven treatment although research for antivirals continue
* Supportive care should include intravenous fluids, antipyretics, and antibiotics for secondary infections
* Patients admitted to the hospital should be placed in negative pressure rooms, staff should use standard precautions to protect against spread of the disease.
* Mortality rate = 30%

Tularemia
Francisella turarensis

Incubation is
1 - 14 days
post exposure

Initial symptoms are fever, pharyngitis, headache, body aches, and upper respiratory illness, rapidly progressing to bronchitis, pneumonia, pleuropneumonitis, bacteremia.
May see nausea, weight loss, malaise with continued illness.
* Inhalation would have the greatest adverse public health consequences … release in a densely populated area would result in an abrupt onset of a sick population (yet, slower progression than anthrax or plague).
* This is a dangerous bioweapon due to its extreme infectivity, ease of dissemination, and substantial capacity to cause illness and death.
Contaminated arthropods, soil, animals, water, and vegetation
* Humans become infected by direct contact, ingestion, or inhaled infective aerosols
Vaccine available, not fully approved for general use No Individual treatment drugs of choice:
Streptomycin
Gentamycin
* Mass Casualty treatment drugs of choice:
Doxycycline
Ciprofloxin
* Special considerations for children, pregnant woman, and those w/ immuno-suppression
<2%
mortality rate
Viral Hemorrhagic Fevers
(VHF)
VHF is a term used to describe a severe multisystem syndrome in which the overall vascular system is damaged.
* Initially, fever, fatigue, dizziness, muscle aches, weakness, and extreme fatigue are seen in the patient.
* Severe infections will produce bleeding
under the skin (petechiae), internal bleeding, or bleeding from body orifices. These patients will progress to shock, nervous system malfunction, coma, delirium, seizures, and/or renal failure.
* VHF refers to a group of illnesses caused by several families of viruses:
Arenaviruses (Argentine, Bolivian, Lassa)
Bunyaviruses (Rift Valley, Hantavirus)
Filoviruses (Ebola, Marburg)
Flaviviruses (Tick-borne, Kyasanur Forest)
Most VHFs are insect or animal borne
* The vector for Ebola and Marburg viruses are unknown
* Humans become infected through contact with rodent’s bodily fluids or when bitten by an arthropod.
Available only for yellow fever and Argentine hemorrhagic fever at this time.
* No vaccines exist for the other VHFs.
Humans may transmit some of these VHFs to other humans

*There are no treatments for most• of the VHFs.

* Supportive care is given.

Mortality rate varies with each VHF … most are between 50-90% mortality rate
Q Fever
Coxiella burnetii

Incubation is
2 - 3 weeks
post exposure

Sudden onset of high fevers (104-105), severe headache, malaise, myalgia, confusion, sore throat, chills, sweats,
nonproductive cough, nausea, vomiting, diarrhea, abdominal pain, chest pain.
* Fever lasts for 1-2 weeks.
* 30-50% of patients develop pneumonia
* This agent is highly infectious and resistant to heat, drying, and most disinfectants. It easily becomes airborne & is inhaled by humans, and therefore is at risk of abuse by bioterrorists.
* Chronic Q fever occurs when infection persists for > 6 months … these patients are prone to endocarditis.
Infected milk, urine, feces, amniotic fluid of animals
* Humans are infected by inhaling dried, contaminated particles
* Ingestion of contaminated milk may produce illness
yes … although not commercially available in the United States rare

Q fever:
* Doxycycline … most efficient when started within first 3 days of illness.

Chronic Q fever:
* Doxycycline with quinolones for at least 4 years or Doxycycline with hydroychloroquine for 1.5 - 3 years.

Q fever< 2% mortality rate

Chronic
Q fever:
65%
mortality rate

 

Instant Feedback:
Weaponized botulinum toxin is most efficiently delivered through which route?
cutaneous
inhalation
food ingestion
eye, oral and nasal mucosal contact


Instant Feedback:

Weaponized Q fever will result in massive casualties initially with recurrent smaller outbreaks.
True
False

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