Bioterrorism Flashcards
(26 cards)
Anthrax tx
2-3 drugs x 60 days
- ) cipro/doxy
- ) Add clindamycin or rifampin to halt protein synthesis
- ) if CNS penetration, linezolid / meropenem + rifampin + pcn/chloramphenicol
Anthrax pep
Levo/cipro + doxy x 60 days (even if preg)
Anthrax vaccine - 3 dose regimen )day 0, 2, 4 wks
Nasal cx can’t exclude a pt from ppx
Plaque (yersinia pestis)
Gram - cocco bacillus (bipolar staining)
Lives in ground squirrels and ground hogs (esp in southwest)
Negative serology does NOT rule out disease
Plague pep
Doxycycline or cipro
Plaque tx
Universal precautions, droplet isolation
Streptomycin/gentamicin/tobramycin
Ceftriaxone
Anthrax
Bacillus anthracis
Gram + rod Quick growth in blood cx Grows in cx in 24 hrs Elisa turns + after 1 week Standard precautions (not resp) Spores taken into lymph nodes, not air spaces
A specimen from pt is more of an infxn control hazard than the patient in?
Tularemia
Smallpox (variola)
Centrifugal rash (peripheral face, hands , feet first) all lesions at same stage
Prodrome: 1-4 d prior to rash; fevers, chills, headache, back ache, pts usually very ill
Pt is infectious until scabs detach
Infected resp mucosa -> lymphatics -> viremia -> spread to liver, spleen, lung, BM
How does varicella differ from smallpox?
No Prodrome
Varicella is centripetal
Lesions at different stages
Monkeypox
Rash spares palms and soles
Variable distribution
Pts with lymphadenopathy
Assoc with contact with exotic animals (prairie dogs, rodents)
Lesions in same stage of development
How is smallpox transmitted?
Person to person resp spread via droplets
Less likely from contact
When is smallpox contagious?
Once exanthem appears
How is smallpox diagnosed?
Viral swab off vesicles
Serology (look for varicella IgG)
VZV culture
DFA
** need 3 specimens from each patient**
How to distinguish pox virus on pathology?
Monkey pox and small pox have Guarneri bodies (pink blobs in cytoplasm)
Smallpox PrEP?
Military get vaccine, avoid if pregnant, IC, on steroids
Smallpox PEP
Vaccinia vax within 3-4d of exposure
Most effective if given
In a smallpox outbreak who gets PEP?
Everyone, no contraindications to vaccine
Tularemia
Small gram negative cocco bacillus
Can be transmitted via inhalation
Sx; abrupt onset fevers, chills, ha, myalgia, cough, LAD, ST, abd pain,
Ulceroglandular, glandular, oculoglandular, oropharngeal, pneumatic
Dx: sputum cx, blood cx, serology
Tularemia tx:
Streptomycin or gentamicin x 10 d
Tularemia Prev
Doxycycline or ciprofloxacin x 14 d
Botulism
1 g dispersed and inhaled could kill 1 million people
Toxin can be absorbed thru mucosal surfaces or wound
Sx: flaccid paralysis (lasts for wks-mos)
Dysphonia, dysarthria, dysphagia, diplopia, Desc symmetric flaccid paralysis within 12-72 hrs.
Botulism tx
Botulism anti toxin
Supportive care
Intubation with mech ventilation
Viral hemorrhagic fever
Can be aerosolized
Sx: fever, dizziness, rash, myalgia, mild subconj hemorrhage, resp sx, renal insufficiency
Dx: serology. Pcr, virus isolation
Ricin
Category B agent
Can be inhaled or ingested
Sx: cough, sob, chest tightness, fever, nausea, airway necrosis with capillary leak leading to pulmonary edema
Tx: supportive
