Bioterrorism Flashcards

(45 cards)

1
Q

What are the three groups biologic agents are divided into?

A

Bacteria
Viruses
Toxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the biologic agents that are considered to have the most severe potential?

A
Bacillis anthracis (anthrax)
Yersinia pestis (plague)
Variola major (smallpox)
Francisella tularensis (tularemia)
Clostridium botulinum (botulism)
Filoviruses and arenaviruses (viral hemorrhagic fevers)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Organism for anthrax

A

B. anthracis
Gram-positive spore-forming bacterium
Appears as long chains, resembling bamboo or boxcars

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where is anthrax found?

A

In grass-eating mammals that ingest or inhale the spores while feeding
Humans become infected by eating infected animals or through contact (skin or inhalation) with spores on the fur or hide of animals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the three forms of anthrax?

A
Cutaneous
-Most common
Pharyngeal or gastrointestinal
Inhaled
-Most deadly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pathophysiology of anthrax

A
Exposure to spore via skin (or worse) inhalation
Spores germinate into bacilli
Transported to regional lymph nodes
Release toxins
Sx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Prevention of anthrax

A

Vaccine available to military at risk only

Cipro or doxy prophylaxis for 30 days (with vaccination) or 60 days (no vaccination)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sx/exam of anthrax

A
Painless papules that become vesicular with significant edema
Progress to ulcerated black eschar in 1 wk
Constitutional sx (fevers, chills, myalgias) and lymphadenopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pharyngeal or GI anthrax

A

Ulcers and edema of pharynx followed in 5 days by abdominal pain, upper and lower GI bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Inhaled anthrax

A

Mild flu-like sx that rapidly progress to respiratory distress and septic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diagnosis of anthrax

A
Primarily a clinical dx
CXR
Mediastinal lymphadenopathy (CT is more sensitive than CXR)
Possible pleural effusions
May be clear of infiltrates
Gram stain and culture of skin lesions
Tissue or pleural fluid evaluation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tx of anthrax

A

Supportive and symptomatic care
Simple cutaneous anthrax (nontoxic): Cipro, doxy, or amoxicillin
Toxic pts or inhalational dz; require triple antibiotic therapy
-Cipro or doxy plus two other abx (e.g., rifampin, clinda)
Antibiotic therapy must continue for 60 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Plague organism and how it’s transmitted

A

Y. pestis, a Gram-neg bacillus

Normally a dz of rodents transmitted to humans by inhalation of flea feces or bite of infected flea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Forms of dz- plague

A

Bubonic (skin)
-Bacilli migrate to regional lymph nodes- bubo
Pneumonic (inhalational)
-MC: may be transmitted person to person
Septicemia (from secondary dissemination)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Bubonic plague

A

Two to three days incubation followed by:

  • Regional painful lymph node inflammation and necrosis (bubo)
  • Fevers, chills, malaise
  • Will disseminate over next week in 50% (if untreated)
  • Leads to septicemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pneumonic plague

A

Two to three days incubation followed by:

  • Abrupt onset of fevers, chills, and flulike illness
  • Severe pneumonia in 24 hrs
  • Pts may develop meningitis, liver injury, coagulation disturbances, and gangrene in extremities (black death)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Septicemic plague

A

Characterized by endotoxemia, shock, DIC, and coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Dx of plague

A

Suspect in any healthy individual who develops overwhelming Gram-negative sepsis
Gram stain and culture all body fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Tx of plague

A
Isolate pts
Do not incise and drain fluctuant lymph nodes (aspiration ok)
Abx: Multiple choices available
Mild bubonic may be treated at home
Prophylaxis: Same drugs for 7-day course
20
Q

Smallpox

A

Organism: V. major, a large DNA virus
Was successfully eradicated in 1980 with small pox vaccine, but US and Russia have viral repositories for research purposes
Threat to resurface d/t lack of vaccination

21
Q

Clinical forms of smallpox

A

Variola major and minor- 90% of cases
-The classic form of dz
Hemorrhagic
Malignant

22
Q

Sx/exam of smallpox- variola major and minor

A

Incubation period of 2 wks followed by:

  • Constitutional sx
  • Maculopapular rash
  • Begins in mouth
  • Predilection for face, then spreads distally involves palms and soles
  • Changes from vesicular to pustular with all lesions in same stage
23
Q

Sx/exam of smallpox- hemorrhagic

A

Quicker and more toxic course
Petechiae and hemorrhage
Ninety percent mortality rate

24
Q

Sx/exam of smallpox-malignant

A

Also quicker and more toxic course

Lesions are flatter and never progress to pustules

25
Major criteria for smallpox
Febrile prodrome Classic smallpox lesions Lesions in some stage of development
26
Minor criteria for smallpox
``` Centrifugal distribution of pustules Toxic appearance First lesions in mouth, face or forearms -Slow evolution of lesions Pustules on the palms and soles ```
27
Major and minor criteria- how they come into play for smallpox
Three major- presumed dz Two major or one major and four minor- probable disease Fever than four minor- dz not likely Lab PCR identification of variola DNA in a clinical specimen
28
Tx of smallpox
Isolate pt Very contagious until all scabs fall off Exposed persons- vaccinate within 3 days to prevent or attenuate dz. Vaccinia immunoglobulin is given simultaneously with vaccine and redosed as needed to limit complications of vaccination Antivirals are being investigated as tx
29
Tularemia
Organism: Francisella tularensis, a Gram-neg intracellular bacterium Tularemia is transmitted primarily from ticks, lagomorphs, and rodents via direct contact or ingestion of infection water, soil, or fomites Several forms exist depending on route of contact
30
Localized dz with regional lymph node involvement- tularemia
Ulceroglandular: MC- ulcers with LAD Glandular: 2nd MC LAD without skin lesions Oculoglandular: Conjunctivitis with preauricular LAD Oropharyngeal: Severe pharyngitis with cervical lymphadenitis
31
Invasive and generalized dz- tularemia
Typhoidal -Fevers, chills, GI sx, NO skin lesions Pulmonary -Fevers, chills, SOB, nonproductive cough
32
Dx of tularemia
Based on clinical findings | Antibody titers, rapid PCR
33
Tx of tularemia
Isolation is not required Antibiotic: Streptomycin is drug of choice Prophylaxis= doxycycline
34
Organisms in viral hemorrhagic fevers
Filoviruses and grenaviruses | Normally transmitted via mosquitoes, rodents, or their parasites
35
Sx/exam of viral hemorrhagic fevers
Incubation period from 4-21 days, followed by: - Fevers, myalgias, prostration - Petechial hemorrhage, DIC - Multisystem organ dysfunction, cardiovascular collapse
36
Dx of viral hemorrhagic fevers
ELISA | PCR
37
Tx of viral hemorrhagic fevers
Supportive care Antiviral: Ribavirin Prophylaxis: Ribavirin
38
Nerve agents
Organophosphates | Include sarin, soman, VX (vesicant?)
39
Vesicants
Agents that induce blistering via cellular damage, including mustard
40
Pathophysiology of nerve agents
Inhibit acetylcholinesterase Leads to accumulation of acetylcholine at muscarinic and nicotinic receptors Leads to cholinergic toxidrome
41
Sx/exam of nerve agents
``` Cholinergic toxidrome Salivation/sweating Lacrimation Urination Defecation Excretion? GI distress Emesis Miotic pupils Fasciculations Muscle weakness Apnea AMS Seizures ```
42
Dx of nerve agents
Based on hx exposure and clinical presentation
43
Tx of nerve agents
Supportive care Atropine dosed to secretion control (may require 2-4 mg at frequent intervals) Pralidoxime chloride (2-PAM) to reverse paralysis Benzodiazepines for seizures
44
Sx/exam of vesicants
Local skin effects: Severe pain, vesicle formation, and inflammation to site of contact Skin injury resembles second-degree burn Inhalation effects: Pharyngeal edema and pulmonary necrosis- varying degrees of respiratory distress Systemic effects: Bone marrow suppression
45
Tx for vesicants
Skin and mucus membrane decontamination with irrigation | Supportive care