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Bioterrorism Agents Flashcards

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1
Q

What are 5 questions to think about in a bioterrorism case?

A
  1. What is it?
  2. How did they get it?
  3. How is it causing disease?
  4. Can it be treated?
  5. Can it be prevented
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2
Q

What is a deliberate release of viruses, bacteria, or other agents used to cause illness or death in people, animals, or plants?

A

Bioterrorism

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3
Q

Where are bioterrorism agents usually found?

A

In nature

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4
Q

Mutations to bioterrorism agents can do what 3 things?

A
  1. To increase their ability to cause disease
  2. Make them resistant to current medicines
  3. Increase their ability to be spread into the environment
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5
Q

What are 3 ways bioterrorism agents can be spread?

A
  1. Air
  2. Water
  3. Food
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6
Q

How many categories of bioterrorism agents exist?

A

3

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7
Q

Which category of agents is

  1. Easily disseminated or transmitted between people
  2. Has high mortality rates and potential for major public health impact
  3. Might cause public panic and social disruption
  4. Requires special action for public health preparedness?
A

Category A: High priority agents

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8
Q

What category of agents is

  1. Moderately easy to disseminate
  2. Has moderate morbidity and low mortality rates
  3. Requires enhancements of CDC’s diagnosis capacity?
A

Category B

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9
Q

What are the 2 characteristics of Category C agents?

A
  1. Availability, easily produced and disseminated

2. Potential for high morbidity and mortality rates

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10
Q

How are category A agents transmitted?

A

Respiratory or blood

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11
Q

What are 6 examples of Category A agents?

A
  1. Anthrax (Bacillus anthracis)
  2. Botulism (Clostridium botulinum toxin)
  3. Plague (Yersinia pestis)
  4. Smallpox (variola major)
  5. Tularemia (Francisella tularensis)
  6. Viral hemorrhagic fevers
    • Filoviruses (e.g., Ebola, Marburg)
    • Arenaviruses (e.g., Lassa, Machupo)
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12
Q
  1. Spore-forming
  2. Gram-Positive Rod
  3. Aerobic
  4. Non-Motile
A

Bacillus anthracis

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13
Q

How is bacillus anthracis arranged?

A

Long serpentine chains and clumps (medusa head) that can be single or paired

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14
Q

Where is bacillus anthracis found?

A

Soil, worldwide

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15
Q

What allows bacillus anthracis to survive in soil for years?

A

Spores (no spores in clinical specimens)

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16
Q

What kind of capsule does anthrax have?

A

Poly-D Glutamic acid, it’s antiphagocytic

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17
Q

When is the anthrax capsule produced?

A

Only during infection

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18
Q

True or False: Anitbodies against capsule for anthrax are not protective?

A

TRUE

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19
Q

What are the 3 proteins the anthrax toxin is composed of?

A
  1. Protective antigen (PA)
  2. Edema factor (EF)
  3. Lethal factor (LF)
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20
Q

What carries the edema factor and lethal factor for anthrax and what does it do?

A

PA

Penetrates cells

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21
Q

What causes edema from anthrax?

A

Protective antigen and edema factor

EF is a cAMP-inducing toxin

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22
Q

What causes death in anthrax?

A

Protective antigen and lethal factor

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23
Q

Where is anthrax serious?

A

In countries where herd vaccination isn’t practiced (rare in US)

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24
Q

What is the required exposure for anthrax?

A

Infected animals or animal products

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25
What are the 3 routes of anthrax acquisition?
1. Inoculation 2. Inhalation 3. Ingestion
26
What % of anthrax infections are via inoculation of spores through exposed skin?
95%
27
True or False: Anthrax is highly contagious
False... not highly contagious, not spread person-person
28
What is another name for inhalation anthrax?
Woolsorter disease
29
Is ingestion of anthrax common?
No, it's rare (herbivores common)
30
What are the 4 steps of clinical disease and progression of pulmonary anthrax?
1. Inhale spores or droplets from infected individual 2. Carried from lungs by macrophages to lymphatic system (1-5 days of malaise, fever, and non-productive cough) 3. Spores germinate and multiply in LN (bacteria make toxin and spread) 4. In 24 hours: Pulmonary necrosis, septicemia, ect.
31
What 3 clinical features happen within 24 hours of pulmonary anthrax?
1. Progressive respiratory distress and cyanosis 2. Massive edema of neck, chest, mediastinum 3. Death if untreated
32
What % mortality is seen with anthrax if therapy isn't started in 48 hours?
95%
33
What has the greatest potential for mass casualties and civil disruption (CDC)?
Anthrax | -Death in 48 hours if untreated
34
What is the number 1 bioterrorism agent for clinical case scenario?
Anthrax
35
What are 3 situations where anthrax has been used before?
1. Iraq and Soviet Union 2. US attacks in 2000 (Letter to abortion clinical from Lexington, KY) 3. Letters after 9/11
36
What are 3 ways to diagnose anthrax?
1. Culture on non-selective media 2. Serology 3. Mediastinal widening on CXR
37
What does anthrax look like on culture?
Gray ground-glass appearance
38
Anthrax colonies?
Non-hemolytic, grow rapidly
39
How is anthrax treated?
1. Ciprofloxacin 2. Doxycycline - For victims of warfare
40
Is there a vaccination for anthrax?
Yes - Formalin-killed B. Anthracis - 6 doses over 18 months - Only available to military personnel
41
1. Gram-Positive 2. Anerobic Rods 3. Spore former
C. Botulinum
42
What is adult botulinum associated with?
Home canning (food-borne)
43
What is infant botulinum associated with?
Honey
44
What type of toxin is associated with foodborne intoxication with C. Botulinum?
Heat-labile neurotoxin
45
What does the heat-labile neurotoxin associated with C. Botulinum do?
- Inhibits the release of acetylcholine | - Causes flaccid paralysis- Most potent known neurotoxin (7 toxins known)
46
What is the classic way to get Botulism?
Foodborne: Associated with the consumption of home-canned foods (Under 30 cases per year) (Bacteria replicates in food, the toxin is ingested = Intoxication)
47
What is a proposed scenario of Botulism that is a major concern for bioterrorism?
Inhalation botulism -Toxin inhaled, potential for high mortality (NO CASES DIAGNOSED)
48
Once you ingest Botulism toxin in food, how many days is the incubation?
1-2 days
49
What are the symptoms of Botulism?
Initial weakness and dizziness, blurred vision, dry mouth, dilated pupils, constipation*, abdominal pain, NO FEVER
50
What is death attributed to from Botulism?
Respiratory paralysis
51
What is the % mortality from Botulism?
10% -Higher mortality proposed with inhalation | Recovery can take months to years
52
What is the treatment for Botulism?
1. ANTITOXIN GIVEN IMMEDIATELY 2. Supportive care: Respirator or tracheotomy 3. Stomach lavage to remove source of toxin * Antibiotics NOT WARRANTED for intoxication
53
What causes the pneumonic plague?
Yersinia pestis
54
1. Oxidase-Negative | 2. Gram-Negative Rod
Yersinia pestis
55
What kind of pneumonia does the pneumoic plague cause?
Hemorrhagic
56
True or False: Yersinia Pestis is easily transmitted between people
True
57
What is the % mortality associated with Yersinia Pestis (pneumonic plague)?
Over 90% | -Dead in 2 days, some within 24 hours
58
How do you diagnose the pneumonic plague?
Gram stain of LN aspirate
59
What does Yersinia Pestis look like on staining?
Bipolar safety pins
60
True or False: It is safe to culture Yersinia Pestis?
False: It is dangerous to culture (cold-enrichment)
61
What is done to prevent Yersinia Pestis?
You isolate the patient and notify health officials | Inactivated vaccine is no longer available
62
How smallpox transmitted (Variola)?
1. Respiratory droplets 2. Person to person 3. Fomites
63
How does smallpox (Variola) occur and what is the associated mortality?
-Occurs in outbreaks | ~30% mortality
64
What results in a rash with papules that become pustules that crust and scab?
Smallpox (Variola)
65
True or False: The pustules caused by Smallpox will present in various stages of development
FALSE: Pustules are all in the SAME stage of development
66
What is the prevention of smallpox (variola)?
There is a vaccine, but immunixation stopped in 1980
67
What causes Tularemia?
Francisella Tularensis
68
1. Aerobic | 2. Gram-Negative Bacillus
Francisella Tularensis
69
What is the % mortality for untreated tularemia?
8%
70
How many cases per year of Tularemia are seen in the US?
Several hundred
71
True or False: Clinical disease associated with Francisella Tularensis is rare
TRUE
72
How many bacilli of Francisella Tularensis need to be inhaled for infection?
10-50
73
What are symptoms of Tularemia?
1. Dry cough, dyspnea, chest pain 2. Lobar pneumonia may develop, ARDS in some pts 3. Can lead to Typhoidal (septicemic) tularemia
74
Is the sputum gram stain for Francisella tularensis usually positive?
No, it's usually negative
75
What kind of agar does francisella tularensis grow on?
Buffered Charcoal Yeast Extract Agar
76
What are category B Agents?
1. Brucellosis (Brucella species) ** 2. Epsilon toxin of Clostridium perfringens 3. Food threats (e.g., Salmonella, EHEC, Shigella) 4. Glanders (Burkholderia mallei) ** 5. Melioidosis (Burkholderia pseudomallei) ** 6. Psittacosis (Chlamydia psittaci) 7. Q fever (Coxiella burnetii) ** 8. Staphylococcal enterotoxin B 9. Typhus fever (Rickettsia prowazekii) 10. Viral encephalitis (VEE, EEE, WEE) 11. Water threats (e.g., Vibrio cholerae, Crypto)
77
What 4 things can cause Brucellosis?
1. Brucella Abortus 2. Brucella Suis 3. Brucella Meletensis 4. Brucella Canis
78
What is Brucellosis associated with?
Aborted fetuses (zoonotic infection)
79
With Brucella, how many organisms need to be inhaled to establish infection?
A low number...10-100
80
What are the symptoms of acute disease with Brucellosis?
Fever, weakness, fatigue, malaise, depression, anorexia, profuse sweats*, chills, arthralgia, myalgia, GI symptoms, headache
81
How do you treat Brucellosis?
1. Doxycycline and Rifampin for 6 weeks | 2. Doxycycline for 6 weeks and streptomycin daily for 2-3 weeks
82
What causes Q Fever?
Coxiella Burnetii
83
Where is Coxiella Burnetii found?
* PLACENTA and feces of infected lifestock | - Goats, sheep, cattle, cats
84
How do you get Coxiella Burnetii?
Inhalation
85
What can Coxiella Burnetii cause?
Pneumonia and hepatitis
86
What is the most common way to diagnose Q Fever?
Serology (Phase I and II Antigens)
87
How do you treat Q Fever?
Acute: Doxycycline Chronic: Combination
88
True or False: There is a vaccine for Coxiella Burnetii
True, there is a vaccine available in some countries like Australia, but it's not approved in the US
89
What are 2 related diseases caused by Burkholderia?
1. Glanders | 2. Meliodosis
90
1. Nonmotile 2. Nonsporulating 3. Obligate aerobic 4. Gram-Negative Rods 5. Nonfermenters
Burkholderia spp.
91
What is caused by Burkholderia Mallei?
Glanders
92
What is caused by Burkholderia Pseudomallei?
Melioidosis (AKA Whitmore Disease)
93
True or False: Glanders and Meliodosis are both considered potential biological warfare in aerosolized form
True
94
How do you get Glanders (Burkholderia Mallei)?
From direct contact with secretions from infected animal (horses, mules, donkeys) -Primarily a disease of animals
95
How do you get Melioidosis/Whitmore Disease (Burkholderia Pseudomallei)?
From direct contact from a contaminated source (soil and water of Middle East, India, China)
96
Where is Malioidosis endemic in?
SE Asia and Australia
97
What are the 3 forms of clinical disease with Glanders and Meliodosis?
1. Localized manifestations with Ulceration (usual form) 2. Pulmonary Form 3. Septicemia
98
What symptoms are associated with the pulmonary form of Glanders and Meliodosis?
- Pneumonia, pulmonary abscesses, pleural effusions | - Cutaneous abscesses may develop
99
What is involved and how many days until fatal is septicemia associated with Glanders?
- Cutaneous, hepatic, splenic involvement | - 7-10 days
100
Who is septicemia due to Melioidosis seen in?
Chronically ill patients (HIV and Diabetes)
101
What symptoms and what fatality rate is seen in septicemia due to Melioidosis?
- Respiratory distress, headache, fever, diarrhea, pus-filled lesions on skin, systemic abscesses - 90% fatality rate in 24-48 hours
102
What is normally seen on blood cultures for Glanders and Meliodosis?
They may be negative
103
What is seen on gram stain of sputum, urine, and skin lesions for Glanders and Meliodosis?
- Small, gram-negative bacilli | - May have safety-pin, bipolar appearance
104
What 3 drugs are seen for treatment of Glanders and Meliodosis?
1. Amoxicillin and clavulanate 2. Doxycycline 3. TMP-SMX
105
What is done for prevention of Glanders and Meliodosis?
Standard precautions
106
What are category C agents?
Emerging Infectious Diseases: Nipah virus and Hanta virus

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