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1

ANTHRAX

Pathogen: Bacillus anthracis (aerobic, gram+)

  • 3 forms:
    • Inhalation 
    • Cutaneous 
    • GI
  • Exists as spores (dormant or active)
  • Ports of entry: skin lesions, respiratory, GI tracts
  • Spores germinate & transform into mature bacteria in the presence of amino acids, glucose 
  • Spores can live for decades
  • Anthrax is not transmitted from person-to-person 

2

ANTHRAX INHALATION

Anthrax spores enter alveolar space and lymph nodes

  • Latency lasts 2-6 weeks 
  • Injury results when mature bacilli release toxins, causing hemorrhage, edema & necrosis 
  • Antibiotics CANNOT prevent death once the toxin reaches critical levels
  • Two symptoms of stages: 

Stage 1 (mild)

  • Fever, cough, malaise, weakness

Stage 2 (2-3 days later)

  • Respiratory distress, septicemia, hemorrhagic meningitis, shock
  • Pneumonia is RARE
  • Mortality as high as 80% 

3

CUTANEOUS ANTHRAX

S&S: Small papule or vesicle associated with itching

  • Injury develops anywhere spores land, 1-7 days after exposure
  • 7-10 days after symptom onset a black scab forms
  • FATAL if systemic infection develops

4

TREATMENT OF ANTHRAX

Inhalation

  • IV ciprofloxacin –OR- IV doxycycline PLUS 1-2 additional antibiotics for 60 days 

Cutaneous 

  • PO ciprofloxacin for 60 days
  • Will not prevent lesions and black scabs
  • WILL prevent systemic infection

5

BIOTRAX VACCINE

Immunization for:

  • People who handle animal products (hides, hair, bones) that comes from anthrax-endemic areas
  • People at high risk of exposure to anthrax spores (vets, lab workers)
  • Military personnel 

If you come in contact, treat as if you are infected

6

PNEUMONIC PLAGUE

Pathogen. Yersinia pestis (gram negative bacilli)

Two forms:

  • Bubonic: tender, enlarged, inflamed lymph nodes
  • Pneumonic: inflammation of the lungs 

Benefits to terrorists:

  • Available worldwide
  • Easy to culture large quantities
  • Bacteria can be aerosolized for wide dissemination

7

BUBONIC vs. PNEUMONIC

Bubonic

  • Acquired through bite of infected flea
  • CANNOT be transmitted person to person  

Pneumonic

  • Acquired by inhaling Y.pestis
  • CAN be transmitted person to person

                   

8

SIGNS and SYMPTOMS OF 

PNEUMONIC PLAGUE

  • High fever, cough, dyspnea, hemoptysis, nausea, vomiting, diarrhea, abdominal pain
  • Tx. Streptomycin & Gentamicin for 10 days 
  • Respiratory failure and death can ensue without treatment
  • No Vaccine exists

9

SMALLPOX

  • Pathogen. Variola Virus
  • Highly contagious, no specific treatment, vaccine only
  • Spread from person-to-person
  • Spread from contaminated bedding and clothing
  • Enters body via mucous membranes of respiratory tract (inhalation)
    • 12-14 days: asymptomatic incubation followed by the prodromal phase 
    • Last reported cased in 1970

10

SIGNS and SYMPTOMS OF 

SMALLPOX

  • High fever, malaise, headache, backache
  • Small red spots in mouth, tongue
  • Bumpy skin rash starts on face and covers body, becomes fluid filled vesicles then pustules 
  • Once they scab, pitted scars remain
  • 30% of people die in second week from smallpox
  • Initial rash or red spot is when someone can transmit
  • Once the scab falls off, it is no longer transmutable
  • Can be weaponized as an aerosol agent, however, is very fragile and will die within 24 hours

11

SMALLPOX VACCINE

  • Benefits if vaccinated BEFORE viral exposure or AFTER exposure (few days)
  • Mandatory for military since 2002
  • Not available to general public
  • High level of immunity for 5-10 years 
  • Vaccine is given via “scarification”
    • 2 prong needle dipped in vaccine pierces the skin several times
    • SS of it working: Red itchy bumps, than blisters, than puss, than drainage – that’s how you know it worked
  • SE: swelling and tenderness of lymph nodes, necrosis at vaccination site 

12

BOTULINUM TOXIN

Pathogen.  Botulinum toxin

  • MOA. Blocks release of Ach from cholinergic neurons where it inactivates SNAP-25
    • SNAP-25 protein is critical to function of Ach containing vesicles
    • No SNAP-25 = no release of Ach into synaptic space

S&S: Symmetric, descending paralysis 12-72 hours after exposure, lasts wks to months; double vision, drooping eyelids, muscle weakness which can progress from head to toe

  • Recovery can can months
  • DEATH results from paralysis of muscles or respiration
  • This is the EXACT toxin used cosmetically for wrinkles

13

TREATMENT OF BOTULINUM

  • Immediate infusion of botulinum anti-toxin
    • Made from horses 
    • Contains neutralizing antibodies that minimize nerve damage
  • Fluids, nutritional therapy
  • Mechanical ventilation due to paralysis of respiratory muscles
  • CANNOT REVERSE DAMAGE ON THE BODY

14

RICIN

  • Produced from the castor bean plant 
  • Formulated as a powder, pellet, mist or dissolved in water 
  • MOA. Promotes injury by disrupting protein production
  • A dose of purified ricin powder the size of a few grains of table salt can kill an adult human.
  • The median lethal dose (LD50) of ricin is around 22 micrograms per kilogram of body weight if the exposure is from injection or inhalation (1.78 milligrams for an average adult).

15

RICIN

ROUTE OF ADMINISTRATION

Inhalation 

•Cough, chest tightness, SOB, nausea, airway inflammation

•Cyanosis and death follow

Ingestion 

•Intestinal hemorrhage, vomiting and bloody diarrhea 

•Death in 10-12 hours after ingestion 

Injection 

•Impracticable as a form of mass attack

16

NERVE AGENTS

•Irreversible cholinesterase inhibitors

•Toxic doses produce excessive muscarinic stimulation 

•Tx: 

•Mechanical ventilation 

•Giving atropine (reduces muscarinic stimulation)

•Giving pralidoxime  

•Reverses inhibitionofcholinesterase

•Give diazepam (valium) to suppress convulsions

17

MUSTARD GAS

•Alkylating agent and vesicant (blister agent)

•Vaporized into the air or released into the water supply

•Allergies can be severe, fatality is low

18

SIGNS and SYMPTOMS OF

MUSTARD GAS

•Skin: pain, swelling, blisters within 4-48 hrs

•Eyes: irritation, pain, swelling within 3-12hrs

•Can cause temporary blindness and can burncorneas

•Respiratory tract: runny nose, sneezing, hoarseness, sinus pain within 2-24 hrs

•Necrosis andhemorrhage oflungtissue

•GI tract: nausea, vomiting, diarrhea, abdominal pain 

•Bone marrow: may suppress, causing neutropenia & thrombocytopenia 

19

TREATMENT OF 

MUSTARD GAS EXPOSURE

•Rapid decontamination 

•Must takeoffallclothesandwash with warm running water

•Irrigation of burn wounds, debridement, topical antibiotic 

•Analgesics for pain 

•Irrigate eyes 

•Granulocyte stimulating factor stimulates bone marrow

20

RADIOLOGIC WEAPONS

•Radiation causes nausea, vomiting, diarrhea, fatigue, skin burns, hair loss, oral ulcerations of mouth, esophagus, GI tract

•Increases risk of cancer 

•Risks can be reduced by ingesting certain agents

21

TREATMENT OF 

RADIOLOGIC WEAPONS

•Drug used for radiation emergency 

•Protects thyroid from radiation damage 

•Dosing lasts 24 hours 

•Highest protect occurs when given BEFORE exposure