Exam 4 Bioterrorism - Schwind Material Flashcards
1
Q
ANTHRAX
A
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
Q
ANTHRAX INHALATION
A
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
Q
CUTANEOUS ANTHRAX
A
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
Q
TREATMENT OF ANTHRAX
A
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
Q
BIOTRAX VACCINE
A
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
Q
PNEUMONIC PLAGUE
A
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
Q
BUBONIC vs. PNEUMONIC
A
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
Q
SIGNS and SYMPTOMS OF
PNEUMONIC PLAGUE
A
- 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
Q
SMALLPOX
A
- 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
Q
SIGNS and SYMPTOMS OF
SMALLPOX
A
- 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
Q
SMALLPOX VACCINE
A
- 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
Q
BOTULINUM TOXIN
A
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
Q
TREATMENT OF BOTULINUM
A
- 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
Q
RICIN
A
- 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
Q
RICIN
ROUTE OF ADMINISTRATION
A
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
