M21: Disease Transmission IV: Biodefense Flashcards Preview

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Flashcards in M21: Disease Transmission IV: Biodefense Deck (53)
1

Policies Against Bioweapons

1. _ (1925): Prohibiting use of biological weapons in war

2. _ (BWC, 1972): prevents development, production and stockpile of biological weapons

The Geneva Convention

The Biological Weapons Convention

2

Differences between biological agents vs. conventional weapons (5)

• Cheaper
• Ubiquitous
• Hard to detect
• Dual-use technology
• Potentially self-perpetuating

3

Components of the US plan include:

_ which capture particles from the air and are analyzed for the presence of bioagents

the strategic national stockpile of _

_ teams

Biowatch detectors

vaccines/antimicrobials

national disaster medical system

4

Epidemiologic clues:

The most likely scenario would be _ among people who are _.

The likely presenting symptoms would be _ because most infectious agents are distributed in _ form, but _ outbreaks through _ could also occur.

Another clue would be if an organism was identified that _.

Also _ around the country or organisms with an unusual pattern of _ would be suspicious.

a large epidemic with severe illness and high death rate
otherwise fairly healthy

respiratory
aerosolized

food borne
ingestion

wasn’t normally present in that part of the country or the world

multiple, simultaneous outbreaks
antibiotic resistance

5

Natural Events

There have been several natural events which would be managed in a fashion similar to an act of bioterrorism. This is an example of an “_” approach to preparedness. Because the principles are the same, these natural events are often discussed along with bioterrorism.

These include such diseases as (4)

The strengths needed to respond to natural outbreaks would be harnessed in the response to an unnatural outbreak.

all hazards

pandemic influenza
SARS
monkeypox
West Nile Virus.

6

Components

The first part of managing an outbreak is _. This can be done through laboratory and/or clinical reporting. This is important for containment but, most importantly, for better outcomes.

We generally rely on _ confirmation of the disease after which we focus on containing it through infection control measures.

This may involve (3) while monitoring for signs of infection.

early identification of it through surveillance

laboratory

isolating infected and contagious patients
finding close contacts
observing/quarantining individuals

7

Category A Agents

1. _ (anthrax)
2. _ (tularemia)
3. _ (plague)
4. _ (smallpox)
5. _ and _ (Viral hemorrhagic fevers)
6. _ (botulism)

1. Bacillus anthracis (anthrax)
2. Francisella tularensis (tularemia)
3. Yersinia pestis (plague)
4. Variola major (smallpox)
5. Arenaviruses and filoviruses (Viral hemorrhagic fevers)
6. Clostridium botulinum toxin (botulism)

8

Category A Agents

1. Bacillus anthracis (_)
2. Francisella tularensis (_)
3. Yersinia pestis (_)
4. Variola major (_)
5. Arenaviruses and filoviruses (_)
6. Clostridium botulinum toxin (_)

1. Bacillus anthracis (anthrax)
2. Francisella tularensis (tularemia)
3. Yersinia pestis (plague)
4. Variola major (smallpox)
5. Arenaviruses and filoviruses (Viral hemorrhagic fevers)
6. Clostridium botulinum toxin (botulism)

9

Category A Agents are considered to be high priority agents because (5)

– They can be easily spread from one person to another
– High mortality rates
– Major public health impact
– Public panic & social disruption
– Special action required for public health preparedness

10

Category B Agents

These are the 2nd highest priority. They are less likely to cause _ but they may be easier to _ and they are fairly easy to _.

fatal disease
obtain
disseminate

11

Category B Agents (7)

E. coli
Salmonella
Burkholderia mallei (glanders)
Burkholderia
pseaudomallei (melioidosis)
Rickettsia prowazekii (typhus fever)
ricin toxin

12

Category C Agents

These are the third highest priority. This group includes pathogens that could be _ because of availability and ease of production and dissemination.

These agents have the potential for high _ and _ and major health impact

engineered for mass dissemination

morbidity and mortality rates

13

Category C Agents (3)

Nipah virus
avian influenza virus
hantavirus

14

Category A Agents:
Anthrax:
Bacillus anthracis

• Gram (positive / negative) _
• Readily forms _ --> Can persist in the soil for years
• Non-_, _ colonies on blood agar
• Anthrax occurs worldwide
• Reservoirs (3)

• Gram positive rod
• spores
• Non-hemolytic, medusa’s head/comet’s tail colonies on blood agar
• Anthrax occurs worldwide
• Reservoirs: cattle, sheep, goats

15

Category A Agents:
Anthrax:

Naturally occurring anthrax is generally a disease of the _

Breakdown (? > ? >?): inhalational, gastrointestinal, cutaneous

skin

cutaneous > inhalational > gastrointestinal

16

Category A Agents:
Anthrax:
Anthrax Infection

In humans, anthrax is fairly (common / rare).

It usually occurs after exposure to _ or _.

In 2001, it was also associated with _ exposure.

Other recent outbreaks of note include cases in _ in Scotland through contaminated _ and people handling _.

rare

infected animals or animal products

intentional

injection drug users
heroin

drums made with animal skins

17

Category A Agents:
Anthrax:
Anthrax Infection

The infection begins with _ when it is in an environment conducive to vegetative growth.

It then _ and produces a _.

The organisms may stay contained in the _ or spread through both the _ and the _.

It causes severe inflammation of the _.

germination of the spore

multiplies
toxin

skin
bloodstream
lymphatics

lymph nodes

18

Category A Agents:
Anthrax:
Virulence Factors

• Capsule: The organism is protected from the immune system by an _ capsule (a _ capsule) encoded on a plasmid.

• Exotoxins (2) encoded on a plasmid

antiphagocytic
polyglutamic acid (PGA)

Edema Toxin (protectiv eantigen + edema factor)

Lethal Toxin (protective antigen + lethal factor)

19

Category A Agents:
Anthrax:
Virulence Factors

a. Edema Toxin

i) an _ that increases intracellular _ concentrations and interferes with _

b. Lethal Toxin

i) _ that cleaves and inactivates multiple _ and interferes with _

adenylate cyclase
cyclic AMP
cell function

calmodulin-dependent zinc metalloprotease
mitogen-activated protein kinases
signal transduction

20

Category A Agents:
Anthrax in 2001

There were 22 cases diagnosed between October and November 2001. Eleven of these were _ infections and all survived. The others were _ anthrax and among these 11 cases; 7 were postal workers, 2 had known exposure to contaminated mail and 2 had presumed exposure to contaminated mail. These infections were all limited _ to Florida, Washington DC, New York, New Jersey and Connecticut. This was consistent with an intentional release in certain geographic areas. However the fear was widespread.

cutaneous

inhalational

geographically

21

Category A Agents:
Cutaneous (skin) anthrax

• Exposure _ to _ of anthrax
• Incubation period of _ days
• _ at site
• Vesicles --> _
• Lesion is usually (painful / painless)
• Enlarged _ in the region of the infection

• Exposure abraded/lacerated skin to spores of anthrax
• Incubation period of 1-7 days
• Pruritic papule at site
• VesiclesàBlack eschar
• Lesion is usually painless
• Enlarged lymph nodes in the region of the infection

22

Category A Agents:
Gastrointestinal Anthrax

• From _
• 40% mortality
• _ day incubation period
• _, _, and _, followed by severe _. Many cases will be associated with _, massive _, and _.

• From uncooked meat
• 40% mortality
• 1-5 day incubation period
• Nausea, vomiting, and fever, followed by severe abdominal pain. Many cases will be associated with hematemesis, massive ascites, and bloody diarrhea.

23

Category A Agents:
Inhalational Anthrax (“_ Disease”)

• 45% mortality in 2001; Patients who survived were recognized and treated early in their course
• Incubation period of _ days
• _ illness (but no _)
• Does not cause _ but does cause _
• _ widening on chest x-ray (_)
• Dissemination from inhalational or GI anthrax can result in _ (“cardinal’s cap”)

Woolsorter’s

• 45% mortality in 2001; Patients who survived were recognized and treated early in their course
• Incubation period of 4-6 days
• Flu-like illness (but no rhinorrhea)
• Does not cause pneumonia but does cause bloody pleural effusions
• Mediastinal widening on chest x-ray (hemorrhagic mediastinitis)
• Dissemination from inhalational or GI anthrax can result in hemorrhagic meningitis (“cardinal’s cap”)

24

Category A Agents:
Anthrax:
Diagnosis

The easiest way to make the diagnosis is by _

– _ cultures turn positive in 6-24 hours
– _ cultures may be used for epidemiologic purposes to see if someone has been exposed

Other diagnostic tests include:

– _
– _stains
– Anthrax _ test
– Looking for a 4-fold increase in _ antibody level—this requires follow up antibody levels (_ diagnosis)

culture of blood, CSF, effusion

Blood
Nasal swab

– PCR
– Immunohistochemical stains
– Anthrax IgM test
– Looking for a 4-fold increase in IgG antibody level—this requires follow up antibody levels (retrospective diagnosis)

25

Category A Agents:
Anthrax:
Transmission-Isolation

There is no _-to-_transmission of inhalational anthrax.

It can be spread by _.

No _ is required: “standard precautions”

There is no person-to-person transmission of inhalational anthrax.

It can be spread by contact with an open, infected wound.

No special isolation is required: “standard precautions”

26

Category A Agents:
Anthrax:
Treatment

The standard treatment was increased in duration in 2001 because of concerns that someone could have been exposed to a “weaponized” form of anthrax which could be easily aerosolized. So the current treatment recommendations are based on the assumption that _ in the lungs could be germinating long after inhalation exposure. Since manufactured anthrax may contain _, multiple antibiotics are recommended.

Cutaneous anthrax:
_ x 60 days or _ x 60 days

Inhalational or gastrointestinal:
_ or _ and 1-2 additional antibiotics x 60 days (7)

Post-exposure prophylaxis:
3 doses of vaccine and _ x 60 days or _ x 60 days

Monoclonal Antibody:
• _: targeted toward protective antigen
• To be used as an adjunct to antimicrobial treatment

spores
antibiotic resistance genes

doxycycline
ciprofloxacin

doxycycline
ciprofloxacin

• rifampin
• vancomycin
• penicillin/ampicillin
• chloramphenicol
• imipenem
• clindamycin
• clarithromycin

doxycycline
ciprofloxacin

Raxibacumab

27

Category A Agents:
Anthrax:
Vaccination

The anthrax vaccine is called the _. It has historically been given with a series of 5 doses plus annual boosters.

It results in antibodies against the “_” which is a component of both of the toxins produced by this organism.

It is generally well tolerated but there are mild _ reactions in 30% of people and _ reactions in 0.2% of people.

Other treatments:
• _ (not FDA approved)

Anthrax Vaccine Adsorbed (AVA)

protective antigen

local
systemic

Anthrax Immune Globulin

28

Category A Agents:
Tularemia:
Francisella tularensis

• Gram-(positive / negative) _
• (Obligate / Facultative) (intracellular / extracellular) pathogen
• Why category A: (#) organisms to cause disease, variety of _, substantial _ if untreated
• _ experimented with it in WWII-era

• Gram-negative coccobacillus
• Facultative intracellular pathogen
• Why category A: 10 organisms to cause disease, variety of sources, substantial mortality if untreated
• Japanese experimented with it in WWII-era

29

Category A Agents:
Tularemia:
Epidemiology

• (Common / rare) in the USA before 1950
• Now (more / less) common
• Disease of the (northern / southern) hemisphere
• Primarily a disease of _
• Peaks in the (summer / winter) (_)
• Small peak in the (summer / winter) (_)

• Common in the USA before 1950
• Now less common
• Disease of the northern hemisphere
• Primarily a disease of animals
• Peaks in the summer (ticks)
• Small peak in the winter (hunters)

30

Category A Agents:
Tularemia:
Naturally occurring infection

This is a naturally occurring infection in the USA. It generally begins after the bite of an infected _.

It is generally found in _ or _ and it may be inoculated directly into the wound.

It can also be seen after contact with contaminated _ and it can be aerosolized (rarely) from contaminated _.

Laboratory workers are at risk if it is in their laboratory so they should be notified if you suspect this infection.

tick

tick saliva or feces

animal products (e.g. skinning, dressing or eating infected animals)
water, dust, or hay

31

Category A Agents:
Tularemia:
Clinical Presentations

• Average incubation period of _ days

• Abrupt onset of _

• Syndromes
o _: most common; lesion + lymphadenopathy
o _
o _
o _: lymphadenopathy
o _
o _: disseminated infection that does not fall into other categories; hardest to diagnose

• In antibiotic era, death rate 4%

3-5

fever, chills, headache, malaise, anorexia, and fatigue

o Ulceroglandular: most common; lesion + lymphadenopathy
o Oculoglandular
o Pharyngeal
o Glandular: lymphadenopathy
o Pneumonic
o Typhoidal: disseminated infection that does not fall into other categories; hardest to diagnose

32

Category A Agents:
Tularemia:

Diagnosis

• Alert microbiology lab!!!
• _ culture - (large / small), gram-(positiv e/ negative) _
• _ cultures (rarely positive)
• Antibodies – _, confirm the diagnosis
• _: inflammation, pleural effusion and enlarged hilar lymph nodes

Transmission-Isolation

• No _-to-_transmission
• No _: “standard precautions”

• Sputum culture - small, gram-negative coccobacilli
• Blood cultures (rarely positive)
• Antibodies – retrospective, confirm the diagnosis
• Chest x-ray: inflammation, pleural effusion and enlarged hilar lymph nodes

• No person-to-person transmission
• No special isolation: “standard precautions”

33

Category A Agents:
Tularemia:

Treatment

Preferred: _ or _ (intramuscular, intravenous) for 10 days

Alternatives: _, _, or _ (all oral) for 10 days

Prevention

• _ no longer available

• _ or _ for 14 days as post-exposure prophylaxis

streptomycin or gentamicin

doxycycline, ciprofloxacin, or chloramphenicol

Vaccine

Ciprofloxacin or doxycycline

34

Category A Agents:
Plague:
Yersinia pestis

• Cause of “_” - 14th Century Europe
• 3 world _
• 3,000 cases worldwide in 1994
• Naturally occurring disease in the _ USA
• Gram-(positive / negative) _
• _ staining, “safety pin”

• Cause of “Black Death” - 14th Century Europe
• 3 world pandemics
• 3,000 cases worldwide in 1994
• Naturally occurring disease in the southwestern USA
• Gram-negative bacillus
• Bipolar staining, “safety pin”

35

Category A Agents:
Plague:

Virulence Factors (some of many):

1. _: acts as a protease, promotes adhesion, and coagulase (flea mid-gut)
2. _: Type III secretion system
3. _

Naturally occurring infection

This is a disease of _.

Fleas obtain a blood meal from an infected _.

_ multiplies and blocks digestive system of flea.

Flea takes another blood meal from _ and regurgitates bacteria into _.

1. Plasminogen activator
2. Yersinia outer protein virulon
3. LPS

rodents

rodent

Y. pestis

human
human

36

Category A Agents:
Plague:

Symptoms (3)

1. Acute febrile lymphadenitis – “bubonic plague”
2. Pneumonic
3. Septicemic

37

Category A Agents:
Plague:
Symptoms

1. Acute febrile lymphadenitis – “bubonic plague”

a. Most (common / rare) form
b. Sudden onset of _
c. Intense pain and swelling in _

2. Pneumonic

a. Infection of the _
b. Incubation: 2-4 days
c. _, _, and _
d. Bloody _
e. _: pneumonia
f. Mortality – 50%

3. Septicemic

a. Generalized infection (_)
b. Presumably after escape from the _

a. Most (common / rare) form
b. Sudden onset of fevers, chills, weakness, headache
c. Intense pain and swelling in lymph nodes

a. Infection of the lungs
b. Incubation: 2-4 days
c. Fever, cough and difficulty breathing
d. Bloody sputum
e. Chest x-ray: pneumonia
f. Mortality – 50%

a. Generalized infection (blood stream)
b. Presumably after escape from the lymph nodes

38

Category A Agents:
Plague:

Transmission (pneumonic plague)-Isolation
• (Contagious / Not contagious)
• _ – gowns and gloves
• _ precautions for 72 hours while on appropriate antibiotics

Treatment
Preferred: _ or _ (intramuscular, intravenous) x 10 days
Alternatives: _, _ or _(oral) x 10 days

Prevention:
Mass casualty setting or post-exposure _
Preferred antibiotics: _ or _ (oral) for 7 days

Vaccine: _

Transmission (pneumonic plague)-Isolation
• Contagious
• Isolation – gowns and gloves
• Droplet precautions for 72 hours while on appropriate antibiotics

Treatment
Preferred: streptomycin or gentamicin (intramuscular, intravenous) x 10 days
Alternatives: doxycycline, ciprofloxacin or chloramphenicol (oral) x 10 days

Prevention:
Mass casualty setting or post-exposure prophylaxis
Preferred antibiotics: doxycycline or ciprofloxacin (oral) for 7 days

Vaccine: No longer available

39

Category A Agents:
Smallpox:

Variola major/Variola minor

• (DNA / RNA) virus
• Only human disease _
o _ as only host

Clinical Presentation

• _ day incubation period
• _ followed 5 days later by _
• Severe subtypes: _ smallpox, _ smallpox

• DNA virus
• Only human disease eradicated from the planet (Rinderpest is an animal disease that has been eradicated)
o Humans as only host

• 10-14 day incubation period
• Prodrome followed 5 days later by rash
• Severe subtypes: hemorrhagic smallpox, flat smallpox

40

Category A Agents:
Smallpox:
Evolution of rash

• _ -_ and _
• _ – filled with _
• _ – filled with _
• _
• _
• all lesions _

• Maculopapular -flat and raised (macular = flat, papular = raised)
• Vesicles – filled with clear fluid
• Pustules – filled with pus
• crusts
• scarring
• all lesions of same form

41

Category A Agents:
Smallpox:

Transmission

• most contagious from the onset of the rash through the first _ of rash
• _ or _ (small particles that can be spread in the air, e.g. from coughing)
• _
• _ – objects which the infection can live on for limited periods of time (e.g. contaminated clothing or bed linens)
• infectious until _

Isolation

• All individuals with possible smallpox should be isolated immediately
1. _ room
2. _ – masks to filter out infection - used for other infections in the hospital, such as patients with tuberculosis
3. _ and _
• _ and _ should be vaccinated and placed under surveillance

• 7-10 days
• droplet nuclei or aerosols
• direct contact
• fomites
• the scabs have healed

1. Negative pressure
2. N95 respirators
hospital, such as patients with tuberculosis
3. Gowns and gloves
• Household and other close contacts

42

Category A Agents:
Smallpox:
Variola vs. Varicella (_ vs. _)

Variola (_)
• Rash most dense on _ and _ (_)
• Lesions appear over _ days and evolve _
• Rash occurs on _
• Pruritic (itchy) / Doesn’t itch

Varicella (_)
• Greater concentration of lesions on _ (_)
• Lesions appear in _, _
• Rarely seen on _ or _
• Pruritic (itchy) / Doesn’t itch

smallpox vs. chickenpox

(smallpox)
• face and extremities (centrifugal)
• 1-2 days, at the same rate
• palms
• Doesn’t itch

(chickenpox)
• the trunk (centripetal)
• crops, different stages of maturation in adjacent areas
• palms or soles
• Pruritic (itchy)

43

Category A Agents:
Smallpox:
Vaccine

The smallpox vaccine comes from the observation that milkmaids who had developed _ never got smallpox.

Historically this has been a _ vaccine. These vaccines have been 95% effective in preventing disease (historically) and are useful even if given 4 days after exposure.

Before 2001 – _

This vaccine is grown on calf skin and contains _, _, _, and _.

It is a _ vaccinia virus so there is a risk of dissemination in someone who is immunocompromised.

It can also lead to complications in people with _ and it can be spread to close contacts.

Current vaccine – _ 2000

This is similar to the previous vaccine but it has been modified to grow in _ cells and it does not contain any _.

There are still the same contraindications as the previous vaccine except for _. This is in the Strategic National Stockpile

Future vaccines

Vaccines that would be safe in _ and _ patients.

cowpox

live cowpox (vaccinia virus)

Dryvax

polymyxin B, streptomycin, tetracycline and neomycin

live, replicating vaccinia

atopic skin disease

ACAM

vero
antibiotics

antibiotic allergies. This is in the Strategic National Stockpile

immunosuppressed and atopic

44

Category A Agents:
Smallpox:

Vaccine Contraindications:

– _ (HIV; corticosteroid use or chemotherapy; organ transplant; leukemia or lymphoma)
– _ – e.g. eczema
– _

Normal, mild adverse reactions
• _ and _
• Swollen regional _
• Low grade _
• _, _, _
• _
• 1 out of 3 people may feel badly enough to miss work, school or recreational activities

Serious adverse reactions
• _ – spreading the vaccinia virus by sexual/skin contact
• _ – a widespread vaccinia rash after hematogenous dissemination
• _ reaction

Life-threatening adverse reactions
• Seen in 14-52/million vaccinations
• Mortality 1-2/million vaccinations
• _ – widespread infection of the skin in people with skin conditions
• _ – progressive infection at the vaccination site with tissue destruction
• Post-vaccinia _

Treatment:

_ (antiviral)-no established efficacy
_

Vaccine Contraindications

– Immunodeficiency
– Chronic skin condition
– Pregnancy

Normal, mild adverse reactions
• Sore and red
• Swollen regional lymph nodes
• Low grade fever
• Fatigue, headache, muscle aches
• Itching
• 1 out of 3 people may feel badly enough to miss work, school or recreational activities

Serious adverse reactions
• Inadvertent inoculation – spreading the vaccinia virus by sexual/skin contact
• Generalized vaccinia – a widespread vaccinia rash after hematogenous dissemination
• Allergic reaction

Life-threatening adverse reactions
• Seen in 14-52/million vaccinations
• Mortality 1-2/million vaccinations
• Eczema vaccinatum – widespread infection of the skin in people with skin conditions
• Progressive vaccinia – progressive infection at the vaccination site with tissue destruction
• Post-vaccinia encephalitis

Treatment:

Cidofovir (antiviral)-no established efficacy
ST-246

45

Category A Agents:
Viral Hemorrhagic Fevers

Diverse viruses from different families that cause _ manifestations

o Filoviridae: Ebola, Marburg
o Arenaviridae: Lassa Fever, Machupo

• (DNA / RNA) viruses causing _ and generalized _ damage

• In animals - may be spread by _, _, _, _, _, and _

• Human infections - contact with _ and _
o exposure to reservoir: _ - _ viruses

high lethality hemorrhagic

o Filoviridae
o Arenaviridae

• RNA viruses causing high fevers and generalized vascular damage

• In animals - may be spread by aerosol, urine, feces, fomites (objects), saliva and ocular exposure

• Human infections - contact with blood and body fluids
o exposure to reservoir: rodents-arenaviruses

46

Category A Agents:
Viral Hemorrhagic Fevers:
Clinical manifestations

• _, _, _, _

• Contagious: _, _, _; some are vector borne (e.g. Crimean Congo Hemorrhagic Fever)

• Generally no treatment (supportive) EXCEPT

a. _ respond to _ (IV form not FDA approved)

• Outbreaks controlled with _ and the use of protective clothing; in the US setting, patients to be placed in negative isolation room with _ precautions.

• Fever, severe illness, petechiae, unexplained bleeding

• Ebola, Marburg, Lassa

a. Arenaviruses respond to ribavirin

• barrier-nursing protocols, airborne

47

Category A Agents:
Botulism

Botulism is a toxin-mediated disease caused by _, a gram (positive / negative) _ forming _.

There are several forms of botulism that occur, but in a bioterrorism situation the presumed route of exposure would be _.

Botulism is (contagious / not contagious) and (does / does not) require isolation of patients.

Inhalational exposure would most closely mimic _ botulism.

Toxin Characteristics

The toxin of botulism is an (endotoxin / exotoxin) that is secreted by the bacteria.

The toxin targets the nerve synapse preventing the release of _ (neurotransmission)

Clostdium botulinum
gram positive spore
anaerobic bacillus

inhalational

not contagious
does not

gastrointestinal

exotoxin

acetylcholine

48

Category A Agents:
Botulism

Clinical Features

Botulism causes a _ that is characterized by cranial nerve dysfunction without sensory symptoms.

There is no _, _, or _.

Diagnosis

The diagnosis of botulism is made _, but culture, PCR, antibody testing, and assays in mice can be used for confirmation.

Treatment

The treatment includes both _, which can include prolonged mechanical ventilation, as well as administration of an _ obtained from the CDC. (FDA approved).

bilateral symmetric descending acute paralysis

fever, tachycardia, or mental status changes

clinically

supportive care

heptavalent anti-toxin

49

Anthrax

1) Microbiology
2) Vector
3) Virulence Factors
4) Treatment
5) Vaccine
6) Clinical Features
7) Other

1) Gram positive, spore-forming bacilli
2) Livestock
3) Capsule, Edema toxin, Lethal toxin
4) Penicillin, Ciprofloxacin, Doxycycline, Raxibacumab
5) 5 doses + yearly booster
6) Cutaneous, GI, Inhalational
7) Amerithrax 2001 attacks

50

Tularemia

1) Microbiology
2) Vector
4) Treatment
5) Vaccine
6) Clinical Features
7) Other

1) Gram negative cocco-bacillus
2) Rabbits, Ticks, Flies
4) Streptomycin
5) N/A
6) Ulceroglandular, Pneumonic, Oculoglandular, Typhoidal, Glandular
7) Martha’s Vineyard

51

Plague

1) Microbiology
2) Vector
3) Virulence Factors
4) Treatment
5) Vaccine
6) Clinical Features
7) Other

1) Gram negative bacillus
2) Rodents, Fleas
3) LPS, Type III secretion system, Plasminogen activator
4) Streptomycin
5) N/A
6) Bubonic, Pneumonic, Septicemic
7) SW US

52

Smallpox

1) Microbiology
2) Vector
4) Treatment
5) Vaccine
6) Clinical Features

1) Orthopox virus
2) Eradicated
4) cidofovir?
5) +++
6) Centrifungal rash, Lesions of same age, Contagious after rash appears

53

Viral Hemorrhagic Fevers

1) Microbiology
2) Vector
4) Treatment
5) Vaccine
6) Clinical Features
7) Other

1) RNA viruses
2) Rodents for arena viruses
4) None
5) None in US
6) Bleeding, shock
7) Africa