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BIOLOGICAL AGENTS
 CDC has prioritized them in Lists A - C
 A List:
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

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Easily transmitted/disseminated
High mortality rate
Potential for public panic
Public Health impact requiring
preparedness
“A” LIST
 Smallpox*
 Anthrax*
 Plague
 Botulism toxin
 Tularemia
 Viral Hemorrhagic Fevers*
 *person to person transmission possible
Anthrax: Overview
 Primarily disease of animals
who ingest anthrax spores
from soil, (spores can last in
soil for decades)
 Natural transmission to
humans by contact with
infected animals or
contaminated animal products
 Cutaneous form most
common form of anthrax
(usually occupational); 224
cases in U.S. between 1944 –
1994
CDC: Gram stain of B. anthracis
Anthrax: Cutaneous
Inoculation of spores under skin
through cut/abrasion
 Incubation: hours to 7 days
(average 5 days)
 Small bump (3 – 5 days) 
ulcer surrounded by blisters
24-28h later
 Toxin production leads to local
edema
 Painless black scab over ulcer
 Painful , swollen lymph nodes
USAMRIID: Eschar with surrounding
possible
edema
 Death 20% untreated; rare
treated
Anthrax: Inhalational
 Inhalation of spores, which
then grow into bacteria
 Incubation: 1 to 43 days
 Initial symptoms (2-5 d)
 fever, cough, myalgia, malaise
 Terminal symptoms (1-2d )
 high fever, shortness of breath
 Most of signs occur in lungs:
swollen lymph nodes and fluid
accumulation
 rapid progression to shock / death
because toxins released by the
anthrax bacteria
 Mortality rate ~100% despite
aggressive Rx
CDC: CXR with widened mediastinum
of inhalational anthrax
Anthrax:
Post-exposure Treatment
 Ciprofloxacin or Doxycycline
Antibiotics for 60 days without
vaccine
 Antibiotics for 30 days with 3 doses of
vaccine (animal studies)
Antibiotic Adverse Effects
 Cipro: Nausea, vomiting, abdominal pain,
dizziness, headache, restlessness, confusion
 Doxy: GI disturbances, diarrhea, teeth staining
in children < 6 y/o
 Compliance?
 Between 25 – 75% of Washington D.C. postal
workers in 2001 did not complete course because
of side effects of antibiotics
Anthrax: Vaccine
 FDA approved for persons 18-65 years of age
 Not entirely sure how fully it protects against
inhalational anthrax
 Six shots over 18 months
 3 shots (0, 2, and 4 weeks ) may be effective for
post-exposure treatment
Plague: Overview
 Bacterial disease found in
certain animals:
 rats, squirrels, chipmunks,
rabbits, and carnivores
 Usual infection through
contact with rodents/fleas that
have bitten animals carrying
plague
 About 10-15 cases / year in
U.S.
 mainly SW states
 bubonic most common form
 only 1-2 cases / yr. of
pneumonic form
CDC: Wayson’s Stain of Y. pestis showing
bipolar staining
Plague: Bubonic
 Incubation: 2-6 days
 Sudden onset headache,
fatigue, muscle aches,
fever, tender lymph nodes
 Lymph nodes in area of
flea bite will swell
(Buboes)
 Not contagious
USAMRIID: Inguinal/femoral
buboes
Plague: Pneumonic
 Incubation: 1-3 days
 Sudden onset
headache, fatigue,
fever, muscle aches,
cough
 Pneumonia progresses
rapidly to shortness of
breath, patient coughs
up blood
 Death from respiratory
collapse and spread of
infection to blood
 Can be contagious
USAMRIID: Pneumonic infiltrate
of pneumonic plague
Plague: Prophylaxis
 Bubonic contacts
 Consider Doxycycline, Tetracycline, or sulfa drug for 7
days
 other close contacts, fever watch for 7 days (treat if
febrile)
 Pneumonic contacts
 consider Doxycycline, Tetracycline, orulfa drug for 7
days
 Vaccine no longer manufactured in U.S.
 not protective against pneumonic plague
Tularemia: Overview
 Acquired through contact with blood/tissue of
infected animals, or bites of infected deerflies,
mosquitoes, or ticks
 About 200 cases/year in U.S.
 most in rural South central and Western states
 majority of cases in summer (tick exposure)
 No person-to-person transmission
Tularemia: Clinical Forms
 Many different types of infections in lymph nodes, can
also occur in eyes
 Pneumonia
 Possible presentation for bioterrorist attackBT
Tularemia: Pneumonic
 Incubation: 3 to 5 days
(range 1-21 days)
 Abrupt onset fever, chills,
headaches, muscle aches,
non-productive cough
 Patchy pneumonia on chest
x-ray
 Mortality 30% if untreated;
< 10% if treated with
antibiotics
USAMRICD: Pneumonic infiltrates of
pneumonic tularemia
Tularemia:
Treatment/Prophylaxis
 Treatment
 Streptomycin or Gentamicin
 Tetracyclines
 Post Exposure Prophylaxis
 Fever watch for 7 days (preferable)
 Doxycycline or Tetracycline for 14 days if
febrile (Cipro also possible)
 Vaccine investigational
 Not available for general use
 Role in treatment of disease or postexposure prophylaxis unknown