* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Biological Warfare Agents
Anthrax vaccine adsorbed wikipedia , lookup
Plague (disease) wikipedia , lookup
Brucellosis wikipedia , lookup
Meningococcal disease wikipedia , lookup
Herpes simplex virus wikipedia , lookup
Henipavirus wikipedia , lookup
Neglected tropical diseases wikipedia , lookup
Yellow fever wikipedia , lookup
Chagas disease wikipedia , lookup
Ebola virus disease wikipedia , lookup
Hepatitis B wikipedia , lookup
Biological warfare wikipedia , lookup
West Nile fever wikipedia , lookup
Typhoid fever wikipedia , lookup
African trypanosomiasis wikipedia , lookup
Onchocerciasis wikipedia , lookup
Eradication of infectious diseases wikipedia , lookup
Schistosomiasis wikipedia , lookup
Orthohantavirus wikipedia , lookup
Visceral leishmaniasis wikipedia , lookup
Middle East respiratory syndrome wikipedia , lookup
Yellow fever in Buenos Aires wikipedia , lookup
Rocky Mountain spotted fever wikipedia , lookup
Marburg virus disease wikipedia , lookup
Leishmaniasis wikipedia , lookup
Multiple sclerosis wikipedia , lookup
History of biological warfare wikipedia , lookup
Steven Hatfill wikipedia , lookup
Lymphocytic choriomeningitis wikipedia , lookup
Coccidioidomycosis wikipedia , lookup
Leptospirosis wikipedia , lookup
Biological Warfare Agents Categories Cat A: high risk; readily disseminated, high mortality, require public health preparedness Smallpox – 30% mortality, no antiviral therapy, stable virus in aerosol form, small dose needed, aerosol/direct contact, infectious during incubation period, no current vaccination herd immunity Anthrax, botulism, plague, tularemia, viral haemorrhagic fevers, adenaviruses Cat B: mod risk; mod disseminated, mod morbidity, low mortality, require diagnostic surveillance; foodbourne/waterbourne normally Brucellosis, C. perfringens, Salmonella, E coli, shigella, glanders, meliodiosis, psittacosis, Q fever, staph enterotoxin B, typhus fever, viral encephalitis, cholera Cat C: potential pathogens (eg. Nipah virus) Incr no pt (exponentially); unusual disease presentation; unresponsive to standard trt Recognition of attack Anthrax Plague Smallpox Tularemia Botulism Viral haemorrhagic fevers Bacillus anthracis: Spore-forming; rod-shaped; G+ive; extracellular; aerobic; Contact with farm and wild animals usually; spores ground into powder for biological warfare; lethal toxin and oedema toxin cause symptoms and death; no person-person transmission Cutaneous anthrax: 95% of naturally occuring infections; painless pruritic papule ulcer --> vesicle within 2 days --> enlarges, with surrounding erythema and lympadenopathy --> vesicle ruptures --> ulcer covered with painless depressed black eschar 1-3cm diameter which dries and falls off in 1-2/52; lymphangitis; bacteraemia rare; mortality rate 20% without ABx Inhalational anthrax (wool sorter’s disease): inhaled alveolar spaces macrophages mediastinal LN --> spores germinate and release toxins Stage 1: 1-6/7 prodromal illness – fever, cough, flu-like illness but no runny nose Stage 2: --> abrupt onset worsened fever, hypoxia, sweating; SOB (80%); CP (65%) --> haemorrhagic mediastinitis, oedema, necrosis, focal haemorrhagic necrotising lesions, pleural effusions, stridor, resp failure, cyanosis, bacteriaemia --> haemorrhagic meningitis in 50%; shock and death in hrs-days GI anthrax: eating undercooked meat; nausea, abdo pain, vomiting --> severe, bloody diarrhoea; acute abdo; mortality >50% Investigation: widened mediasinum (70%), pleural effusions (80%), lesions in MZ; CT scan; pleural aspirate; blood culture; ELISA; blood gases, U+E (hypoCa, hyperK), BSL, FBC; culture skin lesions, stool culture Mng: immediate notification of public health; standard barrier isolation, no need for air filter masks; no direct contact with skin lesions; surface decontamination with bleach and water; urgent Abx; assume resistance to penicillin and tetracycline if terrorist attack; use cipro 400mg IV BD + rifampicin / vanc / penicillin / imipenem / clindamycin; trt for 60/7 Yersinia pestis: Facultative intracellular; Fleabites (blocks gut of flea, flea vomits before feeding); aerosol; Toxins; Proliferate in lymphoid tissue --> kill host phagocytes Bubonic plague: infected fleabite on legs, with small pustule/ulceration --> large tender LN's (buboes) in few days, soft and plum coloured --> infarct / rupture through skin; rapid onset fever, shock, MOF, death Septicaemic plague: all LN's big; GI symptoms, DIC and widespread haemorrhage and thrombi, MOF, rapid death Pneumonic plague: most likely manifestation of bioterrorism; most rapidly progressive and fatal; incubation 1-6/7; watery, mucoid, frothy, bloody sputum, Sx of pneumonia +/- GI symptoms Investigation: microscopy of blood / sputum / CSF / buboe G-ive bacilli; pneumonia on CXR Mng: resp isolation; Abx ASAP = streptomycin / gent best; also doxy / cipro DNA virus: only infectious disease to have been eradicated; spread would be fast by droplet/aerosol Sx: 90% have classical presentation; incubation 7-17/7; infective once maculopapular rash develops (MM, face, forearms, trunk, legs; spares palms and soles) vesicular and pustular in 1-2/7 (all at same stage of development, unlike varicella) high fever and toxaemia, malaise, headache, backache, AP, delirium on D3-8 infectivity wanes as scabs develop (D8-9) scarring; 30% mortality from variola major, 1% from minor; multiplies in spleen, BM, LN; death in 30%, in wk 2 10% atypical: haemorrhagic (more severe; fatal; dusky erythema, petechiae, frank haemorrhage in skin and MM); malginant (similar to haemorrhagic, but slower), minor (milder) Investigation: swab lesions for microscopy Mng: international health emergency; isolate all face-to-face contacts; standard disinfectants work; cremate if die; supportive trt only; can vaccinate within 4/7 exposure (post vaccine encephalitits in 1:300,000, 25% fatal/severe morbidity; post-vaccine gangrene (often fatal); smallpox disease) Francisella tularensis: aerobic, G-ive coccobacillus; highly infective +++; animal hosts human infected by bites, faeces, soil, water; no humanhuman transmission; causes granulomatous necrotic lesions; results in ulceroglandular disease (papulepustuleulcer, eschar), oculoglandular, oropharyngeal (exudative tonsillitis), pneumonia (mortality 30-60%), sepsis (potentially severe and fatal), meningitis; typhoidal tularemia lacks these cutaneous / MM lesions (and may have prominent GI Sx, pulse / T differentiation); mortality 5-15% for type A; overall mortality 2% Mng: streptomycin, gentamicin; if mass involvement, doxycycline / cipro Clostridium botulinum: from soil into food (home canned food, foiled wrapped potatoes, garlic in oil, yoghurt, cream cheese, infant formula, cream cheese) / wound toxin absorbed; major potential in bioterrorism, inhaled; most poisonous substance known to man; no human-human spread; toxin in blood peri cholinergic synapses and NMJ blocks Ach action acute, afebrile, symmetrical, descending flaccid paralysis always beginning in bulbar muscles, multiple CN palsies, vision/speech/swallowing, probs, constipation, ptosis, large, sluggish pupils; normal LOC, no sensory changes, arreflexia; usually 12-72hrs after ingestion, ?72hrs INH Investigation: clinical diagnosis; EMG DD: GBS, MFS, MG, CNS disease Trt: supportive care; antitoxin will decr subsequent nerve damage, but doesn’t reverse existing paralysis See febrile traveller fact sheet Notes from: Dunn