BIOTERRORISM

1. BIOTERRORISM 2011

2. Anthrax A disease caused by Bacillus Anthracis. This disease is characterized by spores. Aerobic, gram positive- spore producing Comes for the Greek word “anthrakis” or coal ( lesions turn black in color) Animals and animal products are the primary source for naturally occurring anthrax.

3. Anthrax Category A Organisms that pose the greatest threats to national security due to the ease of transmission high death rate or serious illness potential for causing public panic special public health measures an epidemic would enquire

4. Ways anthrax can be spread • Anthrax is not know to spread from person to person, however it can be spread from animal to person by eating the meat of infected animals or breathing in the spores of the infected animals. • Anthrax can also be used as a biological weapon, usually inhalant.

5. 4 ways to contract Anthrax • Skin (cutaneous) • Lungs (inhalants) • Digestive (gastrointestinal) • Oropharyngeal

6. Incubation periods • Cutaneous- response usually immediate but can take up to 1-7 days up to 12 • Inhalation-response less than 1 week but can take up to 2 months • Gastrointestinal- 1-7 days for response • Oropharyngeal – 1-7 days

7. Cutaneous symptoms • This usually begins with a small spore that soon turns into a blister. The blister becomes an ulcer with eschar in the center. • These are usually not painful.

8. Cutaneous assessment findings • A culture should be done PRIOR to starting antibiotic treatments • Extended spectrum cephalosporins should NOT be used because anthrax may be resistant to these • Standard precautions should be observed • Case fatality without antibiotics 70% with antibiotics 1%

9. Gastrointestinal symptoms • Nausea • Lack of appetite • Bloody diarrhea • Fever • Stomach pain • Bloody vomiting • Signs of septicemia

10. Gastrointestinal assessment findings • Acute abdominal pain with rebound tenderness • Mediastinal widening on Chest x-ray • Hematemesis or bloody diarrhea may develop • Standard precautions should be observed • Gram positive bacilli in blood culture 2-3 days following onset

11. Inhalant symptoms • Cold and flu like symptoms • Sore throat • Fever • Muscle aches • Cough • Shortness of breath • Lethargy • Case fatality without antibiotics 97% and with antibiotics 75%

12. Symptoms • Appear within 7 days but in some cases of inhalation, symptoms can take up to 2 monthsto appear

13. Inhalant assessment findings • Prodromal period with “viral” like illness – malaise , fatigue, fever with or without respiratory symptoms followed by hypoxia, and dyspnea • Rhonchi on auscultation-initial phase • Chest x-ray with mediastinal widening and pleural effusion-initial phase • High fever –subsequent phase • Shock or death within 24-36 hours- subsequent phase

14. Oropharyngeal symptoms • Throat pain • Dysphagia • Swelling (enough to close airway)

15. Oropharyngeal assessment findings • Throat may be red • Throat may be swollen unilateral or bilateral • Ulcers at the base of the tongue

16. Treatment • Cutaneous- antibiotics-this form is usually not fatal • Gastrointestinal- one fourth to one half of the people infected die • Inhalant- one half of the people infected die • There is a vaccination for anthrax but it is not yet available to the public

17. Antibiotics for treatment after infection • A 60 day course of antibiotics is usually recommended • These are usually started as soon as possible

18. Antibiotics for treatment after exposure • Ciprofloxacin • levofloxacin • doxycycline • penicillin • These are combined with the anthrax vaccine to prevent anthrax infection.

19. Plague

20. Plague • The bacteria that causes the plague is Yersina pestis • The plague is transmitted by fleas that are infected with the bacteria • The infected fleas feed on rodents, such as the chipmunks, prairie dogs, ground squirrels, mice, and other mammals.

21. Plague • The transmission cycle of the plague is completed when the bacteria, that is maintained in the blood systems of the rodents, is transferred to humans by the bite of a flea that has fed off of a contaminated animal. • The incubation time of the plague is two to six days. The p/t will show s/s of infection after this time.

22. Plague • Pneumonic plague • occurs when y. pestis infects they lungs • Can spread form person to person through the air • May also occur if a person with bubonic or septicemic plague is untreated and the bacteria spread to the lungs • Fever, headache, weakness, rapidly developing pneumonia with SOB, chest pain, cough, bloody or watery sputum

23. Plague • Bubonic Plague • most common form of plague • Occurs when an infected flea bites a person or when material contaminated with Y. pestis enter through a break in a person’s skin • Swollen , tender lymph glands ( buboes) and fever, headache, chills and weakness • Does not spread form person to person

24. Plague • Septicemic plague • occurs hen plague bacteria multiply in the blood • Can be a complication of pneumonic or bubonic plague or can occur by itself • Fever, chills abdominal pain, shock and bleeding into skin and organs • Does not spread form person to person

25. The Plague Treatment is as follows: • Hospitalization and isolation • Lab tests and blood cultures for plague bacteria • Microscopic examination of lymph gland, blood, and sputum samples. • Antibiotic treatment should begin as soon as possible and streptomycin is the antibiotic of choice. • Gentamicin when streptomycin is not available or tetracyclines and chloramphenicol.

26. The Plague • Persons who have been in close contact with a plague patient, should be identified and evaluated. • The U.S. Public Health Service requires that all cases of suspected plague be reported immediately to local and state health departments. • The diagnosis be confirmed by CDC and it is required by the International Health Regulations, CDC reports all U.S. plague cases to the World Health Organization.

27. The Plague Risk factors: • Areas where housing and sanitation conditions are poor. • Areas associated with infected rats and rat fleas that live in the home

28. ThePlague This type effects the lymph nodes This type effects the lungs This type effects the blood All types are treated with various antibiotics and can be life threatening if left untreated.

29. Smallpox • Smallpox comes from the variola virus which emerged in human populations thousands of years ago. • Latin word for “spotted” • Two clinical forms of smallpox • 4 types of variola major • DNA virus and a member of the genus orthopoxvirus which also includes monkeypox, vaccinia, and cowpox • The variola virus has been eliminated, except for laboratory stockpile. (Two repositories of smallpox virus exist CDC and Russia) • Serious , contagious and sometimes fatal infectious disease

30. Smallpox • Smallpox is spread from one person to another via direct and fairly prolongedface-to-face contact. • Can be spread through direct contact with infected bodily fluids or contaminated objects • Rarely by the air in enclosed settings • A person is sometimes contagious with onset of fever, but the person becomes most contagious with the onset of a rash • At this stage the infected person is usually very sick and not able to move around in the community • The infected person is contagious until the last smallpox scab falls off.

31. Smallpox • The incubation period averages about 12 to 14 days but can range from 7 to 17 days • During this time people are not contagious • The first symptoms of smallpox (prodromal period 2-4 days) • High fever • Head and body aches • Sometimes vomiting • Too sick to carry on normal activities • Rash emerges first as small red spots on the tongue and in the mouth • Develop into sores that break open and spread large amounts of the virus into the mouth and throat ( most contagious) • Around the time the sores in the mouth break down, a rash appears on the skin, starting on the face and spreading to the arms and legs and then to the hands and feet. • Usually the rash spreads to all parts of the body within 24 hours. • As rash appears the fever usually falls and the person may start to feel better

32. Small pox • By the third day of the rash, the rash becomes raised bumps • 4th day bumps fill with thick opaque fluid and may have a depression in the center ( major distinguishing characteristic of smallpox) • Fever may rise again and remain high until scabs from • Pustules forms and scab • By the end of the second week most of the sores have scabbed over • Scabs begin to fall off, leaving marks on the skin that become pitted scars • Most scabs fall off after 3 weeks after the rash • The person is contagious to others until all of the scabs have fallen off.

33. Smallpox • Smallpox vaccine • No proven treatment • Cidofovir may fight against smallpox virus • Supportive therapy • IV fluids • Drugs for fever and pain • Antibiotics to treat secondary bacterial infections

34. Botulism

35. Botulism • Botulism's neurotoxin is one of the most potent, lethal substances known. • As little as about one nanogram/kg can be lethal to an individual, and scientists have estimated that about one gram could potentially kill one million people. • Botulism is a disease caused by this neurotoxin (or specifically A, B, E, or F type neurotoxin). • The neurotoxin is produced by bacteria called Clostridium botulinum. • The neurotoxin paralyzes muscles and can be deadly. • After several weeks, the paralysis slowly improves as axons in the nerves are regenerated. • If frequently misdiagnosed and mistaken for GuillianBarre syndrome, or myasthenia gravis or a disease of the central nervous system • Clostridium botulinum bacterium that forms spores • Its natural habitat is soil

36. Botulism There are three major types of botulism that differ in how they are acquired: food-borne, infant and wound botulism.

37. Botulism • Food-borne botulism is usually caused by eating contaminated home-canned foods. • Physicians may remove whatever contaminated food is still in the gut by using enemas or by inducing vomiting. • Food-borne botulism symptoms generally begin 12 to 36 hours after eating a contaminated food, but they can occur as early as six hours or as late as 2 weeks afterward. • Never taste-test food that may have gone bad. • Does not spread from person to person

38. Botulism • In infant botulism, the baby consumes spores of the bacteria which then grow in the baby's intestine and release the neurotoxin. • Honey can contain spores of the bacteria and should not be fed to babies less than 1 year of age.

39. Botulism • Wound botulism is due to Clostridium bacteria infecting a wound and releasing the neurotoxin. • Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria

40. Botulism • Early food-borne and wound botulism can be treated with an antitoxin to block the action of the neurotoxin. • Botulism neurotoxin is listed as a potential biological weapon. • Botulism neurotoxin is used in dilute concentration to treat medical and cosmetic conditions.

41. Signs and Symptoms • drooping eyelids • double vision • blurred vision • dry mouth • difficulty swallowing • slurred speech • muscle weakness • The doctor's examination may reveal that the gag reflex and the deep tendon reflexes are decreased or absent.

42. Surviving botulism poisoning may experience • shortness of breath • fatigue for years • long-term therapy may be needed to aid recovery.

43. In infants with botulism appear • lethargic • feed poorly • weak, and floppy • have a weak cry • become constipated • have poor muscle tone • If left untreated, these symptoms may progress to cause paralysis in various parts of the body, often seen as a descending paralysis of the breathing muscles, arms, legs, and trunk.

44. Conformation Confirm the diagnosis by identifying the botulinum neurotoxin in the patient's • blood • serum • Stool

45. Complications • Paralysis and respiratory failure that occur with severe botulism may require a patient to be on a ventilator for weeks • May require intensive medical and nursing care. • Botulism can result in death from respiratory failure

46. Tularemia

47. Tularemia • What is tularemia? Tularemia, also known as “rabbit fever,” is a disease caused by the bacterium Francisellatularensis( gram negative coccobacillus). Tularemia is typically found in animals, especially rodents, rabbits, and hares. Tularemia is usually a rural disease and has been reported in all U.S. states except Hawaii. • How do people become infected with tularemia? Typically, people become infected through the bite of infected insects (most commonly, ticks and deerflies), by handling infected sick or dead animals, by eating or drinking contaminated food or water, or by inhaling airborne bacteria.

48. Tularemia • . What are the signs and symptoms of tularemia? The signs and symptoms people develop depend on how they are exposed to tularemia. Possible symptoms include skin ulcers, swollen and painful lymph glands, inflamed eyes, sore throat, mouth sores, diarrhea or pneumonia. If the bacteria are inhaled, symptoms can include abrupt onset of fever, chills, headache, muscle aches, joint pain, dry cough, and progressive weakness. People with pneumonia can develop chest pain, difficulty breathing, bloody sputum, and respiratory failure. Tularemia can be fatal if the person is not treated with appropriate antibiotics. • The incubation period lasts from 3 to 5 days but can range up to 10 to 14 days.

49. Tularemia • What should someone do if he or she suspects exposure to tularemia bacteria?If you suspect you were exposed to tularemia bacteria, see a doctor quickly. • Treatment with antibiotics( streptomycin is the drug of choice) for a period of 10-14 days or more after exposure may be recommended. If you are given antibiotics, it is important to take them according to the instructions you receive. All of the medication you are given must be taken. • Local and state health departments should be notified immediately so an investigation and infection control activities can begin.

50. Tularemia • How is tularemia diagnosed?When a person has symptoms that appear related to tularemia, the healthcare worker collects specimens, such as blood or sputum, for testing in a diagnostic or reference laboratory. Laboratory test results for tularemia may be presumptive or confirmatory. Presumptive (preliminary) identification may take less than 2 hours, but confirmatory testing will take more time, often 24 to 48 hours or longer depending on the methods that need to be used. • Depending on the circumstances, a person may be given treatment based on symptoms before the laboratory results are returned.