overview of chemical and biological weapons/terrorism tucker greene, md, faaem, acmt cape coral, fl
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Overview of Chemical and Overview of Chemical and Biological Weapons/TerrorismBiological Weapons/Terrorism
Tucker Greene, MD, FAAEM, ACMTTucker Greene, MD, FAAEM, ACMT
Cape Coral, FLCape Coral, FL
IntroductionIntroduction
Long History of humans using both agentsLong History of humans using both agents PrecedentsPrecedents
– AncientAncient» Middle Ages - Anthrax contaminated livestockMiddle Ages - Anthrax contaminated livestock
– RecentRecent» Southeast Asia – TricothecenesSoutheast Asia – Tricothecenes
» Iran/Iraq – SarinIran/Iraq – Sarin
» Arum Shryinko – Tokyo subway attackArum Shryinko – Tokyo subway attack
IntroductionIntroduction
Agent ProgressionAgent Progression– ChemicalChemical
» Industrial process Industrial process
– BiologicalBiological» Agents, offspringAgents, offspring
» toxinstoxins
Different Results than predicted for bothDifferent Results than predicted for both
IntroductionIntroduction
Persistent v. Non-Persistent Biological:Persistent v. Non-Persistent Biological:– Persistent: AnthraxPersistent: Anthrax– Non-Persistent: VirusesNon-Persistent: Viruses
Persistent v. Non-PersistentPersistent v. Non-Persistent– Persistent: Mustard, VXPersistent: Mustard, VX– Non Persistent: Phosgene, CNNon Persistent: Phosgene, CN
IntroductionIntroduction
Stability or InfectivityStability or Infectivity– Anthrax Spores: stable, reasonably infective, Anthrax Spores: stable, reasonably infective,
lethal?lethal?– Tularemia, Q-Fever, Brucellosis: unstable, very Tularemia, Q-Fever, Brucellosis: unstable, very
infective, non-lethalinfective, non-lethal
IntroductionIntroduction
Biological AgentsBiological Agents– Mimic other natural diseasesMimic other natural diseases– Usually incapacitatingUsually incapacitating
Chemical AgentsChemical Agents– Exaggerate or Isolate a particular clinical Exaggerate or Isolate a particular clinical
feature of chemical agents in generalfeature of chemical agents in general– I.e organophosphates and nerve agentsI.e organophosphates and nerve agents
KEY: Mechanism of IntoxicationKEY: Mechanism of Intoxication– Dermal, Inhalation, IngestionDermal, Inhalation, Ingestion
(brief) History(brief) History
DefinitionsDefinitions– Kill: Soman, VXKill: Soman, VX– Injure: PhosgeneInjure: Phosgene– Incapacitate: CS, BZIncapacitate: CS, BZ
CountermeasuresCountermeasures– Until WWI, US not concerned or interestedUntil WWI, US not concerned or interested
(brief) History(brief) History
Pre-WWI DevelopmentsPre-WWI Developments Ancient: hellebore, mandrake in water Ancient: hellebore, mandrake in water
1000-200 b.c1000-200 b.c Recent:Recent:
– 1700-1850: Chlorine, Mustard 1700-1850: Chlorine, Mustard (dichloroehtylsulfide), chloropicrin(dichloroehtylsulfide), chloropicrin
– Civil War: Dougherty: Chlorine, 3 qts in shellCivil War: Dougherty: Chlorine, 3 qts in shell
(brief) History(brief) History
Biological:Biological:– Mongols in Caffa 1346, bubonic plague bodiesMongols in Caffa 1346, bubonic plague bodies– Spanish v French 1495, Leprosy Blood in Spanish v French 1495, Leprosy Blood in
Naples against FrenchNaples against French
Protection, ControlProtection, Control
US Civil War: agreed but not adhered toUS Civil War: agreed but not adhered to Hoffman Respirator in 1866Hoffman Respirator in 1866 Archduke Francis murder in 1914, control Archduke Francis murder in 1914, control
among WWI participantsamong WWI participants
Protection, ControlProtection, Control
WWI ChemicalWWI Chemical– German Wilhelm: Gas cloud due to lack of German Wilhelm: Gas cloud due to lack of
shellsshells– Allies: Chlorine responseAllies: Chlorine response
Biological:Biological:– Both sides attempting to use anthrax and Both sides attempting to use anthrax and
glandersglanders
US Chemical Warfare Service US Chemical Warfare Service (CWS) and New Age(CWS) and New Age
Chemical Agents placed in Artillery ShellsChemical Agents placed in Artillery Shells– Cl2, Choropicrin, Mustard, PhosgeneCl2, Choropicrin, Mustard, Phosgene
Biological AgentsBiological Agents– RicinRicin– BrucellosisBrucellosis
US Chemical Warfare Service US Chemical Warfare Service (CWS) and New Age(CWS) and New Age
Detection, Alarms, TreatmentDetection, Alarms, Treatment– Human and AnimalHuman and Animal– TreatmentTreatment
» InhalationInhalation VomitingVomiting VenesectionVenesection KIKI Steam TentsSteam Tents
» Skin: ZnO, Starch, Boric Acid, CalamineSkin: ZnO, Starch, Boric Acid, Calamine
US Chemical Warfare Service US Chemical Warfare Service (CWS) and New Age(CWS) and New Age
Biologicals get new start in late 1930s after Biologicals get new start in late 1930s after skepticismskepticism
Nuclear Age comes and biologicals take a Nuclear Age comes and biologicals take a back seat (where someone was sitting)back seat (where someone was sitting)
Chemical Warfare takes second PriorityChemical Warfare takes second Priority– Edgewood (Aberdeen), MDEdgewood (Aberdeen), MD– McClellan, ALMcClellan, AL– Rocky Mountain, CORocky Mountain, CO
US Chemical Warfare Service US Chemical Warfare Service (CWS) and New Age(CWS) and New Age
Near ending of CWS:Near ending of CWS:– Binary weaponsBinary weapons– Disposal at SeaDisposal at Sea– Disseminated Danger of Disseminated Danger of lesser nations?lesser nations?– Johnston Atoll Destruction programJohnston Atoll Destruction program
US Chemical Warfare Service US Chemical Warfare Service (CWS) and New Age(CWS) and New Age
Gulf WarGulf War– Iraq with known biological and chemical Iraq with known biological and chemical
weaponsweapons– MARK I KitMARK I Kit
» 2-PAM, atropine, valium2-PAM, atropine, valium
– Pryidostigmine BromidePryidostigmine Bromide– Kamisiyah arsenal detonationKamisiyah arsenal detonation
» MustardMustard» sarinsarin
US Chemical Warfare Service US Chemical Warfare Service (CWS) and New Age(CWS) and New Age
Aum Shinrikyo CultAum Shinrikyo Cult– Experiments with botulinum and anthrax in Experiments with botulinum and anthrax in
subways yields no impactsubways yields no impact– Later sarin attack kills 50 but injures 5000Later sarin attack kills 50 but injures 5000
DEFENSE (WWI)DEFENSE (WWI)
Mask against Chemical AgentsMask against Chemical Agents Plume identificationPlume identification Mobile DecontaminationMobile Decontamination
– 5% of Division strength5% of Division strength Psychological aspect of persistence: Psychological aspect of persistence:
mustard (low volatility, low dose effect, still mustard (low volatility, low dose effect, still used)used)– ““Gas Mania”Gas Mania”
DEFENSE (WWI)DEFENSE (WWI)
MustardMustard– ConjunctivitisConjunctivitis– Skin burnsSkin burns– Inhalation (worse than phosgene and chlorine)Inhalation (worse than phosgene and chlorine)– Accounted for up to 30% of casualties but 1500 Accounted for up to 30% of casualties but 1500
deaths/52,900 US AEF Force deathsdeaths/52,900 US AEF Force deaths
DEFENSE (WWII)DEFENSE (WWII)
Germans thought US possessed secret gases Germans thought US possessed secret gases beyond GA< GB< GD and feared reprisalbeyond GA< GB< GD and feared reprisal
Continued VigilanceContinued Vigilance– Walt Disney exampleWalt Disney example
OrganophoshatesOrganophoshates
HistoryHistory– Ethanol + Phosphoric AcidEthanol + Phosphoric Acid– Tabun - GATabun - GA– Sarin - GBSarin - GB– Soman- GDSoman- GD– VXVX
OrganophosphatesOrganophosphates
AbsorptionAbsorption– inhalationinhalation– dermaldermal– oraloral
ActivationActivation– ie parathionie parathion
MetabolismMetabolism– cholinesterasecholinesterase
Clinical EffectsClinical Effects–MuscarinicMuscarinic (postganglionic (postganglionic
parasympathetic)parasympathetic)» ““SLUDGE”SLUDGE”»miosis, bronchorrhea, bradycardiamiosis, bronchorrhea, bradycardia
–Nicotinic (neuromuscular junction)Nicotinic (neuromuscular junction)–Nicotinic (autonomic ganglionNicotinic (autonomic ganglion))
OrganophosphatesOrganophosphates
OrganophosphatesOrganophosphates
Management/TreatmentManagement/Treatment– DecontaminationDecontamination– StabilizationStabilization– AntidotesAntidotes»AtropineAtropine»PralidoximePralidoxime
Pralidoxime
OrganophosphatesOrganophosphates
Delayed ToxicityDelayed Toxicity
– Intermediate SyndromeIntermediate Syndrome
–Peripheral NeuropathyPeripheral Neuropathy»Tri -o-cresyl phosphate (TOCP)Tri -o-cresyl phosphate (TOCP)»Tri -o-cresyl {tolyl} phosphate TOTPTri -o-cresyl {tolyl} phosphate TOTP»Neurotoxic EsteraseNeurotoxic Esterase
OrganophosphatesOrganophosphates
Delayed ToxicityDelayed Toxicity
– Intermediate SyndromeIntermediate Syndrome
–Peripheral NeuropathyPeripheral Neuropathy»Tri -o-cresyl phosphate (TOCP)Tri -o-cresyl phosphate (TOCP)»Tri -o-cresyl {tolyl} phosphate TOTPTri -o-cresyl {tolyl} phosphate TOTP»Neurotoxic EsteraseNeurotoxic Esterase
OrganophosphatesOrganophosphates
LaboratoryLaboratory–Don’t Need To Treat!!!Don’t Need To Treat!!!
–Cholinesterase LevelsCholinesterase Levels»RBC v PlasmaRBC v Plasma»Variation from BaselineVariation from Baseline
PretreatmentPretreatment
Pyridostigmine (carbamate)Pyridostigmine (carbamate) Used in Gulf WarUsed in Gulf War
Inhalational AgentsInhalational Agents
Upper AirwayUpper Airway– Water solubleWater soluble
Middle AirwayMiddle Airway AlveolarAlveolar
– Non-soluble in waterNon-soluble in water Cellular AsphyxiantsCellular Asphyxiants
Inhalational AgentsInhalational Agents
Cyanide TreatmentCyanide Treatment– NitritesNitrites– ThiosulfateThiosulfate– HydroxycobalaminHydroxycobalamin– Hyperbaric O2Hyperbaric O2
Incapacitating AgentsIncapacitating Agents
AnticholinergicsAnticholinergics LSD, other IndolesLSD, other Indoles OpiatesOpiates
Riot Control AgentsRiot Control Agents
Rapid Onset, Upper Airway and GI Rapid Onset, Upper Airway and GI SymptomsSymptoms
CS (o-Chlorobenzylidene)CS (o-Chlorobenzylidene) CN (1-Chloroacetophenone)CN (1-Chloroacetophenone) OtherOther
– DM (Diphenylaminearsine)DM (Diphenylaminearsine)– CR (Dibenzo(b,f)-1:4oxazepineCR (Dibenzo(b,f)-1:4oxazepine– CA (Bromobenzylcyanide)CA (Bromobenzylcyanide)
Riot Control AgentsRiot Control Agents
CSCS– Solid, low VpSolid, low Vp
– ““Tear Gas”Tear Gas”
– Airway irritationAirway irritation
– Conjunctival tearingConjunctival tearing
– Dermal effects can Dermal effects can cause blisteringcause blistering
– IV/Oral can liberate IV/Oral can liberate cyanide moeitiescyanide moeities
CNCN– Solid powderSolid powder
– Same symptoms as CSSame symptoms as CS
– Highly sensitizing to Highly sensitizing to skin with deaths skin with deaths reported with large reported with large exposuresexposures
Riot Control AgentsRiot Control Agents
TreatmentTreatment– Alkaline decon of skin; no hypochloriteAlkaline decon of skin; no hypochlorite– Topical steroids for skinTopical steroids for skin– Local anesthetics for eyesLocal anesthetics for eyes
Field Management of Chemical Field Management of Chemical CasualtiesCasualties
Hot ZonesHot Zones Clean v Decontamination areasClean v Decontamination areas Counter-current or Reverse Airflow for Counter-current or Reverse Airflow for
Decontamination AreasDecontamination Areas TriageTriage
– Potential IDPotential ID– Look for Combined Agents/InjuriesLook for Combined Agents/Injuries– Difficult to Treat CombinationsDifficult to Treat Combinations
DecontaminationDecontamination
ChemicalChemical– Desirable Traits for Desirable Traits for
Dermal DeconDermal Decon
– Physical RemovalPhysical Removal
– AqueousAqueous
– AdsorbentAdsorbent
BiologicalBiological– Dermal not as Dermal not as
Important (T-2 is Important (T-2 is exception)exception)
– HypochloriteHypochlorite
– Environmental UVEnvironmental UV
HistoryHistory
Secret US Weapons ProgramSecret US Weapons Program Response to Japan during WWIIResponse to Japan during WWII
– Stockpiling 400 kg anthrax bombsStockpiling 400 kg anthrax bombs ExperimentsExperiments
– San Francisco (Serratia marcenscens)San Francisco (Serratia marcenscens)– New York Subway (B. subtilis)New York Subway (B. subtilis)– African Americans exposed to Aspergillus f.African Americans exposed to Aspergillus f.
Use of Biological WeaponsUse of Biological Weapons
RequirementsRequirements– Ease of ProductionEase of Production
– Lethality/IncapacitationLethality/Incapacitation
– Particle sizeParticle size
– Ease of DispersionEase of Dispersion
– StabilityStability
Methods of DeliveryMethods of Delivery– FoodFood
– WaterWater
– AirAir
Use of Biological WeaponsUse of Biological Weapons
Advantage/DisadvantageAdvantage/Disadvantage– Predominantly concerns Predominantly concerns
of the pathogen occurring of the pathogen occurring in aggressorsin aggressors
– PersistencePersistence
– Insidious, low cost, Insidious, low cost, minimal detectionminimal detection
Tactical ConcernsTactical Concerns– Hard to Trace or Hard to Trace or
FingerprintFingerprint
– Terrorism as we now Terrorism as we now have known the have known the anthrax casesanthrax cases
Biological AgentsBiological Agents
AnthraxAnthrax PlaguePlague TularemiaTularemia BrucellosisBrucellosis Q FeverQ Fever
SmallpoxSmallpox Viral EncephalitidesViral Encephalitides Viral Hemorrhagic Viral Hemorrhagic
FeversFevers ToxinsToxins
– PlantsPlants
– AnimalsAnimals
– MycotoxinsMycotoxins
AnthraxAnthrax
HistoryHistory– Bacillus anthracisBacillus anthracis
– Zoonotic:goats sheep, Zoonotic:goats sheep, cattle, swine, horsescattle, swine, horses
– 55thth and 6 and 6thth plagues of plagues of ExodusExodus
– Isolated 1876: KochIsolated 1876: Koch
– Vaccine 1881: Pasteur Vaccine 1881: Pasteur
OrganismOrganism– 1-5 mic x 5-10 mic1-5 mic x 5-10 mic
– Capsule forms in Capsule forms in presence of CO2, presence of CO2, HCO3HCO3
– Sporulation occurs in Sporulation occurs in dead tissue exposed to dead tissue exposed to oxygenoxygen
AnthraxAnthrax
EpidemiologyEpidemiology– 1958: 20-100,000 1958: 20-100,000
cases worldwidecases worldwide
– Since 1970 one Since 1970 one case/decadecase/decade
– Woolsorter’s DiseaseWoolsorter’s Disease
PathogenesisPathogenesis– Antiphagocytic Antiphagocytic
CapsuleCapsule
– Lethal ToxinLethal Toxin
– Edema ToxinEdema Toxin
– Mechanism by cell Mechanism by cell binding and then active binding and then active toxintoxin
AnthraxAnthrax
Clinical DiseaseClinical Disease– CutaneousCutaneous
– InhalationalInhalational
– GastointestinalGastointestinal
– MeningealMeningeal
DiagnosisDiagnosis– CLINICAL CLINICAL
SUSPICION OF SUSPICION OF EXPOSUREEXPOSURE
AnthraxAnthrax
TreatmentTreatment– Pen GPen G
– DoxycyclineDoxycycline
– CiprofloxacinCiprofloxacin
– Many other possibly Many other possibly effectiveeffective
Recombinants may Recombinants may possess resistance as possess resistance as the native vegetative the native vegetative state has lactamasesstate has lactamases
PlaguePlague
HistoryHistory– Pandemics of the 6Pandemics of the 6thth, ,
1414thth, 20, 20thth century century
– 24 Million died from 24 Million died from 1346-13521346-1352
– Endemic throughout Endemic throughout historyhistory
– ZoonoticZoonotic» EnzoonticEnzoontic
» EpizooticEpizootic
Infectious AgentInfectious Agent– Yersinia pestisYersinia pestis
– Gram-neg, non-Gram-neg, non-sporulating, sporulating, coccobacilluscoccobacillus
– pH 6 antigen induced pH 6 antigen induced at low pH for virulenceat low pH for virulence
– Antiphagocytic capsuleAntiphagocytic capsule
– Complex interspecies Complex interspecies toxinstoxins
PlaguePlague
EpidemiologyEpidemiology– Oriental rat flea most Oriental rat flea most
common vectorcommon vector
– Multiple animals serve Multiple animals serve as vectorsas vectors
– US rat squirrel fleasUS rat squirrel fleas
– Endemic in Western Endemic in Western USUS
PathogenesisPathogenesis– 1-10 organism can 1-10 organism can
infect via bitesinfect via bites
– Multiple Virulence Multiple Virulence factorsfactors
– Spread via lymphSpread via lymph
– Sepsis occurs when Sepsis occurs when untreated to all organsuntreated to all organs
PlaguePlague
Clinical FeaturesClinical Features– 80% as bubonic form80% as bubonic form
– 10% as sepsis10% as sepsis
– 10% as pulmonary10% as pulmonary
– As warfare agent As warfare agent presentation would be presentation would be bubonic and bubonic and pulmonarypulmonary
Generally present as Generally present as gram negative gram negative infection with plague infection with plague specific featuresspecific features
PlaguePlague
DiagnosisDiagnosis– DifferentialDifferential
» Cat ScratchCat Scratch
» TularemiaTularemia
» LGVLGV
» ChancroidChancroid
» TBTB
» StreptococccalStreptococccal
» RickettsiaeRickettsiae
Lab ConfirmLab Confirm– Aspiration of BuboAspiration of Bubo
– Wright-Giemsa, Gram Wright-Giemsa, Gram StainStain
PlaguePlague
TreatmentTreatment– Isolation for first 48 hrs of treatmentIsolation for first 48 hrs of treatment– Streptomycin, ceftriaxone, chloramphenical,Streptomycin, ceftriaxone, chloramphenical,– Doxycyclcine all acceptableDoxycyclcine all acceptable– If treated early, buboes do not require drainageIf treated early, buboes do not require drainage– Postexposure Prophylaxis: DoxycyclinePostexposure Prophylaxis: Doxycycline– Immunization: high risk individualsImmunization: high risk individuals
TularemiaTularemia
HistoryHistory– Discovered in 1911 in Discovered in 1911 in
Tulare County, Tulare County, California by McCoyCalifornia by McCoy
– Edward Francis Edward Francis discovered deer fly discovered deer fly transmissiontransmission
– High infectivity after High infectivity after aerosolizationaerosolization
AgentAgent– Francisella tularensisFrancisella tularensis
– Obligate aerobe, Obligate aerobe, coccobacilluscoccobacillus
– Two biovars: US Two biovars: US isolate highly virulent isolate highly virulent for rabbits, humansfor rabbits, humans
TularemiaTularemia
EpidemiologyEpidemiology– Principle reservoir is Principle reservoir is
the tick in the USthe tick in the US
– Abdominal Pain, Abdominal Pain, Pharyngitis, from Pharyngitis, from contaminated water in contaminated water in areas where water areas where water mammals live (non-mammals live (non-US)US)
PathogenesisPathogenesis– Possibly capsularPossibly capsular
– Unclear, no toxinsUnclear, no toxins
– Spreads through skin, Spreads through skin, mucous membranes, mucous membranes, GIGI
– 5-10 organisms5-10 organisms
– Humoral response by Humoral response by MHC II mediated T-MHC II mediated T-cell immunitycell immunity
TularemiaTularemia
Clinical FeaturesClinical Features– Incubation 3-6 dayIncubation 3-6 day
– Ulceroglandular 75%Ulceroglandular 75%» Skin or mucous Skin or mucous
membranes, nodes membranes, nodes >1cm>1cm
– Typhoidal 25%Typhoidal 25%» Smaller nodesSmaller nodes
» Non-mucous Non-mucous membranesmembranes
Multiple Const/Syst Multiple Const/Syst complaintscomplaints– FeverFever
– HAHA
– ChillsChills
– Abdominal painAbdominal pain
– Fluctuant Lymph Fluctuant Lymph nodes (drainage)nodes (drainage)
TularemiaTularemia
DiagnosisDiagnosis– Difficult serology and Difficult serology and
growth medium growth medium proceduresprocedures
– ELISA most reliableELISA most reliable
TreatmentTreatment– StreptomycinStreptomycin
– AminoglycosidesAminoglycosides
– ChloramphenicolChloramphenicol
– TetracyclinesTetracyclines
ProphylaxisProphylaxis– DoxycyclineDoxycycline
BrucellosisBrucellosis
HistoryHistory– Zoonotic infectionZoonotic infection
» DomesticDomestic» WildWild
– Animal Products, contact Animal Products, contact with infected animals, with infected animals, aerosolsaerosols
– Relapsing Fever, associated Relapsing Fever, associated with ruminant abortionwith ruminant abortion
– US actively developed US actively developed warfare agent with Brucellawarfare agent with Brucella
AgentAgent– Non-toxic, Non-toxic,
nonsporulating,aerobic, nonsporulating,aerobic, Gram-neg, coccobacilliGram-neg, coccobacilli
– 6 species with several 6 species with several biovarsbiovars
– Unusual LPS Unusual LPS component of cell component of cell membranemembrane
BrucellosisBrucellosis
EpidemiologyEpidemiology– Transmission at Transmission at
abortion, slaughter, and abortion, slaughter, and milkmilk
– Highly infectious in Highly infectious in lab workers who work lab workers who work with the Brucellawith the Brucella
– Fewer than 200 fatal Fewer than 200 fatal cases/yr in UScases/yr in US
PathogenesisPathogenesis– Enter thru skin, GI, Enter thru skin, GI,
mucous membranesmucous membranes
– Phagocytized by WBC Phagocytized by WBC but carried to lymph but carried to lymph nodesnodes
– Placenta may carry Placenta may carry 10101010 bacteria/gram bacteria/gram
BrucellosisBrucellosis
Clinical FeaturesClinical Features– diverse, diverse,
variabilityvariability
– 3d to weeks incubation3d to weeks incubation
– Neuropsychiatric along Neuropsychiatric along with fever, cough, with fever, cough, arthritisarthritis
– Mild lab abnormalitiesMild lab abnormalities
DiagnosisDiagnosis– Serum agglutinationSerum agglutination
– PCRPCR
– IgGIgG
BrucellosisBrucellosis
TreatmentTreatment– DoxycyclineDoxycycline– StreptomycinStreptomycin– AminoglycosidesAminoglycosides
Prophylaxis Prophylaxis – Prevention (no-vaccine)Prevention (no-vaccine)– DoxycyclineDoxycycline
Q FeverQ Fever
HistoryHistory– 1937 discovery1937 discovery– ZoonoticZoonotic– Coxiella BurnetiiCoxiella Burnetii– 50 g of dried powder 50 g of dried powder
equal to casualty rate of equal to casualty rate of anthrax or tularemiaanthrax or tularemia
– Multiple wars with Multiple wars with soldiers infected from soldiers infected from living in barns, near living in barns, near livestocklivestock
AgentAgent– Close relative of Close relative of
Legionella, not true Legionella, not true rickettsiaerickettsiae
– Obligate intracellular Obligate intracellular pathogenpathogen
– Spore-like formationSpore-like formation
– Phase I/IIPhase I/II
Q FeverQ Fever
EpidemiologyEpidemiology– Extremely infectiousExtremely infectious– Single organism capable of Single organism capable of
diseasedisease– Multiple hosts, arthropod to Multiple hosts, arthropod to
humanhuman– Human infection from Human infection from
livestock same as livestock same as Brucellosis but also shed in Brucellosis but also shed in urineurine
– Urine persistence can infect Urine persistence can infect from objects such as strawfrom objects such as straw
PathogenesisPathogenesis– Inhalation of aerosolsInhalation of aerosols
– Phagocytosis with Phagocytosis with eventual lysis and eventual lysis and releaserelease
Q FeverQ Fever
Clinical FeaturesClinical Features– Incubation 10-40 daysIncubation 10-40 days
– Asymptomatic Asymptomatic seroconversionseroconversion
– Acute Disease:Acute Disease:» Chill,rigors,retroorbital Chill,rigors,retroorbital
HAHA
» Fever, myalgiasFever, myalgias
– Chronic: endocarditisChronic: endocarditis
DiagnosisDiagnosis– SerologicalSerological
» Comp FixationComp Fixation
» Indir Flour AbIndir Flour Ab
» ELISAELISA
Q FeverQ Fever
TreatmentTreatment– TetracyclinesTetracyclines– MacrolidesMacrolides– Quinolones in chronic diseaseQuinolones in chronic disease
ProphylaxisProphylaxis– VaccineVaccine– DoxycyclineDoxycycline
SmallpoxSmallpox
Variola – ds-DNA, Orthopox VirusVariola – ds-DNA, Orthopox Virus– Major: 30% mortality, Asia, AfricaMajor: 30% mortality, Asia, Africa– Minor: 1% mortality, Europe, South AmericaMinor: 1% mortality, Europe, South America
Possible to recover Smallpox from Possible to recover Smallpox from preserved cadavers or recombinant with preserved cadavers or recombinant with monkeypoxmonkeypox
SmallpoxSmallpox
Pathogenesis and Clinical FeaturesPathogenesis and Clinical Features– Highly stable and infective for long periods outside Highly stable and infective for long periods outside
of hostof host– Fever, followed by rash 3-6 days laterFever, followed by rash 3-6 days later– Rash period is infective, lymphoid disseminationRash period is infective, lymphoid dissemination
» Head to toe spreadHead to toe spread
– Incubation avg = 12 daysIncubation avg = 12 days– Sx: fever, delerium, backache, cough (aerosol)Sx: fever, delerium, backache, cough (aerosol)– Hemorrhagic and Flat-type higher mortalityHemorrhagic and Flat-type higher mortality
SmallpoxSmallpox
Diagnosis and TreatmentDiagnosis and Treatment– Dx: Guarnieri bodies = viral aggregationDx: Guarnieri bodies = viral aggregation– Distinguish subclinical Smallpox from VaricellaDistinguish subclinical Smallpox from Varicella– Quarantine for 3 days for rash development post Quarantine for 3 days for rash development post
exposureexposure– VaccinesVaccines
» VacciniaVaccinia
» VIG within 7 days of disease; care if recently VIG within 7 days of disease; care if recently vaccinatedvaccinated
Viral EncephalitidesViral Encephalitides
Zoonotic virusesZoonotic viruses Aerosolization transmission as well as Aerosolization transmission as well as
insect; route of biological warfare agent a insect; route of biological warfare agent a source of concernsource of concern
Each VE has distinct but similar Each VE has distinct but similar incubation, symptoms and mortalityincubation, symptoms and mortality
Vaccines key to management of VEE, Vaccines key to management of VEE, WEE, EEEWEE, EEE
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