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23 Cards in this Set

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Describe the course of Inhalational Anthrax?
THERE IS A 1-6 (UP TO 60) DAY INCUBATION, followed by fever, myalgias, cough & fatigue (“flu-like” sx), hypoxia and dyspnea

Initial improvement followed by abrupt onset of respiratory distress, shock & death in 24-36 hours

Physical findings are non-specific, PNEUMONIA IS RARE

CXR may show WIDENED MEDIASTINUM with or without bloody pleural effusion

50% have associated hemorrhagic meningitis
Is there an FDA licencsed VACCINE for Anthrax?
Yes, but it is not currently commercially available (to general populace)
It involves 3 doses in 4 weeks
Your pediatric patient has inhalational antrax. What is the best treatment?

QUINOLONES?
TETRACYCLINE?
CEPHALOSPORINS?
TMP/SMX ?
penicillin-based therapy?
QUINOLONES? -- no ADVERSE EVENTS common in PEDIATRIC PATIENTS
TETRACYCLINE? – no ADVERSE EVENTS common in PEDIATRIC PATIENTS CEPHALOSPORINS? –NO SUCCEPTIBILTIY
TMP/SMX ? --– NO SUCCEPTIBILTIY
penicillin-based therapy unless contraindicated
T or F: Inhalational antrax has documented cases of person-to-person transmission?
F
“The plague” is caused by Yersinia pestis – gram (-), non-motile, non-spore forming bacillus which is normally a disease of rodents. It travels through a flea vector. It is a bioterrorism hazard because an inhalational form can be made and humans are susceptible. Exposure and recovery from the plague results in a __________.
TEMPORARY IMMUNITY
BUBONIC plague results in _________ infection

PNEUMONIC plague results in _________ infection
LYMPH node(usually lower legs)

LUNG
Diagnosistic work up of the Plague includes gram stain, lymph node biopsy, aspiration cultures or CSF samples. Immunoassays are also available. On bipolar staining ________ may be present
SAFETY PIN bacteria
You diagnose a patient with the plague. What should you do immediately and why?
RESPIRATORY ISOLATION. SECONDARY TRANSMISSION is possible. Start antibiotics within 24 hours of symptoms and keep patient isolated for first 48 hours of treatment.
Is there a vaccine available for the plague?
BUBONIC plague only
several years ago, your patient fell ill from Tularemia and recovered, he has recently been exposed again. Knowing that almost all exposures of Tularemia lead to infection, is he in danger?
NO, RECOVERY OFFERS PERMANENT IMMUNITY
Inhalation of how many organisms is required to produce the most lethal type of Tularemia, the typhoidal form
Only 10-50
Pronounced INFLAMMATION & NECROSIS in lymph nodes, lung, skin, conjunctiva or oropharynx is characteristic of what organism
Tularemia
Diagnosis of Tularemia is problematic due to danger & difficulty of growing organism. You should suspect tularemia with epidemic febrile illness with pronounced tender lymphadenopathy. Is STAINING of ulcerative fluids or sputum diagnostic
No generally NOT helpful
Your patient presents with a high fever (100-104), sweats & chills, severe headache, cough and myalgias. Suspecting Atypical pneumonia you do a chest X-ray and note a GROUND GLASS APPEARANCE. What is the diagnosis? What is the prognosis? Are antibiotics required? Does the patient need to be in isolation?
Q-FEVER
SELF LIMITING disease with 2-14 day course – Most cases resolve spontaneously WITHOUT antibiotics
Secondary transmission does NOT occur
VASCULAR damage is a disease producing property of what type of biological warfare
VIRUSES
What is the treatment for Venezuelan Equine Encephalitis (VEE). Is isolation necessary?
Supportive, NO antiviral medication or vaccination
NO person-to-person transmission
Viral Hemorrhagic Fevers (VHFs) include Ebola, Marburg, Dengue, Crimean-Congo Fever, Lassa Fever, Hantavirus &Yellow Fever. Which is the only one with a COMMERCIALLY AVAILABLE VACCINE?
YELLOW FEVER
TOXINS commonly used as Biologic Agents include Botulinum, Ricin, & Staphylococcal Enterotoxin B. An important general characteristic of toxins is ________
They are NOT PRONE TO PERSON-TO-PERSON TRANSMISSION
Do the toxins Botulinum or Ricin have vaccines or anti-toxins?
Botulinum: CDC vaccine good for Types A & B clostridium neurotoxins only

Ricin: No antitoxin or vaccine available
Which of the biohazards discussed worsen if untreated
Anthrax, Tularemia, Ricin, Plague
3-12 hours after being in a subway where someone sprayed an aerosol can of an unknown substance your patient experiences sudden onset of high fever, headache, chills, myalgias, nonproductive cough, severe SOB, chest pain . What do you think happened. What is the prognosis? What do you expect to find on X-ray findings?
INHALATION of Staphylococcal Enterotoxin B
SEB progresses rapidly to stable clinical state
CXR usually NONSPECIFIC with inhalation
What biohazards hold the risk of SECONDARY transmission
Smallpox
Pneumonic Plague
Viral Hemorrhagic Fever
What biohazards discussed have VACCINES available
Q Fever,
Botulism
Anthrax,
Tularemia
Smallpox