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23 Cards in this Set
- Front
- Back
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past four decades: new pathogens/ re-emerging pathogens in the 70's: (4)
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lyme disease, legionnaire's disease, toxic shock syndrome, swine influenza
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past four decades: new pathogens/ re-emerging pathogens in the 80's:
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ehrlichiosis, babesiosis, human retroviruses, hepatitis C
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past four decades: new pathogens/ re-emerging pathogens in the 90's
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hemorrhagic fever viruses, influenza, viral hepatitis, Group A strep, hantavirus, tularemia, BSE and other prion diseases
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past four decades: new pathogens/ re-emerging pathogens in the 2000's:
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SARS (coronavirus); vaccinia, anthrax, smallpox, west nile virus, monkeypox, metapneumovirus, influenza: H5N1, H1N1; cholera
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Risk equation:
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Risk = Probability (death) + sum of a bunch of different things!
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important historical perspective dates:
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-1346: plague infected corpses used as weapons
-1754: smallpox used as BW -1915: BWs used in WWI -1937: BW experiments in Unit 731 -1940: plague used as BW -1942: offensive US BW program 1972: formal ban of BWs 1979: athrax deaths in Russia 1984: salmonella used as BW 1998-1999: 50 US anthrax threats 1995: Sarin used as BW: -anthrax attacks leave 5 dead and millions in fear! |
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RISKS with BW:
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heart diseae: 1/400; cancer: 1/500: MV : 1/7000; smallpox: 1 in 1,000,000
anthrax attack in 01: 1 in 56,000,000 -RISK OF BT is NOT QUANTIFIABLE!!!! |
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What are factors influencing the risk of emergent infectious diseases?
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-population density;
proximity to animals; global travel; geopolitics (war, poverty, BT, etc.); environmental encroachment (altering nature's balance); natural disasters; human behavior (sex, drugs, etc); technological advances (Abs, ICUs, medical devices, etc). |
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What are scary features of biothreat agents?
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-occult and frightening, inexpensive, aerosolized (1-10 um); survive sunlight, drying, heat, lethal or disabling;
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What are four groups of weapons of mass terror and incubation times
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conventional: immediate
biological: days to weeks chemical: minutes to hours nuclear: varies with dose |
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There are three categories of biological threat agents (A,B,C); what is in category A?
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-anthrax, botulism, plague, poxviruses (smallpox), tularemia, viral hemorrhagic fevers
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Anthrax attacks US, 2001: how many cases and how many deaths:
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22 cases, 11 inhalationa, 5 deaths (45%); critical threshold for mortality despite appropriate antimicrobials
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How do you distinguish between anthrax and influenza-like illnesses?
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-less likely anthrax: rhinitis, coryza, sore throat
-more likely anthrax: tachycardia, chest pain dyspnea, GI szs (nausea, vomiting, pain); decreased alb; increased LFT's; non h/a neuro szs |
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What are two forms of anthrax?
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cutaneous and inhalation anthrax
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-Smallpox features:
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-weaponized viruses may be available;
-airborne transmission, high mortality (30%) -naive population -high transmission risk to HCW's -early symptoms are nonspecific -rash appears on extremities with uniform appearance -SCABS over in 1-2 weeks -contagious until all scabs have fallen off |
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Compare smallpox and chickenpox in terms of prodrome, distribution, evolution, depth of lesion, infectivity, and separate scabs
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variola versus varicella:
prodrome: 2-4 days versus minimal distribution: centrifugal versus centripetal evolution: synch versus asynch depth of lesion; dermal versus subQ infectivity: separation v. scabbing scabs separate: 14-28 days versus < 14 days |
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What are plague syndromes: (there are 7 of them)!
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1. bubonic plague,
2. primary septicemic plague, 3. primary pneumonic plague, 4. plague meningitis, 5. plague pharyngitis, 6. pestis minor, 7. subclinical infection |
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What is the clinical presentation of tularemia?
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-extremely variable, depending on route of inoculation, dose and virulence
incubation: 3-5 days(range: 1-21 days) -febrile illness (chills, headache, myalgia, fatigue, sore throat, cough, shortness of breath, vomiting, diarrhea -prominent lymphadenopathy |
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What are three clinical syndromes of tularemia?
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ulceroglandular (most common form; papule, ulcer at portal of entry and lymphadenopathy)
oculoglandular (eyelids and conjunctiva inflamed, lymphadenopathy; nodules and ulcers on palpebral conjunctivae) typhoidal: acute septicemia with no localizing signs; secondary pleuropulmonary involvement) |
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Describe the SARS epidemic/ dispersal:
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-Guandong province --> HOTEL M --> eventually to 26 countries; 8098 cases, 774 deaths
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seasonal influenza:
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-millions of cases/ year; annually 225,000 hospital and 36,000 deaths
-antigenic drift --> new STRAIN emerges when mutations change virus completely: SHIFT |
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Pandemic prerequisits for influenza:
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-novel virus or subtype in naive population (all met with novel H1N1 2009);
-ability of virus to replicate in humans, resulting in severe illness -efficient human-human transmission leading to multiple generations of infection!!! |
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medical detective situations: (3)
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puerperal fever in Vienna, 1847
cholera in south london, 1854 -potato blight in ireland, 1846 |
