Biothreats/emerging Pathogens

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History of biological weapons:

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Selected emerging and re-emerging pathogens of the past four decades:

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Some Factors Influencing Risk of Emergent Infectious Diseases:

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*Population density (small- & large-scale)
*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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Biothreat agents: Why terrorists love them and we don’t:

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*Occult and frightening
*Inexpensive, easy-to-produce
*Can be aerosolized (1-10 µm)
*Survive sunlight, drying, heat
*Cause lethal or disabling disease
*Person-to-person transmission
*No effective Rx or prophylaxis for some

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Traits of biological weapons:

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2 categories of biological threat agents:

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Anthrax attacks in 2001:

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Inhalational Anthrax
-bacteria gets taken up by alveolar macrophages.
-regional lymph nodes enlarge; widened mediastinum.

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Anthrax v. Influenza-like Illness:

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Cutaneous Anthrax
-dense, woody, indurated edema

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Describe smallpox:

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*Weaponized viruses may be available
*Airborne transmission
*Mortality high; ~30%
*Naïve population
*High transmission risk to HCWs
*Early symptoms 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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-smallpox progression
-day 2, 3, 5, and 8

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Hemorrhagic Smallpox

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Smallpox v. Chickenpox:

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monkeypox

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Plague bacillus in Peripheral blood smear
Wright-Giemsa Stain

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Plague Syndromes:

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Bubonic plague
Primary septicemic plague
Primary pneumonic plague
Plague meningitis
Plague pharyngitis
Pestis minor
Subclinical infection

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-bubonic plague
-bubo = enlarged lymph node

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PLAGUE
*Cervical bubo (not likely after inhalation)
*purpura (late disease)
*Acral gangrene (late disease)

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Tularemia: Clinical Presentation:

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*Francisella tularensis
*Extremely variable, depends on:
-Route of inoculation
-Dose
-Virulence
*Incubation: 3 – 5d (range: 1 – 21d)
*Febrile illness
-Chills, headache, myalgia, fatigue, sore throat, cough, shortness of breath, vomiting, diarrhea
*Prominent lymphadenopathy

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Patient with ulceroglandular tularemia

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Cervical lymphadenitis in patient with pharyngeal tularemia

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Chest radiograph of patient with pulmonary tularemia
(Radiograph shows bilateral pneumonitis and left pleural effusion)

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SARS outbreak results:

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Pandemic prerequisites for flu:

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*Novel virus or subtype in naïve population*
*Ability of virus to replicate in humans resulting in severe illness*
*Efficient human-to-human transmission leading to multiple generations of infection *

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Key organizational aspects of biodefense:

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