Bioterrorism

what is bioterrorism?

the intentional release of biological agents to cause illness or death to a human population

what is an emerging infectious disease?

any pathogen whose incidence has increased within the past 25 years

EIDs are often:

newly identified organisms, newly evolved strains of existing pathogen, known pathogens that spread to new population or region

what are reemerging infectious diseases

pathogens that have become drug resistant and thus are no longer controllable by public health options

what are the emerging threats?

bioterrorism, population growth, health and sanitation, urbanization and first contact, mass production of food, extreme weather, global travel and transmission

what did the Bioterrorism Act of 2002 do?

identifies pharmacists as the first line of defense for public health in event of a national bioterror attack

what are the six factors of an ideal bioterrorist weapon?

mass produced easily and cheaply, stores well, readily aerosolized or transmits from person to person, targets precisely, causes permanent damage in high percent of victims, potential for public panic

characteristics of category A pathogens

highest priority agents; easily disseminated and transmitted with a high mortality rate

characteristics of category B pathogens

moderately disseminated and transmitted with high rates of morbidity but low rates of mortality

characteristics of category C pathogens

emerging pathogens, easily engineered and disseminated with high mortality rates

what are the category A pathogens?

anthrax, plague, tularemia, smallpox, hemorrhagic fevers, botulinum toxin

what are the category B pathogens?

Q fever, brucellosis, equine viruses, food/water borne pathogens, various toxins

what are the category C pathogens?

tick-borne encephalitis viruses, multi-drug resistant tuberculosis

what are the top four bioterror pathogens and what makes them the top four?

anthrax, plague, tularemia, and smallpox; potential for airborne transmission

anthrax etiology

bacillus anthracis

manufacturing of anthrax spores can be made capable of -

being disseminated as aerosols

anthrax produces three -

exotoxins

what are the three exotoxins that anthrax produces?

protective antigen, lethal factor, and edema factor

what does the protective antigen do?

binds to host cell receptors and allows entry by other exotoxins

what do lethal and edema factors do?

paralyze the immune system and cause cell edema and death

bacillus anthracis characteristics

gram postive rod, spore former

bacillus anthracis virulence factors

unique protein capsule, exotoxins

bacillus anthracis diagnostics

gram stain, culture

bacillus anthracis diseases

inhalation anthrax, cutaneous anthrax, GI anthrax

inhalation anthrax phase one symptoms

viral symptoms 1-5 days; chest congestion

inhalation anthrax phase two symptoms

sudden onset respiratory distress; lung necrosis, hemorrhaging, death

cutaneous anthrax symptoms

small papillae, edema, if untreated can cause death

anthrax treatment

prophylactic vaccine, doxycycline

plague etiology

yersinia pestis

yersinia pestis has - stability and - contagious/mortality

lowered; increased

yersinia pestis is a - infection

zoonotic

yersinia pestis transmission cycle

animals to flea, flea bite human, to human, from human to human via airborne transmission

yersinia pestis characteristics

gram negative rod, reservoir in wild rodents/rats, vector in fleas

yersinia pestis virulence factor

fraction capsule antigen antiphagocytic

yersinia pestis diagnostics

culture, gram stain (BIPOLAR STAIN!!)

yersinia pestis disease

bubonic plague, pneumonic plague, septicemic

bubonic plague symptoms

fever, chills, headaches, painful lymph enlargement with inflammation and hemorrhaging, septic shock, gangrene, death

why is it called bubonic plaque

inflammation and hemorrhaging of lymph is called buboes

pneumonic plague symptoms

fever, chills, headaches, pneumonia, blood sputum, cheset pain, death

tularemia etiology

francisella tularensis

francisella tularensis does not form - but -

spores; can survive weeks in the environment

francisella tularensis is extremely infectious but is not spread -

person to person

francisella tularensis characteristics

gram negative coccobacilli, reservoir wild animals/rabbits, vector ticks/deerflies

francisella tularensis virulence factors

antiphagocytic capsule (= facultative intracellular parasite)

francisella tularensis diagnostics g

gram stain, culture, serology, PCR

francisella tularensis diseases

ulceroglandular (bite), pneumonic (respiratory)

tularemia symptoms

highly variable presentation, fever, chills, lethargy, joint pain, diarrhea, dry cough, pneumonia, bloody sputum, painful lymph nodes, death

small pox etiology

pox viridae, variola major and minor

small pox characteristics

dsDNA, linear, complex capsid, reservoir is humans

small pox diagnostics

symptomology and microscopy

small pox symptoms

fever, headache, severe fatigue, discomfort, back pain, diarrhea, red spots, fluid filled blisters, lesions

small pox treatment

vaccine

small pox transmission method

person to person

how long after exposure is the small pox vaccine still protective?

seven days

small pox can spread via:

aerosols or shed from oropharnyx and skin

how does small pox shed from oropharynx and skin

airborne droplets and skin fragments that can be inhaled

hemorrhagic fevers etiology

filo viridae

hemorrhagic fevers examples

ebola, lassa, marburg

hemorrhagic fevers can be used as bioterrorist weapons, however they are not likely because...

they are not easy to handle and they burn themselves out too quickly

hemorrhagic fevers characteristics

ss linear RNA, helical capsid, transmission via direct contact and fomites

hemorrhagic fevers diagnostics

symptomology, electron microscopy, ELISA, PCR

hemorrhagic fevers symptoms

sudden onset flu like symptoms, nausea, abdominal pain, diarrhea, vomiting, respiratory side effects (cough, sore throat, etc), CNS (headache, confusion, etc), edema, hemorrhage, death

hemorrhagic fevers treatment

supportive care

hemorrhagic fevers chart on slide 32????

botulinum toxin etiology

clostridium botulinum

clostridium botulinum *toxin* characteristics

harmful proteins, high toxicity, ease of dissemination,

t/f: many toxins are regarded as possible bio-terror agents

true

what is the most potent toxin?

botulinum neurotoxin

clostridium botulinum characteristics

gram positive rod, obligate anaerobe, reservoir: soil, transmission: ingestion and contact

clostridium botulinum virulence factors

motile, neurotoxins

clostridium botulinum neurotoxin does what?

inhibits release of acetylcholine from peripheral nerves which leads to weakness and paralysis

clostridium botulinum diagnostics

gram stain, PCR, mouse bioassay

clostridium botulinum symptoms

cranial nerve palsies, difficulty talking, respiratory paralysis, coma, death

clostridium botulinum treatment

antitoxin, penicillin, hyperbaric O2

what do antibiotics do to inhibit clostridium?

stops production of toxins