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Bioterrorism chart.pdf

Characteristics and Management of Selected Bioterrorism Agents
Disease/
Incubation
Clinical Syndrome
Lethality
Diagnostic Tests
Treatment2
Chemoprophylaxis
BACTERIAL AGENTS
Cutaneous: Evolving skin lesion 20% if untreated,
Gram stain and culture of Ciprofloxacin; possibly up to 60 (face, neck, arms), progresses blood, pleural fluid, CSF, doxycycline.
doxycycline plus one 6 injections and
Gastrointestinal: Nausea,
vomiting, abdominal pain, bloody if untreated but data inhalational anthrax.3
Inhalational: Abrupt onset of
"flu-like" symptoms, fever, chills, distress develops, headache, dyspnea, chest pain, Begin treatment followed in 2 to 5 days by severe when inhalational hemorrhagic meningitis, sepsis, wait for shock infections indicate that early treatment significantly decreases the mortality rate.
Disease/
Incubation
Clinical Syndrome
Lethality
Diagnostic Tests
Treatment2
Chemoprophylaxis
BACTERIAL AGENTS
Nonspecific "flu-like" symptoms, Less than 5% even Blood and bone marrow Doxycycline plus
None. Only animal Doxycycline plus
incapacitate rather Confirmatory culture and Alternative therapies: ofloxacin plus
health laboratory network. plus gentamicin;
TMP/SMX plus
gentamicin.
3-5 days (range Sudden onset of acute febrile Largely clinical diagnosis. Streptomycin; Culture of blood, sputum, alternative is discomfort, cough, and dyspnea appropriately treated within 18-24 Confirmatory serological ciprofloxacin, and symptoms progress to cyanosis, hours of symptoms. and bacteriological tests chloramphenicol.
when diagnosis of health laboratory network. Chloramphenicol is Disease/
Incubation
Clinical Syndrome
Lethality
Diagnostic Tests
Treatment2
Chemoprophylaxis
BACTERIAL AGENTS
2-14 days (may Nonspecific febrile disease, uncommon even if Confirmatory testing via Disease/
Incubation
Clinical Syndrome
Lethality
Diagnostic Tests
Treatment2
Chemoprophylaxis
VIRAL AGENTS
prostration, headache, vomiting, unvaccinated effective in vitro, and derived from calf definitive testing through in experimental multiforme with bullae, or allergic contact dermatitis.
deficits may be higher after biological attack.
Confirmatory serological tests and viral isolation available through public health laboratory network.
Variable depending Confirmatory serological Supportive therapy.
health laboratory network. effective for Lassa Pathogens Office at 404 and Congo-Crimean (Hanta, Congo-Crimean, Rift Valley);Filoviruses (Ebola, Marburg);Flaviviruses (Yellow Fever, Dengue, tick-borne disease viruses) Incubation
Clinical Syndrome
Lethality
Diagnostic Tests
Treatment2
Chemoprophylaxis
BIOLOGICAL TOXINS
Treatment and reporting Supportive care - Pentavalent toxoid Antitoxin might prevent (typically 12-36 mouth, ptosis, fatigue. As from the CDC) should Not available to the immediately following diagnosis. Anaphylaxis and serum sickness are potential complications from antitoxin.
Aminoglycosides and clindamycin must not be used.
fever, cough, pulmonary edema, available but symptoms may respiratory failure, circulatory appear as early collapse, hypoxemia resulting in is likely to be high as 4-8 hours testing available through decontamination if Probably low (little Clinical diagnosis.
headache, nonproductive cough. data available for T-2 mycotoxins: Minutes to hours Abrupt onset of mucocutaneous Severe exposure Consult with local health Clinical support. Soap No vaccine specimen collection and within 4-6 hours procedures. Confirmation toxicity; washing requires testing of blood, within 1 hour may tissue and environmental eliminate toxicity No effective medications or antidotes.
Incubation
Clinical Syndrome
Lethality
Diagnostic Tests
Treatment2
Chemoprophylaxis
1 Physicians should report noticeable increases in unusual illnesses, symptom complexes, or disease patterns (even without definitive diagnosis) to public
health authorities. Prompt reporting of unusual patterns of illness can allow public health officials to initiate an epidemiologic investigation earlier than would be
possible if the report awaited definitive etiologic diagnosis. If you suspect an unusual disease or possible outbreak, please call your state or local
health department
. These numbers are available at:
http://www.statepublichealth.org/directory.php Information contained in this table was current as of November 2, 2001, and is intended for educational purposes only. Medication information should be researched and verified before initiation of patient treatment.
2 Different scenarios may require different treatment regimens. Please consult listed references and an Infectious Disease specialist for definitive dosage
information.

3 Other agents with in vitro activity suggested for use in conjunction with ciprofloxacin or doxycycline for treatment of inhalational anthrax include rifampin, vancomycin,
imipenem, chloramphenicol, penicillin and ampicillin, clindamycin, and clarithromycin.
4 This table was compiled from the following references:
Arnon SS, et al. Botulinum toxin as a biological weapon. JAMA . 2001;285:1059-1070.
Centers for Disease Control and Prevention. Update: investigation of bioterrorism-related anthrax and interim guidelines for clinical evaluation of persons with possible anthrax. MMWR . 2001;50:941-948. Centers for Disease Control and Prevention. Update: investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy, October 2001. MMWR . 2001;50:909-919.
Centers for Disease Control and Prevention. Vaccinia (smallpox) vaccine: recommendations of the Advisory Committee on immunization Practices (ACIP), 2001. MMWR . 2001;50:RR-10.
Chin J, Ed. Control of Communicable Diseases, Manual . 2000. Washington, DC: American Public Health Association.
Dennis DT, et al. Tularemia as a biological weapon. JAMA . 2001;285:2763-2773.
Dixon TC, et al. Anthrax. N Engl J Med . 1999;341:815-826.
Drugs and vaccines against biological weapons. Med Lett . 2001;43:87-89.
Henderson DA, et al. Smallpox as a biological weapon. JAMA . 1999;281:2127-2137.
Inglesby TV, et al. Anthrax as a biological weapon. JAMA . 1999;281:1735-1745.
Inglesby TV, et al. Plague as a biological weapon. JAMA . 2000;283:2281-2290.
Klietmann WF, et al. Bioterrorism: implications for the clinical microbiologist. Clin Microbiol Rev . 2001;14:364-381.
U.S. Army Medical Research Institute of Infectious Diseases. Medical management of biological casualties handbook, 4th edition . 2001. Available at: http://www.usamriid.army.mil/education/bluebook.html.
Abbreviations:
CDC - Centers for Disease Control and Prevention
CSF - Cerebrospinal Fluid
IND - Investigational New Drug
PCR - Polymerase Chain Reaction
RBC - Red Blood Cell
SMX - Sulfamethoxazole
TMP - Trimethoprim
USAMRIID - United States Army Medical Research Institute of Infectious Diseases
WBC - White Blood Cell

Source: http://dp.ccalac.org/PREPAREDNESS/hazard/CBRNE/Documents/Chemical%20and%20Biological/Characteristics%20and%20Managments.pdf

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