PEMDoc Pearls: Bioterrorism

Here are some pointers and continuation from Dan Fagbuyi’s talk on January 31^st

Category A Bioterrorism Agents/Organisms

Category A agents include organisms that pose a risk to national security as they can

• Easily be disseminated or transmitted from person to person
• Result in high mortality 
• Can cause public panic and social disruption
• Require special action for public health awareness

The following agents/diseases  are classed as category A

Anthrax (Bacillus anthracis)

Botulism (Clostridium botulinum toxin)

Plague (Yersinia Pestis)

Smallpox (variola major)

Tularemia (Francisella tularensis)

Viral hemorrhagic fevers (filoviruses & arenaviruses)

Anthrax

Cutaneous:  Skin sore→blister→ painless skin ulcer with a black center

Gastrointestinal:  Nausea, anorexia, bloody diarrhea, abdominal pain

Inhaled : Biphasic  may resemble flu like illness which may improve but then worsens and can be fatal with chest discomfort, shortness of breath, fatigue and muscle aches. CXR may show widened mediastinum

Botulism

Foodborne: Can occur in all age groups. Symptoms arise  within 6-10 days after exposure and can include diplopia, blurred vision, drooping eyelids, slurred speech, dysphagia, dry mouth and descending paresis (which may be confused with Guillain Barre Miller Fisher variant) leading to respiratory depression

Plague

Classical  finding is a swollen lymph node or ‘Bubo’ with associated history of flea bites.

Small Pox

• Incubation period 7- 17 days ( non contagious) 
• Prodrome ( 2- 4 days duration; flu-like phase with high fevers, may be contagious)
• Early Rash ( 4 days duration;  sores on mouth and tongue that spread to face arms and rest of the body
• patient is most contagious at this point
• Pustular rash ( 5 days duration sharply raised round and firm ‘like BB pellets under the skin) 
• Pustules and scabs ( 5 days duration)
• Resolving scabs ( 6 day duration; scabs fall off and form scars)
• Scabs resolved ( only once all the scabs have fallen off is the patient not contagious).

Tularemia

Symptoms include fevers, chills, headaches, diarrhea, myalgias, joint pain. Think of patients with tick bites, exposure to infected carcasses, contaminated food and water or inhalation – which can result in fatal pneumonia. Patients are not contagious

Viral Hemorrhagic Fevers

Specific agents include Arenaviruses, Ebola virus, Lassa fever and Marburg virus but there are many others in this category.  

Some are spread via person to person contact, through body fluids or cadavers, others are spread zoonotically.

Symptoms may vary according to the virus but patients usually present with abrupt fever, myalgias, prostration followed by coagulopathy, petechial rash and/or ecchymoses. Incubation period can be up to 21 days so patients may not develops illness until returning from travelling to endemic areas such as sub-Saharan Africa, South America or the Middle East.

(Adapted from the CDC)