Navajo Health Foundation /Sage Memorial Hospital

P.O. Box 457, Ganado, AZ 86505

       Tel. (928) - 755 4500

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ANTHRAX  print version

GENERAL INFORMATION: 

The causative agent for anthrax is species of bacteria, Bacillus anthraces. This organism can exist in both vegetative and in spore form. Primary hosts are live stocks including goats and sheep. Anthrax occurs most frequently in persons who work with livestock that are infected with this organism. Gastrointestinal anthrax may occur if undercooked, infected meat is consumed.

There are three (3) types of anthrax syndromes:

·    Delivery: As a biological weapon, anthrax spores would most likely be  delivered in an aerosol form. (inhalation type)

·   Transmission: Inhalation anthrax is not transmitted from person to person.

Humans can become infected with anthrax by handling products from infected animals or by inhaling anthrax spores from contaminated animal products. Anthrax can also be spread by eating undercooked meat from infected animals - spores can survive outside host for years. 

·   Incubation: One to six (1-6) days but may be up to 6 weeks

·   Infection Control Precautions: Standard Precautions (Contact also if cutaneous or gastrointestinal anthrax is present)

·   Signs/Symptoms: Inhalation: Flu like symptoms, cough, widened mediastinum.  May have a period of time (2-3 days) of pseudo improvement followed by severe respiratory distress, septicemia, shock and death. Cutaneous: Painless, necrotic ulcers.  Gastrointestinal: Nausea, abdominal pain, bloody diarrhea

·   Treatment:

Cutaneous Anthrax: Ciprofloxacin or Doxycycline for 60 days.

Inhalational Anthrax: Multi-antibiotic therapy is recommended. Ciprofloxacin or Doxycycline plus one or two other drugs from the list below:

Quinolones, Rifampin, Tetracycline, Vancomycin, Imipenem, Chloramphenicol, Clindamycin, Aminoglycosides or Penicillin

·   Key Differential Diagnosis: Hantavirus pulmonary syndrome, Plague, Tularemia

Anthrax

Q 1: Name 3 types of anthrax syndromes.

Q 2: How anthrax could be delivered as a biological weapon?

Q 3: Is inhalation anthrax transmittable from person to person?

Q 4: What is the incubation period for anthrax?

Q 5: What are the signs and symptoms of inhalation, coetaneous and gastrointestinal anthrax?

BOTULISM  (print version)

GENERAL INFORMATION: 

 Botulism is caused by the toxin produced by the bacterial species Clostridium botulinum. This is generally food borne disease and usually caused by ingestion of improperly prepared foods. It is a rare but serious paralytic illness caused by a neuro toxin that is produced by the bacterium.

·   Delivery: As a biological weapon, Botulism would most likely be delivered in an aerosol form or by food sabotage. 

·   Transmission:  Botulism is not transmitted from person to person. Infection may occur after ingestion of bacterium Clostridium botulinum

·   Incubation: Symptoms generally begin 18 to 36 hours after eating a contaminated food, but they can occur as early as 6 hours or as late as 10 days. Generally felt to be within 1-5 days

·   Infection Control Precautions: Standard Precautions

·   Signs/Symptoms:  Systemic infection: Blurred vision, double vision, photophobia, slurred speech, muscle weakness, progressive paralysis, respiratory failure and death in untreated sever cases. Gastrointestinal: Nausea, vomiting, diarrhea

·   Treatment: Trivalent antitoxin (type A, B, E) however, anaphylaxis is a risk and the patient must be screened for sensitivity (horse serum product).  Prolonged ventilator assistance may be required for up to one year after exposure. Antitoxin available only through CDC

·   Key Differential Diagnosis: Guillain-Barre, Polio, Myasthenia Gravis, Tick paralysis, organophosphate poisoning

 Botulism Quiz:-

Q 1: How does botulism affect the patient (route of administration)?

Q 2: How would botulism may be delivered as a biological weapon?

Q 3: Is botulism transmittable from person to person?

Q 4: What is the incubation period for botulism?

Q 5: What are the signs and symptoms of botulism?

   BRUCELLOSIS    (print version)

GENERAL INFORMATION: 

Brucellosis is also known as “undulant fever”.  It is usually associated with contaminated and non pasteurized dairy-product consumption. 

Brucellosis can be caused by the members of bacterial genra called Brucella. The species causing this disease could be any of the following:

Brucella abortis, Brucella melitensis, Brucella suis and Brucella canis.

            The primary hosts of these bacterial species are animals like cattle, sheep or goats, swine or dogs

·   Delivery: As a biological weapon, Brucellosis would most likely be delivered in an aerosol form or by food sabotage. 

·   Transmission: Brucellosis is not transmitted from person to person. 

·   Incubation: Five (5) to 60 days

·   Infection Control Precautions: Standard Precautions

·   Signs/Symptoms: Flu like symptoms, cough, fever, headache, weakness, myalgias.  Cough or chest pain may occur. Gastrointestinal: Nausea, vomiting, diarrhea, constipation, anorexia

·   Treatment: Doxycycline, with Rifampin or Gentamicin; continue for six weeks

·   Key Differential Diagnosis: TB, influenza, malaria

 Brucellosis -

Q 1: What is another name for brucellosis and how does it spreads?

Q 2: How brucellosis could be delivered as a biological weapon?

Q 3: Is brucellosis transmittable from person to person?

Q 4: What is the incubation period for this disease?

Q 5: What are the signs and symptoms of brucellosis?

Q 6: What are the antibiotic(s) used for the treatment of brucellosis and how long should be the duration of treatment?

 PLAGUE  (print version)

INFORMATION: 

The causative agent of plaque is member of bacteria belonging to enterobacteriaceae genra Yersinia. The species that causes plague is known as Yersinis pestis. Plague bacterium may be inhaled or spread through the bite of infected fleas. The fleas in turn get the organism from the infected mouse, making the chances of natural infection remote.

This is a highly virulent organism. The three forms of disease are Bubonic, Septicemic and Pneumonic plague. Once a human is infected, untreated progression of the disease leads to blood infection (septicemic plague) and eventually to lung infection (pneumonic plague) and it can be transmitted to others through the expulsion of infective respiratory droplets by coughing.

·   Delivery: As a biological weapon, Plague would most likely be delivered by aerosol.

·   Transmission: Transmission occurs with exposure to respiratory droplets or contact with draining buboes. Highly contagious via respiratory droplets - aerosol route in Pneumonic Plague. Bubonic plague is flea‑borne, from infected rodents to humans or direct contact with infected tissues or fluids from handling sick or dead animals.

·   Incubation: One to three (1-3) days for pneumonic, 2-10 days for bubonic

·   Infection Control Precautions: Standard Precautions and droplet precautions. Direct contact in case of bubonic plague.

·   Signs/Symptoms: Fever, chills, headache, malaise, cough with hemoptysis, vomiting, diarrhea, purpura, bubo.  Pneumonic plague rapidly progresses to dyspnea, cyanosis and death.

 Bubonic plague: Fever, chill and prostration are common.  It is characterized by high fever, and painful inflammatory swelling of axilla and groin lymph nodes

Pneumonic plague:  It involves the lungs and is characterized by malaise, and pulmonary signs.

Septicemic plague: Fever, chills, prostration, abdominal pain, shock and bleeding into skin and other organs

·   Treatment:  Isolation of the patient with intravenous antibiotic therapy such as streptomycin or gentamicin, but a number of other intravenous antibiotics are also effective. Generally dosed at twice daily for 14 days. Doxycycline and Ciprofloxacin for 10 days

·   Key Differential Diagnosis: Hantavirus pulmonary syndrome, meningococcemia, Tularemia, community acquired pneumonia

 Plague :-

Q 1: How does plaque affect the patient (route of administration) for both types?

Q 2: How would plaque possibly be delivered as a biological weapon?

Q 3: Is plaque transmittable from person to person?

Q 4: What is the incubation period for both types pf plaque?

Q 5: What are the signs and symptoms for pneumonic and bubonic plaques?

  Q Fever  (print version)

GENERAL INFORMATION: 

 The causative agent for Q fever is bacteria Coxiella burnetti. It is common in animals, although animals do not develop the disease. Humans would normally contract Q Fever by inhaling spores from contaminated hay, dirt or manure. It is an acute systemic infection that primarily affects the lungs. 

·   Delivery:  As a biological weapon, Q Fever would be delivered by aerosol or food sabotage. 

·   Transmission:  Q Fever is not transmitted from person to person.  

·   Incubation:  Two (2) to 14 days

·   Infection Control Precautions: Standard Precautions

·   Signs/Symptoms: Fever, non-productive cough, fatigue, headache, diaphoresis

·   Treatment: Tetracycline or Doxycycline for 5-7 days 

·   Key Differential Diagnosis: Legionella pneumonia, Psittacosis, Tularemia, Chlamydia pneumonia 

Q Fever :-

 Q 1: How does human being contracts Q fever?

Q 2: How Q fever possibly be delivered as a biological weapon?

Q 3: Is Q fever transmittable from person to person?

Q 4: What is the incubation period for Q fever?

Q 5: What are the signs and symptoms for Q fever?

                       Serving Navajo Members since 1901