Navajo Health Foundation /Sage Memorial Hospital

P.O. Box 457, Ganado, AZ 86505

       Tel. (928) - 755 4500

                      Welcome 

News Page

Services

Products/Gifts

Map/Location

Contacts

Human Resources

Philanthropy

Ganado History

SMH History

Management

Medical Services

Sage Dental

Physical Rehabilitation

WEBmail

RICIN     (print version)

GENERAL INFORMATION: 

This is a highly potent toxin. It is derived from the Caster bean. (Ricinus communis). Ricin is a poison that can be made from the waste left over from processing castor beans. It can be in the form of a powder, a mist, or a pellet or it can be dissolved in water or weak acid. It is a stable substance and is not affected much by extreme conditions such as very hot or very cold temperatures. It is a potent protein synthesis inhibitor and cells die because of protein lack of synthesis.Effects of ricin poisoning depend on whether ricin was inhaled, ingested or injected. 

·   Delivery: Aerosol or food sabotage

·   Transmission: Not transmitted from person to person

·   Incubation:  Four (4) to eight (8) hours 

·   Infection Control Precautions: Standard Precautions. 

·   Signs/Symptoms: Inhalation: Weakness, fever, progressive cough, dyspnea, pulmonary edema, myalgia, arthralgia.  Nausea, abdominal pain, vomiting and diarrhea are common if ingested. 

·   Treatment:  Supportive only (no antidote is available.)

·   Key Differential Diagnosis:  Staphylococcal Enterotoxin B, Q Fever, Plague, Tularemia, Phosgene.

 RICIN -

 Q 1: what is the source of ricin toxin and how do human beings may acquire it?

Q 2: How could ricin toxin possibly be delivered as a chemical/ biological weapon?

Q 3: Is the disease caused by ricin toxin transmittable from person to person?

Q 4: What is the incubation period for ricin toxin?

Q 5: What are the signs and symptoms for ricin intoxication?

SMALLPOX     (print version)

GENERAL INFORMATION: 

 Smallpox has been eradicated worldwide since 1977; vaccination programs ended in 1980.  Smallpox is highly contagious and is caused by Variola virus (Orthopoxvirus) the virus can remain viable in the environment for many hours. Viriola major refers to the form with higher mortality rate while the Variola minor is a milder form.

·   Delivery: As a biological weapon, Smallpox would be delivered by aerosol. 

·   Transmission: Occurs by inhalation of the virus.  However, the viable virus is also shed from skin lesions. Highly contagious via respiratory droplets -aerosol or contact with pox scabs

·   Incubation: Seven (7) to 17 days

·   Infection Control Precautions:  Standard Precautions plus airborne and contact.  Patient is placed in a negative pressure room, if possible, and doors and windows remain closed.

                   ·        If no negative pressure room is available, the patient is placed in a private room with a HEPA filtration unit, windows and doors remain closed.

·        Should a large number of patients requiring airborne isolation be admitted to the hospital, an entire unit should be considered for use as an isolation wing.

·        Access to this unit must be limited to trained staff.

·        The existing ventilation system must be sealed off from the rest of the hospital so that contaminated air is not recirculated to other floors.

 ·        Signs/Symptoms:

Fever, malaise, rash, headache, backache, vomiting, marked prostration, delirium in some cases, abdominal pain, death results in 20-30% of cases.

Rash starts as tense blisters/vesicles, 6mm in diameter, progresses to turbid fluid filled lesions (pustules), progressing to shrunken and drying lentil-like crusts in the skin.

Eventually they separate leaving a sunken scar. The hard material which comes away contains smallpox virus in its substance.

At this point in the disease process, the distribution of this focal rash is characteristic of smallpox affecting the head and extremities much more than the trunk. 

·   Treatment:  Symptomatic only

·   Key Differential Diagnosis: Cowpox, disseminated herpes zoster, varicella, Erythema Multiforme

Smallpox :-

Q 1: How does human being contracts smallpox?

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

Q 3: Is smallpox transmittable from person to person?

Q 4: What is the incubation period for smallpox?

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

TRICHOTHECENE (print version)

GENERAL INFORMATION: 

Naturally occurring substance produced by fungi. There are an estimated 300 mycotoxins produced by 350 species of fungi, however, T-2 is the only one known to be used as a biological weapon.  It is also known as “yellow rain”.

·   Delivery: As a biological weapon, mycotoxins T2, would most likely be delivered in an aerosol form but may be delivered by food or water sabotage.

·   Transmission:  May be transmitted by direct contact.

·   Incubation:  Minutes to hours

·   Infection Control Precautions:  Standard Precautions and Contact Precautions 

·   Signs/Symptoms: Tearing eyes, blurry vision.  Red, burning, blistering skin, cough, sore throat, sneezing,nasal itching and pain, epistaxis, vomiting, diarrhea, pulmonary edema, bone marrow suppression.

·   Treatment:  Decontaminate within 6 hours (soap and water).  Contain clothing to avoid environmental contamination.  Supportive care.  Activated charcoal if ingested.  High dose steroids.

·   Key Differential Diagnosis:  Mustard gas, SEB, Ricin

Trichothecene :-

Q 1: How does human being contract trichothecene mycotocin T2?

Q 2: How would trichothecene mycotocin T2 be delivered as a biological weapon?

Q 3: Is trichothecene mycotocin T2 transmittable from person to person?

Q 4: What is the incubation period for trichothecene mycotocin T2?

Q 5: What are the signs and symptoms for trichothecene mycotocin T2?

TULAREMIA (print version)

          GENERAL INFORMATION: 

Tularemia is also known as rabbit fever. It is caused by bacterial specie Francisella tularensis.  It is usually acquired by contact with infected animals, ticks or deer flies.

 There are six (6) possible syndromes: pneumonic, systemic, ulceroglandular, glandular, oculoglandular, oropharyngeal.

·   Delivery: As a biological weapon, Tularemia would be delivered by aerosol.

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

Most common - Inoculation of skin or mucous membranes with blood or tissue of infected victim.  Contact with fluids from infected deer flies or ticks; or handling or eating insufficiently cooked rabbit meat.

Less common - Transmission is through drinking contaminated water, inhaling dust from contaminated soil. 

·   Incubation:  One (1) to 14 days. Symptoms start appearing usually after 3 days

·   Infection Control Precautions: Standard Precautions

·   Signs/Symptoms: Fever, cough, chest pain, chills, headache, malaise.  May include sore throat, abdominal pain, skin ulcers, conjunctivitis, pleural effusions. The disease is seldom fatal.

·   Treatment:  Gentamicin, Streptomycin, tobramycin or Ciprofloxacin for 10 days; or Doxycycline, for 14-21 days.

·   Key Differential Diagnosis: Q Fever, Brucellosis, Plague, community acquired pneumonia

Tularemia

Q 1: How does human being contracts tularemia?

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

Q 3: Is tularemia transmittable from person to person?

Q 4: What is the incubation period for tularemia?

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

VIRAL HEMORRHAGIC FEVER   (print version)

GENERAL INFORMATION:

        “Viral Hemorrhagic Fever” viruses are classified into several distinct groups: 

Filoviruses:

 n      Marburg       n      Ebola

           Bunyaviridae:

 n   Hantavirus      n       Rift Valley Fever      n      Congo-Crimean

            Arenaviruses:

 n      Lassa    n        Junin    n       Sabia    n         Machupo     n       Guanarito

            Flaviviridae:

 n      Yellow Fever   n        Dengue

 ·   Delivery:  As a bioterrorism weapon, they would be delivered by aerosol

 ·   Transmission:  Through exposure to patient fluids. Normally transmitted to humans by rodents, mosquitoes, ticks or domestic animal slaughter. The natural reservoir of the Ebola and Marburg viruses are unknown.   Blood and other body fluids from infected patients contain the virus and increases as the patient deteriorates. Certain viruses (Lassa, Ebola, Marburg and Congo-Crimean) may be prone to aerosol nosocomial transmission..

 ·   Incubation:  Five (5) to 42 days, depending on the virus.

 ·   Infection Control Precautions:

 ·        Airborne, Contact and Standard Precautions  In addition, fluid proof, calf high shoe covers should be worn if any body fluids have soiled the floor.  Fluid resistant N95 disposable respirators, disposable face shields, fluid proof, long sleeved disposable gowns and head covers are to be worn if body fluids are present.  Jewelry should be removed before entering the room.  Patient is placed in a negative pressure room, if possible, and doors and windows remain closed.  The patient should not leave the room.

            ·        If no negative pressure room is available, the patient is placed in a private room with a HEPA filtration unit, windows and doors remain closed. 

            ·        Should a large number of patients requiring airborne isolation be admitted to the hospital, an entire unit should be considered for use as an isolation wing.

            ·        Access to this unit must be limited to trained staff.

  ·        The existing ventilation system must be sealed off from the rest of the hospital so that contaminated air is not recirculated to other floors.

 ·   Signs/Symptoms: High fever, low blood pressure, subcutaneous hemorrhage, malaise, prostration, conjunctival hemorrhage, postural hypotension, petechiae, DIC, flushing of face and chest, non-dependent edema and bleeding from mucous membranes, organ failure and death

·   Treatment: Supportive care.  Ribavirin may be of some help with Lassa Fever, Rift Valley Fever, Congo-Crimean and Hantavirus.

·   Key Differential Diagnosis:  Meningococcemia, Rickettsia, Leukemia, Thrombotic Thrombocytopenic Purpura, Malaria, Thyroid Fever, Hemolytic Uremic Syndrome

Viral Hemorrhagic Fever -

Q 1: How does human being contracts viral hemorrhagic fever?

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

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

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

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

                       Serving Navajo Members since 1901