Name

Etiology

Forms/Types

Pathophysiology/Symptoms

Diagnoses

Management

Anthrax

Aerobic, gram-positive rod:

Bacillus anthracis.

Spore-forming capability.

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  Cutaneous: painless ulcer.

  
  
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  Gastrointestinal: acute gastritis or ulcers.

  
  
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  Inhalation.

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  Spores enter macrophages which then travel to regional lymph nodes, break open, release bacteria, replicate, and result in bacteremia and sepsis with high rates of mortality.

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  Clinical presentation.

  
  
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  Chest radiograph: widened mediastinum or large pleural effusion.

  
  
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  Positive blood cultures.

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  Ciprofloxacin or doxycycline for 60 d.

Botulism

Spore-forming bacteria found in soil, intentionally contaminated water or food, or aerosolization; toxins are most poisonous substance known to man.

Human contact with spores contaminated with Clostridium botulinum.

Gram-negative bacilli: Clostridium botulinum.

Three types: infantile/intestinal (70% of reported cases), food borne, and wound (rare).

Toxin affects presynaptic membranes, preventing acetylcholine release into the synaptic cleft, resulting in absence of depolarization of the postsynaptic membrane, and ultimately flaccid paralysis.

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  Clinical diagnosis, initially. Confirmatory tests sent to CDC or US Public Health laboratories.

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  Supportive care (ventilation if indicated).

  
  
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  Infant and young child management found in Section 6: Neurologic.

  
  
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  Antibiotics should not be administered; bacterial lysis may result in toxin release.

Smallpox

Smallpox has been used as a biological weapon for centuries.

Mortality rate 30%.

Hemorrhagic or flat forms: mortality 95%.

Encephalopathy is main complication.

DNA virus, Poxvirus variolae, a member of the orthopoxvirus family. Spread from person to person by aerosols and direct contact; caused by one of two viruses: variola major or variola minor.

Entering nose or oropharynx.

Symptoms: viremia, fever, toxemia, and rash. May be accompanied by malaise, myalgias, and gastrointestinal complaints.

Maculopapular lesions are predominant on the face (including oropharynx) and upper extremities, then spread to trunk and lower extremities in fewer numbers.

Become vesicular and pustular over several days.

Fluid collection from unroofed lesions or eschar.

Diagnosis with electron microscopy, viral culture, and staining. Specimen collection limited to those who have received vaccination.

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  Report to local and state health departments immediately.

  
  
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  Respiratory isolation.

  
  
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  Supportive care.

  
  
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  Protection of health care workers including laboratory personnel.

  
  
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  No available antiviral agent.

  
  
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  Cidofovir may be considered for postexposure prophylaxis.

Tularemia

Gram-negative coccobacillus:

Francisella tularensis.

Presents as a systemic illness without a focal lesion. Typically results in fever, headache, chills, nausea, vomiting, diarrhea. When associated with pneumonia, cough, pharyngitis, bronchiolitis, pneumonitis, or pneumonitis may be present.

Clinical presentation depends on method of exposure.

Seven types of clinical syndromes: pneumonic, typhoidal, ulceroglandular, glandular, oculoglandular, oropharyngeal, and septicemic.

Infection occurs when skin or mucous membranes come in contact with carcass or body fluids of an infected animal, through aerosolization or through contaminated food or water; also occurs through bite from infected tick or deer fly. Bacteria enter through skin, gastrointestinal tract, mucous membranes, or lungs and spread to local lymph nodes and multiply in macrophages, disseminating through the body.

Diagnosis is made through sputum culture, nasal pharyngeal swabbing, or secretions/exudates.

Antibodies are not reliable until approximately 2 wk after the onset of infection.

Signs of atypical pneumonia with pleural effusion or enlarged hilar lymph nodes may be noted on chest radiograph.

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  Streptomycin (medication of choice), gentamicin; alternatively, amikacin for 10 d.

  
  
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  Notification of local or state health departments.

  
  
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  Postexposure prophylaxis with doxycycline or ciprofloxacin for 14 d. Only for those with possible direct exposure to F. tularensis; not required for household contacts of infected patients.

Viral Hemorrhagic Fever

A group of RNA viruses (Filoviridae, Arenaviridae, Bunyaviridae, and Flaviviridae) that results in fever and bleeding diathesis.

This diverse group of viruses is highly contagious and is associated with high mortality rates.

Largely unknown.

All affect the vasculoendothelial system, though mechanism is unclear.

Abrupt fever, malaise, facial flushing, conjunctivitis, myalgia, petechiae, mucosal bleeding, vomiting, diarrhea, hemorrhage.

Spread by aerosols, tick bite, rodent feces, and secretions of infected animals.

Human-to-human spread for select diseases; have resulted in hospital outbreaks.

Laboratory studies demonstrate thrombocytopenia and coagulation dysfunction.

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  Supportive care.

  
  
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  Respiratory isolation.

  
  
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  Intubation and mechanical ventilation may be required in some cases.

  
  
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  Fluid resuscitation, blood products, vasopressor agents, and invasive monitoring are commonly required.

  
  
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  Monitor family members/close contacts for fever. Yellow fever vaccine is the only viral hemorrhagic fever (VHF)-approved vaccine.