Terrorism Biological Agents

Anthrax

Etiology: Bacterial (Bacillus anthracis)

Signs and Symptoms: Initial flu-like symptoms (fever, muscle ache, cough, chest pain), which rapidly (over days) progress to severe respiratory difficulty and shock. Cutaneous anthrax is marked by a boil-like lesion that typically forms an ulcer with a black center.

Onset: Within 7 days, but most cases occur within 48 hours; inhalation can take as long as 6 weeks.

Transmission: Cutaneous and inhalation.

Communicability: Inhalation anthrax cannot be transmitted from person to person. On rare occasions, cutaneous anthrax can spread via direct contact with an open sore.

Prognosis: Inhalation anthrax is usually fatal if not treated immediately. Cutaneous is less fatal, but still requires prompt treatment.

Treatment: Ciprofloxacin or doxycycline.

Prevention: Currently, a vaccine is available only to people in high-risk areas such as military personnel.

Botulism

Etiology: Botulism is a muscle-paralyzing disease caused by a toxin made by a bacterium called Clostridium botulinum.

Signs and Symptoms: Double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, muscle weakness that always descends through the body: first shoulders are affected, then upper arms, lower arms, thighs, calves, etc. Paralysis of breathing muscles can lead to respiratory arrest.

Onset: Symptoms begin within 6 hours to 2 weeks (most commonly between 12 and 36 hours) after eating toxin-containing food.

Transmission: Botulism is transmitted by eating food contaminated with the botulinum toxin.

Communicability: Not spread from person to person.

Prognosis: Most Pts recover after weeks to months of supportive care.

Treatment: Antitoxin is available and will reduce the severity of the symptoms if administered early.

Prevention: No vaccine available.

Plague

Etiology: Bacterial (Yersinia pestis).

Signs and Symptoms: Fever, cough, chest pain, hemoptysis.

Onset: 1–3 days for inhaled aerosol exposure; 2–8 days for flea-borne transmission.

Transmission: Person-to-person contact and direct contact with bodily fluids and contaminated objects. May be dispersed by intentional release of an aerosol form of plague.

Communicability: Pts are contagious until they have completed 72 hours of antibiotic treatment.

Prognosis: Fatal if not treated.

Treatment: Doxycycline (1st choice); ciprofloxacin (2nd choice).

Prevention: No vaccine available.

Smallpox

Etiology: Viral (Variola virus, of the genus Orthopoxvirus).

Signs and Symptoms: Skin lesions quickly appear, progressing from macules to papules to vesicles. Other symptoms include fever, myalgia, and rash. Note that the smallpox rash is more prominent on the head and extremities, whereas chicken pox is more concentrated around the trunk.

Onset: 7–17 days (the average onset is 12 days).

Transmission: Person-to-person contact and direct contact with bodily fluids and contaminated objects.

Communicability: From onset of rash until lesions have scabbed over and fallen off (approximately 3 weeks).

Prognosis: About 30% fatality rate.

Treatment: Supportive care only.

Prevention: Vaccine available.

Chemical and Nerve Agents

Mustard Gas

Signs and Symptoms:

■ Itching and urticaria followed by blistering.

■ Irritation of eyes, including pain, swelling, and tearing.

■ Runny nose, epistaxis, sneezing, hoarseness, coughing, and shortness of breath.

■ Abdominal pain, diarrhea, fever, nausea, and vomiting.

Onset: 2–24 hours after exposure.

Transmission Route: Skin contact, eye contact, or breathing.

Communicability: Not communicable.

Prognosis: Usually not fatal.

Treatment: Remove mustard residue from the body by blotting and then washing with soap and water. Treat effects of exposure as clinically indicated. No antidote is available.

Sarin Gas

Signs and Symptoms: Runny nose, sweating, blurred vision, headache, difficulty breathing, drooling, nausea, vomiting, ↑urination,

↑defecation, muscle cramps and twitching, confusion, convulsions, paralysis, and coma.

Onset: Within seconds of exposure.

Transmission Route: Skin/eye contact, inhalation, ingestion.

Communicability: Not likely after decontamination.

Prognosis: Can be fatal within 15 minutes of exposure.

Treatment: Antidote → Atropine 2–6 mg IM. Remove from source, remove and double-bag clothing, wash skin with soap and water, and irrigate eyes with water for 10–15 minutes. Do not induce vomiting.

VX Nerve Agent

Signs and Symptoms: Runny nose, sweating, blurred vision, headache, difficulty breathing, drooling, nausea, vomiting, ↑urination, ↑defecation, muscle cramps and twitching, confusion, convulsions, paralysis, and coma.

Onset: Within seconds to hours of exposure.

Transmission Route: Skin/eye contact, inhalation; ingestion is possible, but unlikely.

Communicability: Contaminated clothing can release VX for approximately 30 minutes after exposure.

Prognosis: Mild to moderate exposures usually recover within 1–2 weeks; however, severe exposure is usually fatal.

Treatment: Antidote → Atropine 2–6 mg IM. Remove from source, remove and double-bag clothing, wash skin with soap and water, and irrigate eyes with water for 10–15 minutes. Do not induce vomiting.