FMMS PRIMER ON BIOTERRORISM

The most likely agents are:

• Bacillus anthracis (anthrax).
• Yersinia pestis (plague); pulmonary syndrome.
• Francisella tularensis (tularemia); pulmonary syndrome.
• Variola (smallpox).
• Clostridium botulinum (botulism).
• Viral hemorrhagic fevers: Ebola, Marburg, Lassa, etc…

The most common syndromes are:

• Acute respiratory distress with fever.
• Influenza-like illness.
• Gastrointestinal illnesses.
• Skin lesions.
• Acute onset neuromuscular symptoms/signs.

Clues to unnatural occurrences of infections are:

• An unusual increase in numbers of patients presenting with a similar syndrome.
• A large number of fatal cases.
• Clusters of an illness from a single locale or temporally related.
• Any infection that is non-endemic in Fresno-Madera.
• Common infections occurring during unusual seasons (i.e. influenza in San Diego in summertime).
• Increase in sick or dead animals.
• Intelligence information.

Bioagents versus the Flu

• As several of the bioagents may produce febrile illnesses with respiratory symptoms/signs that could be confused with influenza, during the annual influenza season in Fresno-Madera (December - March) the clinician should consider performing specific, diagnostic tests for the presence of influenza virus or antigen.
• Several rapid diagnostic tests are commercially available and can be performed on sputum samples.
• Viral isolation is also available and may assist in the management of these patients and others in the community (i.e. use of specific anti-influenza medications and vaccine optimization).
• Negative rapid tests do not exclude influenza as a diagnosis, but a positive test will reassure you and the patient.
• Remember to give Flu vaccines, where indicated by the CDC guidelines.

Bioagent-Specific Infection Control Measures

• Anthrax   Standard Precautions.
  • Pulmonary infection is NOT transmitted person to person.
  • Cutaneous infection can be transmitted by drainage.
• Smallpox  Airborne Precautions (like tuberculosis).
• Plague     Droplet Precautions (standard masks for 72 hours after Rx).
• Botulism   Standard Precautions.
• Tularemia Standard Precautions.
• Hemorrhagic Fever Standard Precautions, Airborne Precautions, Droplet Precautions and Contact Precautions to avoid exposures due to excessive hemoptysis, or hemetemesis.
  • Treat blood stained material as infectious.