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| TheAnthrax Spores which were sent through the U. S. Mail in 2001 were considered the first use of dangerous bioterrorist agents (virus) against the United States during this century. Other agents have been used in the past, however. These "Category A" agents are listed below. |
 otulism |
Microbiology (Name) |
 Botulism is a bacteria called Clostridium botulinum. The disease is caused by a toxin produced by these bacteria. |
| Precautions to take to prevent spreading the disease: |
Person to person contact does not spread the disease. Only standard precautions are necessary. Disease is spread by eating contaminated food. |
| Clinical Features (What the Infection looks like) |
Symptoms begin within 6 to 12 hours. They include double vision, blurred vision, drooping eyelids,slurred speech,  difficulty swallowing, and dry mouth. Muscle weakness starts with the muscles in the shoulders. Weakness progresses downwards through all the muscles, ending with the calf muscle. Breathing muscles become paralyzed. To prevent death, patient must be placed on a ventilator.
For Clinicians: Symmetric descending flaccid paralysis. Cranial neuropathies. Respiratory failure. Check gag & vital capacity. Remember the 4 D's:
Diplopia, Dysarthria, Dysphonia, & Dysphagia. |
| Diagnosis: |
Laboratory tests confirm illness. Serum (blood test), stool, toxin assay, and gastric aspirate tests are used. |
| Vaccinations: |
None are available. The CDC is currently investigating the use of 7 different botulism toxins. |
| Therapy: (Help in healing) |
Supportive care only. Elevate the head and watch breathing closely. Patient may aspirate (vomit) fluid into their lungs. In the hospital, patients are placed in the ICU and given a saline drip which includes a equine antitoxin. There is no antibiotic available. |
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 bola |
Microbiology (Name) |
 RNA Fiolvirus
There are more than 10 strains of the ebola virus. |
| Precautions to take: |
 Patients are quarantined. Responders must use a fit-tested N-95 (TB) mask or powered air-purifying respirators (as shown on the left). This mask also protects against SARS.The Ebola virus is spread person to person, not from air droplets. Therefore, in addition to the mask, other nursing barrier techniques such as face shields, rubber gloves, goggles, etc. are necessary. |
| Clinical Features (What the Infection looks like) |
The incubation period is 2 - 21 days after exposure. Red,  swollen eyes. High fever.
Lassa fever, an arena virus, is carried by the Mastomy Rat. Clinical signs and symptoms are similar to the Ebola Virus, however it belongs to a different genus. (Move your mouse over the photo on the right.) |
| Diagnosis: |
The virus is confirmed by laboratory tests. Two tests in particular: the ELISA (which is the same lab test used to detect the HIV/AIDS virus), and the PCR lab test. The PCR test separates the virus from the blood. |
| Vaccinations: |
There are no vaccinations available for Ebola. Vaccines are in the early stage of development.
For Clinicians: Ribavirin 30 mg/kg IV may be used for Lassa fever. Side effects are hemolytic anemia as well as neuropsychiatric changes.
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| Therapy: (Help in healing) |
Supportive care only. Patients who are hospitalized are placed in the ICU and monitored carefully. |
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 lague |
Microbiology (Name) |
Yersina pestis |
| Precautions to take: |
Highly contagious bacterium. Spreads by respiratory droplets released into the air from coughing or sneezing. Surgical masks help block the spread. N-95 masks are not required but helpful. Some type of protection mask is mandatory. Patients and close contacts should all use masks. |
| Clinical Features (What the Infection looks like) |
 Incubation period is 1-6 days. Symptoms include fever, cough, chest pain, skin lesions, respiratory failure, and shock. Death is a possibility if treatment is not begun within 24 hours of pneumonia symptoms. Rash (as shown on the right) is often called the "black death". It is caused by necrosis (death of the cells). |
| Diagnosis: |
Blood tests are used to diagnose plague. Sputum is also tested. Diagnosis can take several days. Therefore, medication may need to be given before the diagnosis is confirmed.
For Clinicians: Final DX may take several days. Call STAT for gram stain and culture (both at 28 and 37 degrees). Request PCR and fluorescent Ab test STAT.
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| Vaccinations: |
None. Masks must be used. |
| Therapy: (Help in healing) |
Streptomycin daily for 7 days. In some cases, doxycycline and ciprofloxacin may be given for 7 days. |
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 nthrax |
Microbiology (Name) |
 Bacillus anthracis
Long "Bamboo" or "Boxcar" rods |
| Precautions to take: |
Standard precautions. Anthrax is not spread person-to-person. |
| Clinical Features (What the Infection looks like) |
 Incubation period is 2 - 43 days after exposure. Flu like symptoms get progressively worse. As the disease progresses, shock and meningitis increases. Bacteria may be inhaled (breathed in) or cutaneous (break in the skin). Mouse over the photo on the right to view inhaled anthrax. Cutaneous anthrax is painless in the early stages. |
| Diagnosis: |
Blood test and nasal cultures are taken. Blood must be drawn before antibiotics are administered. Positive/negative results can be read in 24 hours.
For Clinicians: Nasal culture is Epi test only. Gram stain. IHC and PCR.
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| Vaccinations: |
3 doses of an FDA-licensed vaccine. Vaccine is not offered to the general public.
For Clinicians: FDA-licensed vaccine under (IND) protocol at 0,2,4 weeks.
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| Therapy: (Help in healing) |
Cipro is the drug of choice for Anthrax. Doxycycline and/or penicillin may also be used. Drugs are taken orally (by mouth) every day for 60 days.
Supportive care is also necessary as patient is very ill. |
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 mallpox |
Microbiology (Name) |
Variola is a DNA Virus which causes Smallpox. Variola IS NOT the virus used in the vaccination. Vaccinia, a distant cousin to Variola is used for immunization. Variola DOES NOT EVER cause smallpox. |
| Precautions to take: |
Smallpox is highly contagious. Patient must be isolated immediately. N-95 masks are necessary for patient, close contacts, and clinicians. All contacts MUST be vaccinated.
For Clinicians: Need Biosafety Level 4 at CDC. PCR, culture, electron microscopy. See the CDC rash, DDx algorithm.
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| Clinical Features (What the Infection looks like) |
 1-4 days after exposure patient has high fever, headache, backache, chills, vomiting and abdominal pain. Lesions (bumps) begin to appear. They are deep seated, firm, round, and hard. (When touched, they feel like bb's made for a bb gun which are covered by skin.) They all appear in the same stage of development on the face, arms, palms, soles of the feet, and trunk. Survival rate is only one third. Lesions leave deep scars, and survivors have permanent scarring. |
| Diagnosis: |
If lesions are present on the palm of the hands, and the soles of the feet, Smallpox is diagnosed. Blood tests will confirm diagnosis. If patient is immunized within 4 days of exposure, illness will be less severe. |
| Vaccinations: |
 Vaccina (the Cowpox virus) prevents smallpox. It is a live virus delivered to the patient with the use of a bifurcated needle. Because it is a live virus, it is not injected into the muscle as other immunizations are. Special care must be taken with the injection site, because the patient can "self-inoculate" themselves if they touch the virus, then touch another part of their body. |
| Therapy: (Help in healing) |
Supportive care only. Patient will be violently ill. Survival rate is low. Cidofovir, an antiviral drug, may be offered under an FDA Investigational New Drug protocal.
For Clinicians: Vaccinia Immunoglobulin (VIG) is not used for variola. VIG is useful for some (but not all) serious vaccine (Vaccinia) reactions such as eczema vaccinatum and generalized vaccinia.
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 ularemia |
Microbiology (Name) |
 Francisella tulrensis
Bacteria is difficult to see even under the microscope. |
| Precautions to take: |
Standard. Tularemia is not spread person to person. |
| Clinical Features (What the Infection looks like) |
Abrupt onset of fever, headache, chills,  sore throat, and generalized body aches within 1 - 2 days after incubation period. Lungs may be infected, and if so, illness may progress to pneumonia. Sores (ulcers) may form at bite site. (Mouse over the photo on the right to view ulcer.) |
| Diagnosis: |
Blood and sputum tests are used to diagnose. Bacteria is cultured in a lab.
For Clinicians: Antigen, detection assays, polymerase, chain reaction, immunoblotting, and other specialized techniques may be used. Gram stain culture. (DFA), ELISA, PCR, & CXR for broncho-pneumonia.
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| Vaccinations: |
None.
For Clinicians: Post exposure doxycycline or ciprofloxacin for 14 days.
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| Therapy: (Help in healing) |
Supportive care. Antibiotics are used to treat tularemia. Patients begin have symptom relief with 48 hours after antibiotics are administered. In a contained setting, streptomycin or gentamicin may be administered for 10 days. |
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These posters are also available at the Tooele County Health Department. If you would like a laminated poster, please contact the health department. |
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Tooele County 
