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Biological Terrorism

HARRT 2004

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 Anthrax (Inhalational)

Bacillus anthracis Early Symptoms/Signs

Fever, Malaise,Fatigue, Chills,Myalgia

Cough Delayed Symptoms/Signs

Stridor  Dyspnea Pleural Effusions Respiratory Distress

Chest Pain Edema Abdominal Pain !"

#ype

Delayed Symptoms/Signs$%ontinued& Meningitis $'emorrhagi%

CSF in ()*&

Septi% Sho%+ Painless e%roti% -l%ers

.ith la%+ ase DermalConta%t

Classi% Symptoms/Signs 0"DEED MED"AS#"-M

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 Anthrax (Inhalational)

Bacillus anthracis Bioterrorism Mode of Dissemination:

 Aerosol (!"taneo"s#)

Inc"$ation %eriod: &'d

("s"all *ithin 4+h)

D"ration of Illness: Das

,ethalit: High (+0'-0.)

Transmissi$ilit: ,o*(c"taneo"s Anthrax

onl)

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/l" s1 Anthrax

(lo* ris 3o3"lation)(MMR 200&5 60(44):-+4'-+)

7asal congestion8rhinorrhea: Thin fl" not

anthrax

!9R a$normal# ' !onsider !T to r8o mediastinal3atholog

Ds3nea chest discomfort 3le"ritic 3ain: Thin

anthrax

Ra3id fl" tests: 7ot hel3f"l1

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Mass creening for Inhalational

 Anthrax: ,essons ,earned Ann Intern Med 200;5 &;-:;;<;46

o"rces: 2+ cases of inhalationalanthrax (&-20'200&)5 2<2 cases ofinfl"en=a > &-;2 cases onnoninfl"en=a iral res31 disease

Res"lts: /eer8co"gh don?t discriminate  Anthrax:

7onheadache ne"rologic sx(,@! conf"sion $l"rredision di==iness)

Ds3nea 7a"sea or omiting  A$normal l"ng so"nds

iral res31 tract infection: Rhinorrhea ore throat

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ExposedPatients

Any nonheadacheNeurologicSymptoms?

Any dyspnea orNausea/vomiting or

Abnormal lungExam?

Consider sending To hospital for

e!nitive Testing "#nitiation

$f therapy

Any rhinorrhea orSore throat?

Consider to home %ithProphylactic

Antibiotics and&ollo%'up instructions

N$

N$

 (ES

N$

 (ES

&ever/chills orCough?

N$

 (ES

 (ES

$ne ScreeningProtocolAnn #ntern )ed

*++,-.,0,,1',23

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&0 confirmed8s"s3ected inhalational

anthrax cases(MMR 200&5 60(4;):-4&'-4+)

Median age1 (2 yr3

Age range1 4565 yr3

Se71 6 males

"3P31 6d $range1 (88d&

Fever1 9 S.eats/%hills1 2

Malaise1 :

Cough1 9

Chest dis%omfort/pleuriti% pain1 :

Abdominal pain, ;<1 (

Dyspnea1 6 'eada%he1 (

Myalgias1 4

Sore throat1 =

0C1 0>/slight in%rease

C?R/C#1 Pleural effusions

$6&, infiltrates $6&,

mediastinallymphadenopathy

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Inhalational anthrax case

re3ort 28 year old female

@%t3 =(1 Malaise, myalgias

@%t3 =2=61 Dyspnea, %hestdis%omfort, produ%tive

%ough, bloody sputum @%tober =:1 #o ER in

respiratory distress fever,.idened mediastinum andbilateral pleural effusions onC?R

@%t3 581 Death MM0R =))81 () $45& 948:3

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The

Connecticut

Case

12

3

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!"taneo"s anthrax case reie* (&&)(MMR 200&5 60(4;):-4&'-4+)

I1%1: 6d (Range: &'&0d)

,ocation: /orearm nec chest fingers

%rogression: %a3"le esicle

"lcer $lac eschar 

%ainless *ith tingling or 3r"ritic sensation ,ethalit (historicall): 20.

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7 month old New Yorker with

 microangiopathic hemolytic

anemia, thrombocytopenia,

renal insufficiency

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!"taneo"s anthrax case re3ort

;4 ear old male@ct1 &2'&6: Handling mail

@ct1 &-: mallerthemato"s 3r"ritic3a3"le on left forearm

@ct1 &-'20: esicle@ct1 22'26: Increasingl

larger eschar *itherthema edema andind"ration