Fong / Alibek Bioterrorism and Infectious Agents

A New Dilemma for the 21st Century
1. Auflage 2010
ISBN: 978-1-4419-1266-4
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 273 Seiten

Reihe: Emerging Infectious Diseases of the 21st Century

Compiled by two leading experts in the field, this volume provides a concise, timely, and authoritative review of some of the most problematic infections of the new century. It presents issues and new ideas for preventing and controlling infectious diseases.

Autoren/Hrsg.

Alibek, Kenneth

Fong, I. W.

Inhaltsverzeichnis

1;Contributors;6
2;Preface;8
3;Contents;9
4;Chapter 1;17
4.1;Anthrax: A Disease and a Weapon;17
4.1.1;1. History of Anthrax;17
4.1.1.1;1.1. Anthrax in the United States;19
4.1.2;2. Anthrax as a bioogical weapon;20
4.1.3;3. The organism;24
4.1.4;4. Pathogenesis of Anthrax infection;26
4.1.5;5. Clinical manifestation of Anthrax infection;29
4.1.5.1;5.1. Cutaneous Anthrax;30
4.1.5.2;5.2. Systemic Anthrax;30
4.1.5.2.1;5.2.1. General Symptoms of Anthrax Infection;31
4.1.5.2.2;5.2.2. Respiratory Symptoms and Findings;33
4.1.5.2.3;5.2.3. Neurological Symptoms and Signs;34
4.1.5.2.4;5.2.4. Cardiovascular Symptoms and Signs;35
4.1.5.2.5;5.2.5. Gastrointestinal Symptoms and Signs;35
4.1.5.2.6;5.2.6. Miscellaneous;36
4.1.5.2.7;5.2.7. Findings – Autopsies;37
4.1.6;6. Conssiderations on clinical manifestations of system Anthrax;39
4.1.7;7. Laboratory diagnosis;40
4.1.8;8. Vaccination;40
4.1.9;9. Postexposure prophylaxis;41
4.1.10;10. Treatment of Anthrax infection;41
4.1.11;11. Protection;44
4.1.12;12. Isolation;45
4.1.13;13. Afterward;45
4.1.14;Acknowledgments;45
4.1.15;References;45
5;Chapter 2;52
5.1;Plague as a Biological Weapon;52
5.1.1;1. History of Plague and Its Potential as A Weapon of Bioterrorism;52
5.1.1.1;1.1. Pandemic History and Epidemic Potential;52
5.1.1.2;1.2. Plague as a Weapon of Biological Warfare;53
5.1.1.3;1.3. US Countermeasures to Plague as a Weapon of Terrorism;54
5.1.1.4;1.4. Preparedness and Response to a Possible Plague Attack;55
5.1.2;2. Plague Microbiology and Pathogenesis;56
5.1.2.1;2.1. The Agent;56
5.1.2.1.1;2.1.1. General Characteristics;56
5.1.2.1.2;2.1.2. Molecular Genetics;57
5.1.2.2;2.2. Pathogenicity of Y. pestis;57
5.1.2.2.1;2.2.1. Virulence Factors;57
5.1.2.2.2;2.2.2. Pathology of Infection;58
5.1.3;3. Clinical spectrum;59
5.1.3.1;3.1. Bubonic Plague;59
5.1.3.2;3.2. Septicemic Plague;61
5.1.3.3;3.3. Pneumonic Plague;63
5.1.3.4;3.4. Other Clinical Syndromes;65
5.1.3.5;3.5. Pediatric Plague;65
5.1.3.6;3.6. Plague in Pregnancy;66
5.1.4;4. Diagnosis;66
5.1.4.1;4.1. Laboratory Diagnosis;66
5.1.4.1.1;4.1.1. Laboratory Response Capabilities;66
5.1.4.1.2;4.1.2. Collection and Processing of Specimens;67
5.1.4.2;4.2. Recognizing a Plague Outbreak Resulting from Intentional Release;68
5.1.4.3;4.3. Detection of Y. pestis in the Environment;68
5.1.5;5. Medical Management of Plague patients;70
5.1.5.1;5.1. Antimicrobial Treatment of Acute Illness in Naturally Occurring Plague;70
5.1.5.2;5.2. Postexposure Prophylaxis;72
5.1.5.3;5.3. Treatment of Cases and Case Contacts in a Bioterrorism Event;73
5.1.6;6. Infection control;75
5.1.6.1;6.1. Hospital Infection Control;75
5.1.6.2;6.2. The Role of Isolation and Quarantine;76
5.1.7;7. Prevention;77
5.1.7.1;7.1. Prevention and Control of Naturally Occurring Plague;77
5.1.7.1.1;7.1.1. General Guidelines;77
5.1.7.2;7.2. Plague Vaccine;78
5.1.8;8. Research directions;78
5.1.9;References;79
6;Chapter 3;86
6.1;Tularemia and Bioterrorism;86
6.1.1;1.Introduction;86
6.1.2;2. Microbilogy;87
6.1.2.1;2.1. Taxonomy;87
6.1.2.2;2.2. Virulence;88
6.1.3;3. Pathogenesis;89
6.1.3.1;3.1. Pathophysiology;89
6.1.3.2;3.2. Host Immunity;90
6.1.3.2.1;3.2.1. Humoral Immunity;90
6.1.3.2.2;3.2.2. Cellular Immunity;91
6.1.3.2.2.1;3.2.2.a. Early responses.;91
6.1.3.2.2.2;3.2.2.b. Cell-mediated immunity.;91
6.1.3.2.3;3.2.3. Immune Responses in the Lungs;92
6.1.4;4. Epidemiology;93
6.1.5;5. Clinical manifestation;95
6.1.5.1;5.1. Nonpneumonic Tularemia;95
6.1.5.2;5.2. Pneumonic Tularemia;97
6.1.5.3;5.3. Spectrum of Disease following Intentional Release of F. tularensis;98
6.1.5.4;5.4. Complications;99
6.1.6;6. Diagnosis;99
6.1.7;7. Treatment;101
6.1.7.1;7.1. Treatment of Endemic Tularemia;101
6.1.7.2;7.2. Treatment of Tularemia Resulting from Bioterrorism;103
6.1.8;8. Intection control;104
6.1.9;9. Prevention;105
6.1.9.1;9.1. Antibiotic Prophylaxis;105
6.1.9.2;9.2. Vaccination;106
6.1.10;10. Future direction;107
6.1.11;References;107
7;Chapter 4;114
7.1;Melioidosis and Glanders as Possible Biological Weapons;114
7.1.1;1. Introduction;114
7.1.2;2. History, Distribution, and Epidemiology;114
7.1.2.1;2.1. Melioidosis;114
7.1.2.2;2.2. Glanders;116
7.1.3;3. Microbiology and Pathogenesis;116
7.1.3.1;3.1. Taxonomy;116
7.1.3.2;3.2. Characteristics;117
7.1.3.2.1;3.2.1. General;117
7.1.3.2.2;3.2.2. Antigenic Structure;117
7.1.3.3;3.3. Ecology and Environmental Survival;119
7.1.3.4;3.4. Antibiotic Susceptibility;119
7.1.3.5;3.5. Genomics;120
7.1.3.6;3.6. Typing Systems;121
7.1.3.7;3.7. Bacterial Virulence;121
7.1.3.7.1;3.7.1. Endotoxin and Lipids;121
7.1.3.7.2;3.7.2. Capsule;122
7.1.3.7.3;3.7.3. Flagella;122
7.1.3.7.4;3.7.4. Exotoxins and Enzymes;122
7.1.3.7.5;3.7.5. Secretion Systems;123
7.1.3.7.6;3.7.6. Siderophores;123
7.1.3.7.7;3.7.7. Adhesion;123
7.1.3.7.8;3.7.8. Intracellular Growth;124
7.1.3.8;3.8. Host Defense;125
7.1.3.8.1;3.8.1. Humoral Immunity;126
7.1.3.8.2;3.8.2. Intrinsic and Cellular Immunity;126
7.1.3.8.3;3.8.3. Immunopathogenesis;127
7.1.4;4. Clinical spectrum;127
7.1.4.1;4.1. Melioidosis;127
7.1.4.1.1;4.1.1. Mild and Subclinical Infections;128
7.1.4.1.2;4.1.2. Latent Infections;128
7.1.4.1.3;4.1.3. Clinical Disease;128
7.1.4.2;4.2. Glanders;130
7.1.5;5. Animal models;131
7.1.5.1;5.1. Melioidosis;131
7.1.5.2;5.2. Glanders;132
7.1.6;6. Potential as a Biological weapon;132
7.1.6.1;6.1. Glanders;132
7.1.6.2;6.2. Melioidosis;133
7.1.7;7. Diagnosis and Treatment;134
7.1.7.1;7.1. Clinical Diagnosis;134
7.1.7.2;7.2. Laboratory Diagnosis;135
7.1.7.2.1;7.2.1. Microscopy and Culture;135
7.1.7.2.2;7.2.2. Serological Methods;137
7.1.7.2.3;7.2.3. Molecular Diagnosis;138
7.1.7.3;7.3. Treatment;139
7.1.7.3.1;7.3.1. General;139
7.1.7.3.2;7.3.2. Specific Chemotherapy;139
7.1.7.3.3;7.3.3. Adjunctive Treatments;141
7.1.7.3.4;7.3.4. Outcome and Follow-up;141
7.1.8;8. Infection control measssures;141
7.1.8.1;8.1. Secondary Spread and Isolation;141
7.1.8.2;8.2. Environmental Contamination;142
7.1.8.3;8.3. Antibiotic Prophylaxis and Vaccines;142
7.1.9;9. Future direction;143
7.1.10;References;144
8;Chapter 5;161
8.1;Smallpox as a Weapon for Bioterrorism;161
8.1.1;1.Introduction;161
8.1.2;2. Virology;161
8.1.3;3. Pathology;162
8.1.4;4. Clinic disease;163
8.1.5;5. Diagnosis;165
8.1.6;6. Epidemiology;167
8.1.6.1;6.1. Surveillance and Containment Strategy;167
8.1.7;7. Patient management and infection control;168
8.1.8;8. Potential as a bioweapon;169
8.1.9;9. Prevention;172
8.1.9.1;9.1 Vaccination policy;173
8.1.10;10. Future direction;175
8.1.11;References;176
9;Chapter 6;182
9.1;Hemorrhagic Fever Viruses as Biological Weapons;182
9.1.1;1. Introduction;182
9.1.2;2. Epidemiology;186
9.1.2.1;2.1. Filoviridae: Ebola and Marburg viruses;188
9.1.2.2;2.2. Arenaviridae: Lassa, Junin, Machupo, Guanarito, and Sabia;190
9.1.2.3;2.3. Bunyaviridae: Rift Valley Fever and Crimean-Congo Hemorrhagic Fever;192
9.1.3;Patient Management;193
9.1.3.1;3.1. Clinical Recognition;193
9.1.3.2;3.2. Laboratory Diagnosis;193
9.1.3.3;3.3. Treatment;194
9.1.4;4. Vaccines;196
9.1.5;5. Public Helth Measures;197
9.1.5.1;5.1. Infection Control;197
9.1.5.2;5.2. Environmental Decontamination;198
9.1.6;6. Ongoing Research and Proposed Agenda;199
9.1.7;7. Conclisions;199
9.1.8;8. Acknowledgments;200
9.1.9;References;200
10;Chapter 7;205
10.1;Botulism as a Potential Agent of Bioterrorism;205
10.1.1;1. Introduction;205
10.1.2;2. History of Botulism;206
10.1.3;3. Botulinum Toxin as a Weapon;207
10.1.4;4. Diagnosis;210
10.1.5;5. Treatment;212
10.1.6;6. Management;213
10.1.7;References;214
11;Chapter 8;217
11.1;Ricin: A Possible, Noninfectious Biological Weapon;217
11.1.1;1. Introduction;217
11.1.2;2. History;217
11.1.2.1;2.1. The Story of a “Death Umbrella”;218
11.1.3;3. The Toxin;220
11.1.3.1;3.1. Toxicity;221
11.1.4;4. Ricin as a Potential Bloweapon;222
11.1.5;5. Clinical Presentation;223
11.1.5.1;5.1. Prognosis;224
11.1.5.2;5.2. Diagnosis;224
11.1.6;6. Treatment;224
11.1.7;7. Prevention and Vaccine;225
11.1.8;8. Medical Use of Ricin;226
11.1.9;9. Conclusion;226
11.1.9.1;Acknowledgments;226
11.1.10;References;227
12;Chapter 9;229
12.1;Bioterrorism Alert for Health Care Workers;229
12.1.1;1 Introduction;229
12.1.2;2. Step 1. Maintain a Healthy "Index of Suspicion" (Or,"How to Recognize Illness Due to Bilogical Weapons");230
12.1.3;3. Setp2. Protect Thyself Frist;231
12.1.3.1;3.1. Physical Protection;232
12.1.3.2;3.2. Chemical Protection;232
12.1.3.3;3.3. Immunologic Protection (Including “Pros and Cons of Mass Vaccination”);233
12.1.4;4. Step 3. Save the Patient's Life ("The Primary Assessment");236
12.1.5;5. Step 4. Disinfect or Decontaminate as appropriate;236
12.1.6;6. Step 5. Establish a Diagnosis ("The secondary assessment");238
12.1.7;7. Step 6. Provide Prompt Therapy;238
12.1.8;8. Step 7. Institute Proper Infection Control Measures;240
12.1.9;9. Step 8. Alert the Proper Authorities ("Which Agency should One Notify for Suspicious Cases?");241
12.1.10;10. Step 9. Conduct an Epidemiologic Investigation (and Manage the Medical and Psychological Aftermath of Bioterror Attack);244
12.1.11;11. Step 10. Maintain a Level of Proficiency;245
12.1.12;Acknowledgments;246
12.1.13;References;246
13;Chapter 10;249
13.1;The Economics of Planning and Preparingfor Bioterrorism;249
13.1.1;1. Introduction;249
13.1.2;2. How Many Resources?: Basic Concept;249
13.1.3;3. Refining the Basic Concept:Being More Realistic;250
13.1.3.1;3.1. Cost of Deploying a Planned Intervention;251
13.1.3.2;3.2. A Special Case: Optimal Amount for Pre-event Protective Interventions;251
13.1.3.3;3.3. Example 1: Annual “Premiums” for Pandemic Influenza Preparations;253
13.1.3.4;3.4. Example 2: Annual “Premiums” to Reduce Probabilityof Losses Due to Anthrax Attack;254
13.1.4;4. Categories of Interventions;256
13.1.4.1;4.1. Postevent Medical Interventions (Reaction Interventions);258
13.1.4.2;4.2. Pre-event Medical Interventions (Reaction Interventions);258
13.1.4.3;4.3. Pre-event Protective Interventions: Reducing the Probability of Attack;259
13.1.4.4;4.4. Calculating the Savings in Post-event Interventions Due to Pre-event Interventions;259
13.1.5;5. Selecting Interventions for Evalution for Funding;260
13.1.6;6. Calculating the Number of Casualties and Casualties Averted;261
13.1.6.1;6.1. Types of Mathematical Models;261
13.1.6.1.1;6.1.1. Increasing Complexity;262
13.1.6.1.2;6.1.2. Deterministic Mathematical Models;262
13.1.6.1.3;6.1.3. Stochastic Models;263
13.1.6.2;6.2. Model Limitations;263
13.1.6.2.1;6.2.1. Size of Attack;263
13.1.6.2.2;6.2.2. Numbers Initially Infected and Implicit Assumptions;264
13.1.6.2.3;6.2.3. Why Not Use “Worst Case?”;264
13.1.6.3;6.3. Realistic Expectations and Keeping It Simple;265
13.1.6.3.1;6.3.1. Sensitivity Analyses and Policy Levers;265
13.1.7;7. Calculating the Value of Casualties and Other Losses Averted;266
13.1.8;8. Probability of anEvent Occurring;267
13.1.9;9. Selecting Between the Options ;268
13.1.10;10. Summary;268
13.1.11;References;269
14;Index;270