Bioterrorism and Infectious Agents: A New Dilemma for the 21st Century

464 Pages·2009·3.65 MB·English

by  Kenneth Alibek

Cover Page
Title: Bioterrorism and Infectious
©
Contributors
Preface
Contents
1 Anthrax: A Disease and a Weapon
2 Plague as a Biological Weapon
3 Tularemia and Bioterrorism
4 Melioidosis and Glanders as Possible Biological Weapons
5 Smallpox as a Weapon for Bioterrorism
6 Hemorrhagic Fever Viruses as Biological Weapons
7 Botulism as a Potential Agent of Bioterrorism
8 Ricin: A Possible, Noninfectious Biological Weapon
9 Bioterrorism Alert for Health Care Workers
10 The Economics of Planning and Preparing for Bioterrorism
1 Anthrax: A Disease and a Weapon
1. History of Anthrax
1.1. Anthrax in the United States
2. Anthrax as a bioogical weapon
3. The organism
4. Pathogenesis of Anthrax infection
5. Clinical manifestation of Anthrax infection
5.1. Cutaneous Anthrax
5.2. Systemic Anthrax
5.2.1. General Symptoms of Anthrax Infection
5.2.2. Respiratory Symptoms and Findings
5.2.3. Neurological Symptoms and Signs
5.2.4. Cardiovascular Symptoms and Signs
5.2.5. Gastrointestinal Symptoms and Signs
5.2.6. Miscellaneous
5.2.7. Findings – Autopsies
6. Conssiderations on clinical manifestations of system Anthrax
7. Laboratory diagnosis
8. Vaccination
9. Postexposure prophylaxis
10. Treatment of Anthrax infection
11. Protection
12. Isolation
13. Afterward
Acknowledgments
References
2 Plague as a Biological Weapon
1. History of Plague and Its Potential as A Weapon of Bioterrorism
1.1. Pandemic History and Epidemic Potential
1.2. Plague as a Weapon of Biological Warfare
1.3. US Countermeasures to Plague as a Weapon of Terrorism
1.4. Preparedness and Response to a Possible Plague Attack
2. Plague Microbiology and Pathogenesis
2.1. The Agent
2.1.1. General Characteristics
2.1.2. Molecular Genetics
2.2. Pathogenicity of Y. pestis
2.2.1. Virulence Factors
2.2.2. Pathology of Infection
3. Clinical spectrum
3.1. Bubonic Plague
3.2. Septicemic Plague
3.3. Pneumonic Plague
3.4. Other Clinical Syndromes
3.5. Pediatric Plague
3.6. Plague in Pregnancy
4. Diagnosis
4.1. Laboratory Diagnosis
4.1.1. Laboratory Response Capabilities
4.1.2. Collection and Processing of Specimens
4.2. Recognizing a Plague Outbreak Resulting from Intentional
Release
4.3. Detection of Y. pestis in the Environment
5. Medical Management of Plague patients
5.1. Antimicrobial Treatment of Acute Illness in Naturally
Occurring Plague
5.2. Postexposure Prophylaxis
5.3. Treatment of Cases and Case Contacts in a Bioterrorism
Event
6. Infection control
6.1. Hospital Infection Control
6.2. The Role of Isolation and Quarantine
7. Prevention
7.1. Prevention and Control of Naturally Occurring Plague
7.1.1. General Guidelines
7.2. Plague Vaccine
8. Research directions
References
3 Tularemia and Bioterrorism
1.Introduction
2. Microbilogy
2.1. Taxonomy
2.2. Virulence
3. Pathogenesis
3.1. Pathophysiology
3.2. Host Immunity
3.2.1. Humoral Immunity
3.2.2. Cellular Immunity
3.2.2.a. Early responses.
3.2.2.b. Cell-mediated immunity.
3.2.3. Immune Responses in the Lungs
4. Epidemiology
5. Clinical manifestation
5.1. Nonpneumonic Tularemia
5.2. Pneumonic Tularemia
5.3. Spectrum of Disease following Intentional Release of F.
tularensis
5.4. Complications
6. Diagnosis
7. Treatment
7.1. Treatment of Endemic Tularemia
7.2. Treatment of Tularemia Resulting from Bioterrorism
8. Intection control
9. Prevention
9.1. Antibiotic Prophylaxis
9.2. Vaccination
10. Future direction
References
4 Melioidosis and Glanders as Possible Biological Weapons
1. Introduction
2. History, Distribution, and Epidemiology
2.1. Melioidosis
2.2. Glanders
3. Microbiology and Pathogenesis
3.1. Taxonomy
3.2. Characteristics
3.2.1. General
3.2.2. Antigenic Structure
3.3. Ecology and Environmental Survival
3.4. Antibiotic Susceptibility
3.5. Genomics
3.6. Typing Systems
3.7. Bacterial Virulence
3.7.1. Endotoxin and Lipids
3.7.2. Capsule
3.7.3. Flagella
3.7.4. Exotoxins and Enzymes
3.7.5. Secretion Systems
3.7.6. Siderophores
3.7.7. Adhesion
3.7.8. Intracellular Growth
3.8. Host Defense
3.8.1. Humoral Immunity
3.8.2. Intrinsic and Cellular Immunity
3.8.3. Immunopathogenesis
4. Clinical spectrum
4.1. Melioidosis
4.1.1. Mild and Subclinical Infections
4.1.2. Latent Infections
4.1.3. Clinical Disease
4.2. Glanders
5. Animal models
5.1. Melioidosis
5.2. Glanders
6. Potential as a Biological weapon
6.1. Glanders
6.2. Melioidosis
7. Diagnosis and Treatment
7.1. Clinical Diagnosis
7.2. Laboratory Diagnosis
7.2.1. Microscopy and Culture
7.2.2. Serological Methods
7.2.3. Molecular Diagnosis
7.3. Treatment
7.3.1. General
7.3.2. Specific Chemotherapy
7.3.3. Adjunctive Treatments
7.3.4. Outcome and Follow-up
8. Infection control measssures
8.1. Secondary Spread and Isolation
8.2. Environmental Contamination
8.3. Antibiotic Prophylaxis and Vaccines
9. Future direction
References
5 Smallpox as a Weapon for Bioterrorism
1.Introduction
2. Virology
3. Pathology
4. Clinic disease
5. Diagnosis
6. Epidemiology
6.1. Surveillance and Containment Strategy
7. Patient management and infection control
8. Potential as a bioweapon
9. Prevention
9.1 Vaccination policy
10. Future direction
References
6 Hemorrhagic Fever Viruses as Biological Weapons
1. Introduction
2. Epidemiology
2.1. Filoviridae: Ebola and Marburg viruses
2.2. Arenaviridae: Lassa, Junin, Machupo, Guanarito, and Sabia
2.3. Bunyaviridae: Rift Valley Fever and Crimean-Congo
Hemorrhagic Fever
Patient Management
3.1. Clinical Recognition
3.2. Laboratory Diagnosis
3.3. Treatment
4. Vaccines
5. Public Helth Measures
5.1. Infection Control
5.2. Environmental Decontamination
6. Ongoing Research and Proposed Agenda
7. Conclisions
8. Acknowledgments
References
7 Botulism as a Potential Agent of Bioterrorism
1. Introduction
2. History of Botulism
3. Botulinum Toxin as a Weapon
4. Diagnosis
5. Treatment
6. Management
References
8 Ricin: A Possible, Noninfectious Biological Weapon
1. Introduction
2. History
2.1. The Story of a “Death Umbrella”
3. The Toxin
3.1. Toxicity
4. Ricin as a Potential Bloweapon
5. Clinical Presentation
5.1. Prognosis
5.2. Diagnosis
6. Treatment
7. Prevention and Vaccine
8. Medical Use of Ricin
9. Conclusion
Acknowledgments
References
9 Bioterrorism Alert for Health Care Workers
1 Introduction
2. Step 1. Maintain a Healthy "Index of Suspicion" (Or,"How to
Recognize Illness Due to Bilogical Weapons")
3. Setp2. Protect Thyself Frist
3.1. Physical Protection
3.2. Chemical Protection
3.3. Immunologic Protection (Including “Pros and Cons of Mass
Vaccination”)
4. Step 3. Save the Patient's Life ("The Primary Assessment")
5. Step 4. Disinfect or Decontaminate as appropriate
6. Step 5. Establish a Diagnosis ("The secondary assessment")
7. Step 6. Provide Prompt Therapy
8. Step 7. Institute Proper Infection Control Measures
9. Step 8. Alert the Proper Authorities ("Which Agency should One
Notify for Suspicious Cases?")
10. Step 9. Conduct an Epidemiologic Investigation (and Manage the
Medical and Psychological Aftermath of Bioterror Attack)
11. Step 10. Maintain a Level of Proficiency
Acknowledgments
References
10 The Economics of Planning and Preparingfor Bioterrorism
1. Introduction
2. How Many Resources?: Basic Concept
3. Refining the Basic Concept:Being More Realistic
3.1. Cost of Deploying a Planned Intervention
3.2. A Special Case: Optimal Amount for Pre-event Protective
Interventions
3.3. Example 1: Annual “Premiums” for Pandemic Influenza
Preparations
3.4. Example 2: Annual “Premiums” to Reduce Probabilityof
Losses Due to Anthrax Attack
4. Categories of Interventions
4.1. Postevent Medical Interventions (Reaction Interventions)
4.2. Pre-event Medical Interventions (Reaction Interventions)
4.3. Pre-event Protective Interventions: Reducing the Probability
of Attack
4.4. Calculating the Savings in Postevent Interventions Due to
Pre-event Interventions
5. Selecting Interventions for Evalution for Funding
6. Calculating the Number of Casualties and Casualties Averted
6.1. Types of Mathematical Models
6.1.1. Increasing Complexity
6.1.2. Deterministic Mathematical Models
6.1.3. Stochastic Models
6.2. Model Limitations
6.2.1. Size of Attack
6.2.2. Numbers Initially Infected and Implicit Assumptions
6.2.3. Why Not Use “Worst Case?”
6.3. Realistic Expectations and Keeping It Simple
6.3.1. Sensitivity Analyses and Policy Levers
7. Calculating the Value of Casualties and Other Losses Averted
8. Probability of anEvent Occurring
9. Selecting Between the Options
10. Summary
References
Index
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