Practical Practitioner
By: Pamela Egan, FNP-C CDE
Bioterrorism Illness Similar to the Flu
The majority of questions these past few weeks have focused on how to recognize bioterrorism-related illnesses. The syndromes of prime concern include Anthrax, Botulism, Smallpox, Plague and Tularemia. Many of the symptoms are similar to influenza, which is why health authorities are recommending that everyone get the influenza vaccine this year.
Plague is a severe, potentially fatal infection that is caused by the bacterium Yersinia pestis (also called Pasteurella pestis). It occurs primarily in wild rodents (rats, mice, squirrels) but can be transmitted to humans. Three are two main forms of plague that affect humans: bubonic plague, which results from the bite of an infected animal flea: and primary pneumonic plague which results from inhaling droplets breathed by infected people. Both forms of plague are now rare.
The symptoms of bubonic plague include a variable incubation period, which is usually between two and eight days, there is a sudden onset of repeated shivering attacks, and the patient’s body temperature rises to over 104 Fahrenheit. The lymph nodes become swollen and painful, and the patient may become delirious. The death rate in untreated patients is higher than 50 percent, with most deaths occurring within about five days.
In the case of bioterrorism, it is felt that symptoms would be those of primary pneumonic plague. After an incubation period of about two days, there is a sudden onset of high fever, chills, and headache. There may also be increasing breathlessness and coughing with foamy, bloodstained sputum. Most untreated patients die within about two days. Diagnosis is confirmed through sputum, blood or lymph node aspirant cultures. Immediate treatment can be lifesaving. Both forms of plague are treated with large doses of antibiotics. The patient must be isolated to prevent the spread of infection. Prompt treatment usually alleviates the symptoms rapidly and enables most patients to survive the infection. The treatment of choice is streptomycin. Prevention of spread includes isolation for the first 48 hours of treatment. In mass casualty settings and post exposure prophylaxis, oral doxycycline or ciprofloxin are recommended.
Rodent control and the use of insect repellents to reduce the incidence of flea bites. All persons traveling to India or Southeast Asia should be immunized against plague. Anybody who has been in contact with an infected person should be treated with antibiotics immediately.
Tularemia, also known as rabbit fever, is an infectious disease that is caused by the bacterium Francisella tularensis. The bacteria can penetrate unbroken skin, and most cases of tularemia result from handling infected wild animals, particularly rabbits. Occasionally, infection may result from eating undercooked meat from a diseased animal or from the bite of an infected tick.
After an incubation period of about one-week, there is a sudden onset of high fever, headache, nausea, vomiting, and extreme weakness. A day or two later, an inflamed nodule appears at the site of the infection. The nodule ulcerates rapidly, and additional ulcers may appear near the mouth or eye. The lymph glands around the site of infection may become swollen, ulcerate, and discharge pus. The patient may develop a skin rash or pneumonia at any time during the illness, which usually lasts three or four weeks.
A man-made aerosolized form could present with acute fever, progressing to sore throat, bronchiolitis, pneumonia, and inflammation of the lungs and lymph node infection. Complications include sepsis, meningitis, pericarditis (infection in the heart), perisplenitis (infection in the spleen) or osteomyelitis (bone infection). If contaminated food is ingested, gastrointestinal symptoms may occur with subsequent enlarged spleen, stupor and delirium. Treatment with streptomycin or tetracycline is effective in most cases. The patient should undergo the full course of treatment to prevent relapse.
PamelaEgan.com > Health Articles > Disease
