BIOTERRORISM

terroristic activities in which biological substances/weapons are used to kill or cause

harm to other people
biological weapons include chemicals, radiations, or any organism such as bacteria,
viruses, or fungi or toxin found in nature
POSSIBLE BIOLOGICAL WARFARE AGENTS
Bacteria
Bacillus anthracis (anthrax)
Yersinia pestis (plague)
Francisella tularensis (tularemia)
Brucella species (brucellosis)
Coxiella burnetii (Q fever)
Viruses
Variola virus (smallpox)
Equine encephalitis viruses (viral equine encephalitides)
Arenaviruses, bunyaviruses, filoviruses, flaviviruses (hemorrhagic fevers)
Toxins
Staphylococcal enterotoxin B
Ricin
Botulinum toxins
Trichothecene mycotoxins
Saxitoxin

*The common thread among all diseases is the entry of AGENTS into the body
Most common routes of entry of agents into the body are
Inhalation: vapor, aerosol, solid
Absorption: liquid, vapor, solid
Ingestion: solid, liquid
Injection: liquid

HISTORY of BIOTERRORISM
400 BC - Scythian archers infected their arrows 14th century AD - the attacking Tatar forces
by dipping them in decomposing bodies or in
hurled plague-infected corpses into the Kaffa
blood mixed with manure
city in an attempt to cause an epidemic within
enemy forces.
300 BC - Persian, Greek, and Roman used to
contaminate wells & other sources of water
1710 - when the Russians besieging Swedish
forces at Reval in Estonia catapulted bodies of
190 BC in Battle of Eurymedon, Hannibal
people who had died from plague.
won a naval victory over King Eumenes II of
Pergamon by firing earthen vessels full of
18th century AD - British forces under the
venomous snakes into the enemy ships.
direction of Sir Jeffrey Amherst gave blankets
that had been used by smallpox victims to the
12th century AD - In battle of Tortona,
Native Americans in a plan to spread the
Barbarossa used bodies of dead &
disease
decomposing soldiers to poison wells.
HISTORY (Modern times, 1900s)
World War I - the German Army developed
anthrax, glanders,cholera, and a wheat fungus
to spread plague in Russia, infected mules with
glanders in Mesopotamia, and attempted to do
the same with the horses of the French Cavalry.

1951-1954 - harmless organisms were released

off both coasts of the United States to
demonstrate the vulnerability of American
cities to biological attacks.

The Geneva Protocol of 1925 was signed by

108 nations. This was the first multilateral
agreement that extended prohibition of
chemical agents to biological agents.
Unfortunately, no method for verification of
compliance was addressed.

1966 - a test substance was released in the New

York City subway system.
Vietnam War - Viet Cong guerrillas used
needle-sharp punji sticks dipped in feces to
cause severe infections after an enemy soldier
had been stabbed

World War II - Japanese forces operated a

secret biological warfare research facility (Unit
731) in Manchuria that carried out human
experiments on prisoners. They exposed more
than 3000 victims to plague, anthrax, syphilis,
and other agents

1979 - accidental release of anthrax from a

weapons facility in Sverdlovsk, USSR, killed at
least 66 people. The Russian government
claimed these deaths were due to infected meat,
and maintained this position until 1992 Russian President Boris Yeltsin finally admitted
to the accident
1985 - Iraq began producing anthrax,
botulinum toxin, and aflatoxin. 751 people
were intentionally infected with Salmonella in
Oregon.

1942-1944 - the US formed the War Research

Service. Anthrax and botulinum toxin initially
were investigated for use as weapons,
stockpiled to allow unlimited retaliation if the
German forces first used biological agents. The
British also tested anthrax bombs for the same 1994 - a Japanese sect of the Aum Shinrikyo
reason.
cult attempted an aerosolized (sprayed into the

air) release of anthrax from the tops of

buildings in Tokyo.

2002 - 6 terrorist suspects were arrested in

Manchester, England cause of "ricin
laboratory."

1995 -2 members of a Minnesota militia group

were convicted of possession of ricin, for use in
retaliation against local government officials.
2003 - British police found traces of ricin,
Chechen separatist plan to attack the Russian
1996 - an Ohio man attempted to obtain
embassy with the toxin
bubonic plague cultures thru mail.
2004 - 3 US Senate office buildings closed after
2001 - anthrax delivered by mail to US media the toxin ricin found in mailroom of Senate
& government offices caused 4 deaths.
Majority Leader Bill Frist's office.
BIOLOGICAL WARFARE AGENTS
CHEMICAL AGENTS
Are available and well-known
Can exists in an aerosol, gas (vapor), liquid, or solid state
Can cause major injury and death, and result in panic and social disruption
Includes nerve agents, vesicants, blood agents, and pulmonary agents
NERVE AGENTS
odorless, colorless, and volatile liquids in their pure form (organic phosphorus pesticides,
carbamate pesticides, sarin, soman, tabun, VX)
absorbed through the mucous membranes by inhalation and thru the skin
Produces symptoms sec-min (inhaled), min-hr (skin absorbed)
EFFECTS:
prevents proper functioning of the nervous system
hyperexcitability of the nervous system
Signs & Symptoms:
Miosis, Visual disturbances, Substernal spasm, Indigestion, Rhinorrhea,
Brochospasm/laryngeal spasm, Bradycardia, AV block, copious secretions, apnea
(PARASYMPATHETIC overactivity)
Increased GI motility, Nausea & vomiting, Diarrhea, Salivation, Lacrimation (Increase
PARASYMPATHETIC tone or overstimulation)
Confusion, forgetfulness, insomnia, impaired judgment, depression, irritability, loss of
consciousness, seizures, apnea (Penetration of blood-brain barrier by nerve agents)
Weakness, fasciculations (Prolonged stimulation of receptors at the neuromuscular
junction)
D iarrhea, U rination, M iosis, B bronchospasm, B radycardia, E mesis, L
acrimation, S alivation

Diagnostic Tests:
ABGs: assess ventilation
Cardiac telemetry: detect arrhythmias
EEG in unresponsive clients: detects nonconvulsive status epilepticus
Treatment & Management:
Decontamination: large amount of soap and water or saline solution for 20 min, dont
wipe
Maintain airway
Suction frequently
IV atropine 2-4 mg then 2 mg every 3-8 min up to 24 hrs treatment
Pralidoxine 1-2 mg in 100-150 mL NSS given over 15-30 min; activates cholinesterase
Diazepam (valium)
What can harm the client?
recontamination
coma

Resp. distress
MI

VESICANTS
Colorless or yellowish/brown chemicals that cause blistering (lewesite, phosgene,
nitrogen mustard, sulfur mustard)
Typically persistent oily liquids that can cause symptoms from within sec (lewisite,
phosgene) to 24-36 hrs (mustard)

Cause cellular damage or death within minutes when absorbed

Eyes, skin, & resp. tract are most affected

Signs & Symptoms:

Skin exposure: burn, erythema, vesicles, cancer
Respiratory: purulent discharge, cough, violent sneezing, copious mucus production,
obstructed airways, recurrent infxns, lung fibrosis, asmatic bronchitis, upper airway
cancers
Eye exposure: pain, photophobia, lacrimation, decreased vision, conjunctivitis, corneal
ulcer, corneal edema
GI: n/v, bloody diarrhea, constipation, upper GI bleeding
*Protect yourself by wearing personal protective equipment (PPE)
Diagnostic Tests:
Urinalysis: identify metabolite
Serum WBC: falls several days
Chest X-ray

Pulse oximetry
ABG
Stool for occult blood

Treatment & Management:

Maintain airway
Rapid decontamination
Eye irrigation
Topical or systemic antibiotics
Lubricating ointment to eyelids
Dark glasses
Bronchodilators & steroids
What can harm the client?
secondary bacterial infxn
laryngospasm
hemorrhagic pulmonary edema

O2 assisted ventilation
Intubation
Bronchoscopy & suctioning
Dimercaprol (BAL in oil) IV
Analgesics
Topical antibiotics
Topical antipruritics

resp. failure
Bone marrow suppression
Sepsis

BLOOD AGENTS
Highly volatile chemicals that present as colorless gas or liquids (arsine, carbon
monoxide, cyanogen chloride, cyanide, sodium monoflouroacetate)
Absorbed thru vapor inhalation or ingestion, wet skin (cyanide)
Onset of Symptoms 10-15 sec to min
Cause:
failure of central resp. drive
(cyanide/CO)

renal failure (arsine)

Signs & Symptoms:

Cyanide
Rapid pulse, profound hypotension, pink skin (initial) to cyanosis, deep resp. to dyspnea
to gasping then cessation of resp., n/v, excited (initial) to depression, giddiness, irrational
behavior, ataxia, convulsions, possible coma, weak, drowsy
Arsine
Abdominal pain, bloody urine, jaundice
Initial Sx: thirst, shivering, malaise, weakness, dizziness, dyspnea, abdominal & back
pain, hepatomegaly, n/v
Diagnostic Tests:
CBC: (+) anemia
ABG: metabolic acidosis
Urinalysis: (+) hematuria & protein

Serum globulin, CPK, lactate, & liver

enzymes: elevated
PT time: prolonged

Treatment & Management:

Decontamination
Respiratory support: intubation & ventilator
Amyl nitrite pearls crushed & placed in ventilator reservoir: antidote for cyanide; relaxes
blood vessels & increases blood supply
Sodium nitrite 300 mg IV slowly greater than 5 min: preferred treatment for cyanide
poisoning

Sodium thiosulfate 12.5 g IV over 10 min: antidote for cyanide & the only med given to
patient with CO poisoning when concomitant cyanide poisoning is suspected
What can harm the client?
resp. arrest
coma
Sepsis
cardiac arrest
PULMONARY AGENTS
gases or volatile liquids absorbed thru the body primarily thru inhalation, although
mucosal & dermal absorption is possible (ammonia, bromine, chlorine, HCl, methyl
bromide, methyl isocyanate, osmium tetroxide, phosgene, phosphine, phosphorus, &
sulfuryl flouride)
S/Sx appear in sec-min.
Cause:
alveolar-capillary membrane disruption
O2 reduction fluid fills interstitium & alveoli
Signs & Symptoms:
Pulmonary edema
Rales
Cough
Pulmonary edema leading to
Dyspnea
intravascular depletion resulting to
Chest discomfort to tightness
hypotension
Hypoxemia
Diagnostic Tests:
O2 sat
ABG
Chest X-ray
Treatment & Management:
Decontamination
Beta 2 agonists
Restore & maintain airway
Suction excess secretions
Administer O2
Corticosteroids
What can harm the client?
resp. arrest
cardiac arrest
recontamination
RADIATION
Acute radiation syndrome is the major illness associated with radiation exposure
Thorough decontamination should be performed to all exposed clients
Limit yourself from exposure to radiation
Minimize time spent near radiation sources
Maximum practical distance should be maintained
Use shielding sources
Acute Radiation Syndrome
Occurs as a result of high dose of radiation exposure (min. 100 rad)
Determinants of radiation sickness
Degree of exposure
Genetics
Pre-existing state of health
Sex
Age
6

Cause:
Invisible exposure to radiation
external irradiation: radiation passes completely through the body; not a medical
emergency- client not radioactive
Contamination: gases, liquids, or solids are exposed to body externally or internally;
requires immediate medical mgt to prevent incorporation
Incorporation: radioactive material is taken up by the cells, tissues, & susceptible organs
kidneys, bone, liver, & thyroid; requires immediate medical mgt to decontaminate &
administer treatment
Signs & Symptoms:
Hematologic: hemolysis, neutropenia, thrombocytopenia, spleen & lymph nodes atrophy,
lethargy, anorexia, n/v, hemorrhage, fever, sepsis
GI: vomiting, bloody diarrhea, fluid loss, electrolyte imbalance, shock, sepsis,
opportunistic infections, fever
CNS: cerebral edema, n/v, headache, tremors, ataxia, shock, increased ICP,
cardiovascular collapse
Skin: erythema, radiation dermatitis, necrosis
Trauma 2o to radiation blast: burn, crushing injury, severed limbs
*Protect yourself by wearing personal protective equipment (PPE)
Diagnostic Tests:
Monitor CBC
Urinalysis
Swab body orifices & wounds
Treatment & Management
Secure ABCs
Treat major trauma, burns & resp.
injury
Decontamination
GI symptoms: IVF replacement,
antiemetics, antidiarrheal,
prophylaxis for GI ulcerations
What can harm the client?
resp. distress
cardiovascular collapse
kidney failure

24-hr urine & feces collection

ABG

Prevention & treatment of infections

in neutropenic patients
RBC or Platelet transfusion
Psychological support
Comfort measures/pain mgt
Consult with radiation, hematology,
radiotherapy experts for prognosis &
treatment

coma
cancers
PTSD

ANTHRAX (Bacillus Anthracis)

Naturally occuring spore that lives throughout the world
Spores are very resistant to drying, heat, & UV radiation, & can survive for decades
Causes shock & death when host is infected
Caused by replicating bacteria that release toxins resulting in hemorrhage, edema, &
necrosis
Incubation period: 1-6 days
Method of infection: skin contact, inhalation, GI ingestion
Signs & Symptoms:
Skin contact: edema, pruritis, macule, papule, ulceration, vesicle, painless eschar
GI ingestion: fever, n/v, abdominal pain, bloody diarrhea, ascites, sepsis
Inhalation: mimic flu symptoms (fever, malaise, cough, & myalgia), advanced (bloodtinged sputum, dyspnea, pleuritic pain, n/v, chest heaviness, hemorrhagic pleural
effusion, shock, death)
Diagnostic Tests:
Culture results
Chest X-ray
Treatment & Management:
Maintain airway
Provide supplemental Oxygen
Antibiotics penicillin, erythromycin, chloramphenicol, gentamicin, or doxycycline:
death can be prevented if antibiotics are given within 24 hrs after exposure
*After death, patients should be cremated to prevent the survival of spores that can cause threat
to morticians & forensic medicine personnel
SMALL POX
DNA virus
Caused by variola virus
Incubation period: 12 days (7-17 days)
Extremely contagious & is spread by direct contact
Signs & Symptoms:
High fever, malaise, headache, backache, abdominal pain, delirium
Maculopapular rash on face, mouth, & forearms; rash progresses to trunk & becomes
vesicular & pustular
Dusky erythema, petechiae, hemorrhage of skin & mucous membranes, death
Diagnostic Tests:
Wound sample
CBC
Treatment & Management:
Decontamination of clients room
Isolation
Antibiotics
Cremation
Antiviral
What can harm the client?
immunosuppression
Malnutrition
Infection