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Table 6-30

Disease	Pathophysiology	Transmission and Incubation	Signs/Symptoms	Treatment
Anthrax—Greek word for “coal” Cutaneous GI Inhaled (most lethal)	Caused by Bacillus anthracis, a bacterium that is commonly found in grazing animals Forms spores that live in soil for years Man-made form more potent and resistant to treatment	Contact with spores through break in skin Eating contaminated meat Inhaling spores Not spread from person to person Incubation: 1–6 days (inhalation can take up to 42 days)	Cutaneous: Skin sores that turn black after a few days GI: Nausea, loss of appetite, bloody diarrhea, fever, followed by bad stomach pain Inhaled: Cold or flu-like symptoms; cough, fatigue, chest discomfort → shortness of breath (SOB) → severe pneumonia → severe respiratory distress: diaphoresis, stridor, cyanosis, shock; death in 24–36 hours	Ciprofloxacin or doxycycline plus one or two additional antimicrobials (e.g., rifampin, vancomycin, penicillin, ampicillin, clindamycin [60-day treatment]) isolation not required Standard precautions
Botulism—a neuroparalytic illness	A potent neurotoxin produced from Clostridium botulinum, an anaerobic, sporeforming bacterium Characterized by: symmetrical, descending flaccid paralysis of motor and autonomic nerves Always begins with cranial nerves	Foodborne; ingestion of toxin produced in food (home-canned is most frequent) Fatal in 5% of cases	Vision: double, blurred Eyelids: drooping Speech: slurred Mouth: dry Muscles: weakness, symmetrical flaccid paralysis Swallowing: dysphagia If untreated, → descending paralysis of respiratory muscles, arms and legs; death from respiratory failure	Botulinum antitoxin from CDC If survive, have SOB and fatigue for years
Plague Pneumonic Bubonic Septicemic	Caused by bacterium Yersinia pestis (Y. pestis); found in rodents and their fleas Easily destroyed by sunlight and drying Will survive up to 1 hr	Pneumonic: Infects lungs Airborne transmission Spreads person to person Bubonic: Most common form Infected flea bites the skin Does not spread person to person Septicemic: Often complication of pneumonic or bubonic Does not spread from person to person	Pneumonic: Fever Headache Weakness Signs of pneumonia for 2–4 days (SOB, chest pain, cough, bloody or watery sputum) → respiratory failure → shock Bubonic: Swollen lymph glands (buboes) Fever Headache Chills Weakness Septicemic: Fever Chills Prostration Abdominal pain Shock Bleeding into skin and organs	Give antibiotics within 24 hr of symptoms—streptomycin, gentamicin, tetracyclines, chloramphenicol Prophylactic antibiotics for 7 days Close-fitting surgical mask to protect against infection
Smallpox—Latin word for “spotted” Variola major (severe and most common) Variola minor	An acute contagious disease caused by variola virus (a member of the orthopoxvirus family)	Aerosolized; droplets Direct face-to-face, prolonged contact Incubation: 7–21 days—not contagious at this time Lethal in 20%–40% of cases if unvaccinated	Prodrome 2–4 days (sometimes contagious): flu-like—malaise, fever (101°–104°F), headache, body aches, sometimes vomiting Early rash about 4 days (most contagious): small red spots on tongue and mouth; erythema spreads from face/arms to legs, then centrally Pustular rash: macules (bellybutton center) → papules → pustular vesicles → scabs	No specific treatment Smallpox vaccine effective if given within 3 days of exposure Cidofovir possibly effective Ribavirin Victim of attack should be undressed, shower with soap For visible contamination, use 0.5% diluted household bleach
Tularemia (“rabbit fever”)	A bacterial zoonosis Caused by Francisella tularensis, one of the most infectious pathogenic bacteria Survives for weeks at low temperatures in: water, moist soil, hay, straw, and decaying animal carcasses	Infects humans through: skin, mucous membranes, GI tract, and lungs Abrupt onset Lower fatality rate than plague or anthrax Aerosol release would be likely in terrorist attack Incubation: 1–14 days Not transmitted person to person	Skin and oral ulcers Fever (sudden) Chills Headache Rigor Generalized body aches (low back) Coryza Sore throat, dry or slightly productive cough Substernal pain or tightness Atypical pneumonia Pleuritis Hilar lymphadenopathy	Medications: Streptomycin (drug of choice) Gentamicin (an alternative) Doxycycline and ciprofloxacin in mass casualty isolation not recommended In hospitals, standard precautions are recommended
Viral hemorrhagic fever (VHF) (multisystem syndrome) Ebola (severe, often fatal) Lassa Hantavirus pulmonary syndrome	Four distinct RNA viruses: arenaviruses, filoviruses, bunyaviruses, and flaviviruses Often animal or insect host, except for Ebola (host unknown) Damaged vascular system → bleeding	Infected host or vector initially transmits to human; then human to human with Ebola or Lassa. Ebola: 2–21 days; abrupt onset Lassa: Spread through contact with body fluids 1–3 wk Hantavirus: Carried by rodents (mice) Aerosolization of virus shed in urine, droppings and saliva No person-to-person transmission 1–5 wk after exposure	VHF: marked fever, fatigue, dizziness, muscle aches, loss of strength, exhaustion. Bleeding: under skin, organs, mouth, eyes, ears (rarely fatal) Ebola: fever, headache, red eyes, hiccups, joint/muscle aches, sore throat → diarrhea, vomiting, stomach pain Lassa: 80% may have no symptoms or mild. May be varied; fever, retrosternal pain, sore throat, back pain, cough, abdominal pain, vomiting, diarrhea, conjunctivitis, facial bleeding Hantavirus: Early—fatigue, fever, muscle aches, headache, nausea, vomiting, abdominal pain Late—4–10 days; cough, SOB, chest tightness, feeling of suffocation	Ebola: Supportive therapy—fluids, electrolytes, O2 Lassa: Ribavirin Supportive care Hantavirus: No specific cure Early admission to ICU—intubation and ventilator support

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