Dr. Eddie Hooker is currently an Assistant Professor in the Department of Health Services Administration at Xavier University in Cincinnati, Ohio. He is also an Associate Clinical Professor in the Department of Emergency Medicine at the University of Louisville and at Wright State University. His areas of expertise include emergency medicine, epidemiology, health-services management, and public health.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
What are the warning signs of a bioterrorism attack?
Although the government continues to search for an early detection system
for biological, chemical, and radiation terrorist attacks, none of these systems
have been perfected. The medical community is advised to look out for unusual
diseases not typically seen in the area. Other potential clues that raise
suspicion for a bioterrorism attack include new types of antibiotic resistance
in bacteria, because some biologic agents are modified (weaponized) to make them
more lethal, unusual numbers of cases of a disease, and atypical presentation of
diseases.
The general public should constantly be vigilant for bioterrorism. Events
that might suggest an attack include a large number of ill or dead people in a
small geographic area, multiple dead animals of different species, and patients
with multiple different diseases, indicating a mixed attack.
What should I do if there has been a bioterrorism attack?
If you think that you have been exposed to a biological agent, the most
important thing to do is to quickly remove your clothing and wash off your skin.
Most biological agents cannot penetrate intact skin. Showering with soap and
water will remove most agents from the skin. If you have already inhaled or
ingested the agent, decontamination using soap and water may not help you but
might help prevent exposing other family members or coworkers.
If the biological agent has been released into the air but you do not
believe (or do not know) you have been exposed, you can utilize masks to help
prevent inhalation of the agent. The problem is that standard surgical masks
offer little protection. Specialized high-efficiency particulate air (HEPA)
masks are available that offer better protection; however, they are more
expensive, not easily found, and should be fitted to the person using them.
The two most important tools used by public health officials will be
isolation and quarantine. Isolation is keeping people known to be ill away from
other people. Quarantine is keeping people who may have been exposed away from
other people. The problem is that many times we may not know who has been
exposed. In these cases, the public health officials will likely recommend that
everyone stay in their homes and avoid all public gatherings. By doing this, we
will isolate those sick and quarantine those infected but who do not yet have
symptoms. Those cities that utilized this technique during the Spanish
flu
pandemic of 1918 had much lower rates of death than did cities that did not
practice good quarantine procedures.
If there has been a bioterrorism attack, the first important step is to get
information immediately from the news media as to the right course of action.
For some terrorist attacks, it may be correct to try and leave the area;
however, for other events, it may be more appropriate to shelter in place. With
bioterrorism, there may be the possibility of transmission of disease from one
human to another (for example, measles, influenza, avian flu, smallpox, plague, and
viral hemorrhagic fevers). In the case of either a bioterrorism attack or just a
natural outbreak, it may be necessary to avoid contact with infected people or
just remain inside for a period of time until the infected people are no longer
contagious. Again, the key action is to understand the recommendations from
public health officials as delivered through the news media.
Dengue fever is contracted from the bite of a striped Aedes aegypti mosquito. Symptoms of dengue include headache, fever, exhaustion, severe joint and muscle pain, rash, and swollen glands. Since dengue is caused by a virus, there is no specific medicine to treat it. Treatment instead focuses on relieving the symptoms.
Influenza (flu) is a respiratory illness caused by a virus. Flu symptoms include fever, cough, sore throat, runny nose, headache, fatigue, and muscle aches. The flu may be prevented with an annual influenza vaccination.
Salmonella bacteria are known to cause salmonellosis, typhoid fever, and paratyphoid fever in humans. Salmonella infection is usually caused by ingesting large amounts of the bacteria in contaminated food or water.
There are many types of E. Coli (Escherichia coli ). Pathogenic E. coli can cause urinary tract and bladder infections, or lead to sepsis. E coli O157:H7 (EHEC) causes bloody diarrhea and colitis. Complications of E. coli infection include hemorrhagic diarrhea, hemolytic-uremic syndrome, and thrombotic thrombocytopenic purpura. Symptoms include severe abdominal pain and bloody diarrhea. E coli O157:H7 commonly is due to eating raw or undercooked hamburger or raw milk or dairy products.
Botulism is an illness caused by a neurotoxin produced by the bacterium Clostridium botulinum. There are three types of botulism: food-borne, wound, and infant. Symptoms include muscle paralysis, dry mouth, constipation, slurred speech, and blurred vision. If food-borne and wound botulism are detected early enough, they may be treated with an antitoxin. Infant botulism is treated intravenously with BabyBIG (Botulism Immune Globulin).
Encephalitis is a brain inflammation that causes sudden fever, vomiting, headache, light sensitivity, stiff neck and back, drowsiness, and irritability. Meningitis is an infection that causes inflammation of the meninges that surround the brain and spinal cord. Symptoms of meningitis include high fever, headache, nausea, vomiting, and stiff neck.
Plague is an infectious disease caused by the Yersinia pestis bacteria, which is primarily found in rodents the fleas that feed off of them. The bacteria are passed to humans through flea or rodent bites. There are three forms of plague: bubonic, septicemic, and pneumonic. The symptoms and method of transmission vary with each form of plague. Plague can be treated with antibiotics.
Cholera is an infectious disease characterized by intense vomiting and profuse watery diarrhea and that rapidly lease to dehydration and often death. Cholera is caused by infection with the bacteria Vibrio cholerae, which may be transmitted via infected fecal matter, food, or water.
Brucellosis is an infectious disease caused by the Brucella bacteria. Symptoms and signs include sweating, fever, fatigue, dizziness, headache, cough, chest, joint, and abdominal pain, and enlarged liver and/or spleen. Brucellosis is treated with antibiotics.
Anthrax is a deadly infectious disease that may be transmitted to humans by infected animals or by biological warfare. There are three types of anthrax: cutaneous, inhalation, and gastrointestinal. Symptoms of cutaneous anthrax include a swollen glands, muscle ache, headache, fever, nausea, vomiting, and a red-brown raised spot that enlarges, blisters, and hardens, forming an ulcer crater with black crust. Symptoms of inhalation anthrax are flulike and may progress to respiratory distress, shock, coma, and death. Symptoms of gastrointestinal anthrax include loss of appetite, bloody diarrhea, and abdominal pain. Treatment for cutaneous anthrax involves penicillin, tetracycline, erythromycin, and ciprofloxin. Inhalation anthrax necessitates treatment with IV therapy with antibiotics.
Arsenic comes in two forms, inorganic and organic. Organic arsenic poisoning is usually not poisonous to humans; however, inorganic arsenic in large enough amounts can lead to shock and death. Symptoms of arsenic poisoning include nausea, abdominal pain, diarrhea, dehydration, dark urine, vertigo, delirium, shock, and death. Treatment for arsenic poisoning includes Hemodialysis and a variety of drugs.
Shigellosis is a disease caused by the Shigella bacteria. Bloody diarrhea, stomach cramps and fever are common symptoms. Mild infections usually resolve on their own. Antibiotics are used to treat more severe cases.
Thallium is a metal that can be found in small amounts in the soil. When thallium enters the environment through coal-burning or smelting, it stays in the air, soil, and water for a long time and doesn't break down. Thallium exposure may come from eating contaminated foods, smoking cigarettes, touching or eating contaminated soil, living near a hazardous-waste site, or breathing workplace air in industries that use thallium.
Cryptosporidiosis is an intestinal disease caused by the Cryptosporidium parasite. Symptoms include watery diarrhea, stomach cramps, nausea and vomiting, fever, weight loss, dehydration, and weight loss. Antibiotics are used in the treatment of cyptosporidiosis.
Ricin is a biological toxin that can be made from processing castor beans. Symptoms of ricin poisoning include fever, cough, nausea, low blood pressure, diarrhea, seizures and blood in the urine. As there is no antidote, treatment focuses on minimizing the effects of poisoning.
Typhus is a disease caused by Rickettsia bacteria. Symptoms and signs include fever, headache, nausea, vomiting, diarrhea, and rash. Antibiotics are recommended as the treatment for endemic and epidemic typhus infections.
Melioidosis (Whitmore's disease) is an infectious disease caused by Burkholderia pseudomallei bacteria. Symptoms include bronchitis, pneumonia, fever, headache, loss of appetite, cough and chest pain. Treatment involves antibiotics or surgical removal of the lung abscess in severe cases.
Smallpox is a disease caused by the variola virus. Symptoms and signs include a characteristic rash and high fever. Treatment focuses on supporting the patient. Smallpox may be prevented with the ACAM2000 smallpox vaccine.
Tularemia (rabbit fever) is an infection caused by the Francisella tularensis bacteria. People can become infected with tularemia by coming into contact with infected animals or via a tick bite. Symptoms and signs include fever, headache and rash. Tularemia is treated with streptomycin or gentamicin.
Extensively drug-resistant tuberculosis (XDR TB) is a rare form of multidrug-resistant tuberculosis (MDR TB) that's transmitted when TB germs are expelled into the air by sneezing, speaking, singing, or coughing.
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