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Biosafety Levels

BSL-1

• Do not usually cause disease minimal
safety equipment
• Usually those found in high
school/coll...
Public Health Preparedness


Three categories


Category A
• Greatest impact




Category B




Salmonella, ricin, E...
Key Indicators of a Potential Bioterror
or Biocrime Event
General Characteristics of Bioterror
Agents


Easily made




Mobile




Low skill required
Easy to transport

Transm...
History of Criminal Use of Microbial
Agents


Salmonella




Anthrax spores




Sprayed onto salad bars in restaurant...
Laboratory Response Network (LRN)



Established in 1999
Community hospitals with microbiology
capabilities


Sentinel ...
Laboratory Response Network (LRN)


Reference laboratories




Perform confirmatory tests on several biothreat
agents
•...
Structure of the Laboratory
Response Network
Agents of Bioterror


Bacillus anthracis


Cutaneous anthrax
• Very few cases




Black eschar on skin

Gastrointestin...
Agents of Bioterror


Specimen collection



Swabs from black eschar
Blood sample from inhalation and gastrointestinal
...
Morphology of Anthrax on Blood
Agar, Gram Stain, and Spore Stain
Agents of Bioterror


Yersinia pestis



“Black death”
Linked to bubonic plague in 1894
• Major vector is flea

Elsevie...
Agents of Bioterror


Transmission






Bite of infected fleas
Handling contaminated materials
Inhaling aerosolized ...
Agents of Bioterror


Symptoms



Fever, chills, headache, malaise
Buboes
• Inflammation of the lymph node causing swel...
Agents of Bioterror


Direct examination and culture



Plump gram-negative rods
Bipolar staining
• Safety pin appearan...
Agents of Bioterror


Francisella tularensis






BSL-3 pathogen
Zoonotic disease
Infectious dose
• As low as 10 org...
Cutaneous Lesions
Agents of Bioterror


Clinical manifestations




Symptoms
• Fever with chills
• Headaches
• Cough
• Chest pain
• Lesio...
Agents of Bioterror


Brucella spp.





Small gram-negative pleomorphic aerobic
coccobacilli
• Brucella melitensis
• ...
Agents of Bioterror (Cont’d)


Symptoms




Can persist for months




Malaise, night sweats, relapsing fever, chills...
Agents of Bioterror (Cont’d)


Burkholderia species




B. mallei
• Glanders
B. pseudomallei
• Melioidosis
Symptoms
• ...
Agents of Bioterror (Cont’d)


Coxiella burnetii





Causative agent of Q fever (Query fever)
Reservoirs
• Cattle, sh...
Agents of Bioterror


Smallpox


Two major forms
• Variola major



30% mortality in unvaccinated
3% in vaccinated

• ...
Smallpox Pustules
Agents of Bioterror


Viral hemorrhagic fevers




Ebola, Marburg, Lassa fever, Crimean-Congo, Rift
Valley fever, Hanta...
Agents of Bioterror (Cont’d)


Clinical manifestations




Incubation period 2 to 3 weeks
Fever, rash, myalgia, arthra...
Agents of Bioterror


Toxins




Clostridium botulinum toxin
Staphylococcal enterotoxins
Ricin
• Contamination of food...
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Microbiology - Agents of Bioterrorism

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Agents of Bioterrorism

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Microbiology - Agents of Bioterrorism

  1. 1. Biosafety Levels BSL-1 • Do not usually cause disease minimal safety equipment • Usually those found in high school/college student labs • Example: Bacillus subtilis BSL-2 • Known to cause human disease • Encompasses most clinical hospital laboratories • Ex. HBV and salmonellae BSL-3 • Known to produce serious disease • Transmitted by respiratory route • Not identifying directly from specimens(BSL-2) but culturing M. tuberculosis BSL-4 • Require containment suits • High risk of serious disease • No available treatment • Ebola
  2. 2. Public Health Preparedness  Three categories  Category A • Greatest impact   Category B   Salmonella, ricin, E.coli O157:H7 Category C • Less impact   Anthrax, hemorrhagic fevers MDR-TB, hantavirus See Table 30-1 for full list of examples
  3. 3. Key Indicators of a Potential Bioterror or Biocrime Event
  4. 4. General Characteristics of Bioterror Agents  Easily made   Mobile   Low skill required Easy to transport Transmission    Aerosol Person-to-person spread Resistant to decay
  5. 5. History of Criminal Use of Microbial Agents  Salmonella   Anthrax spores   Sprayed onto salad bars in restaurants Contaminated letters in NY, DC, and Florida Ricin toxin
  6. 6. Laboratory Response Network (LRN)   Established in 1999 Community hospitals with microbiology capabilities  Sentinel laboratories • Must have BSL-2 capabilities  Five agents with protocols – – – – – B. anthracis Y. pestis F. tularensis Brucella spp. Etc.
  7. 7. Laboratory Response Network (LRN)  Reference laboratories   Perform confirmatory tests on several biothreat agents • State public health laboratories • Department of defense medical center laboratories National laboratories   Can perform complex forensic studies Definitive characterization of biothreat agents • CDC • USAMRIID • National Research Medical Center
  8. 8. Structure of the Laboratory Response Network
  9. 9. Agents of Bioterror  Bacillus anthracis  Cutaneous anthrax • Very few cases   Black eschar on skin Gastrointestinal anthrax • Ingestion of spores in contaminated food  Inhalation anthrax • Generally none unless bioterror or lab accident
  10. 10. Agents of Bioterror  Specimen collection   Swabs from black eschar Blood sample from inhalation and gastrointestinal anthrax • Colonies have medusa-head morphology  Nonhemolytic
  11. 11. Morphology of Anthrax on Blood Agar, Gram Stain, and Spore Stain
  12. 12. Agents of Bioterror  Yersinia pestis   “Black death” Linked to bubonic plague in 1894 • Major vector is flea Elsevier items and derived items © 2011, 2007 by Saunders, an imprint of Elsevier Inc. 13
  13. 13. Agents of Bioterror  Transmission     Bite of infected fleas Handling contaminated materials Inhaling aerosolized bacteria Weaponized Y. pestis  Primarily pneumonic plague • Person-to-person transmission
  14. 14. Agents of Bioterror  Symptoms   Fever, chills, headache, malaise Buboes • Inflammation of the lymph node causing swelling  Bacteria disseminate and cause DIC – Results in gangrene in fingers and nose
  15. 15. Agents of Bioterror  Direct examination and culture   Plump gram-negative rods Bipolar staining • Safety pin appearance
  16. 16. Agents of Bioterror  Francisella tularensis     BSL-3 pathogen Zoonotic disease Infectious dose • As low as 10 organisms Ulceroglandular tularemia  Skin infection • Bite of infected insect • Handling infectious materials
  17. 17. Cutaneous Lesions
  18. 18. Agents of Bioterror  Clinical manifestations   Symptoms • Fever with chills • Headaches • Cough • Chest pain • Lesions at site of entry Occasionally respiratory disease
  19. 19. Agents of Bioterror  Brucella spp.    Small gram-negative pleomorphic aerobic coccobacilli • Brucella melitensis • Brucella suis • Brucella abortus Mostly eliminated in the United States • BSL-3 containment required Transmission • Breaks in skin • Ingestion of food products • Aerosols in laboratory conditions
  20. 20. Agents of Bioterror (Cont’d)  Symptoms   Can persist for months   Malaise, night sweats, relapsing fever, chills, myalgia • Requires 5-35 days of incubation before symptoms Most recover without treatment Previous use as a biologic weapon
  21. 21. Agents of Bioterror (Cont’d)  Burkholderia species    B. mallei • Glanders B. pseudomallei • Melioidosis Symptoms • Fever, myalgia, headache, and chest pain  Caused by cutaneous lesions, bloodstream infections, pneumonia
  22. 22. Agents of Bioterror (Cont’d)  Coxiella burnetii    Causative agent of Q fever (Query fever) Reservoirs • Cattle, sheep, goats, dogs, cats, deer, fowl, and humans • Exposure in vet or animal handlers Transmission • Urine, milk, feces, tissues, and fluids expelled during birth • Incubation period 2-3 weeks
  23. 23. Agents of Bioterror  Smallpox  Two major forms • Variola major   30% mortality in unvaccinated 3% in vaccinated • Variola minor  Similar but much less severe disease
  24. 24. Smallpox Pustules
  25. 25. Agents of Bioterror  Viral hemorrhagic fevers   Ebola, Marburg, Lassa fever, Crimean-Congo, Rift Valley fever, Hantavirus Transmission   Direct contact Urine, semen
  26. 26. Agents of Bioterror (Cont’d)  Clinical manifestations    Incubation period 2 to 3 weeks Fever, rash, myalgia, arthralgia, nausea, conjunctivitis, diarrhea, and CNS symptoms Bleeding, DIC, hemorrhage of mucous membranes • Some have high mortality rates
  27. 27. Agents of Bioterror  Toxins    Clostridium botulinum toxin Staphylococcal enterotoxins Ricin • Contamination of food or water sources

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