The document summarizes several biological agents that could potentially be used for bioterrorism, including their transmission, clinical presentation, diagnosis, treatment and public health concerns. It discusses anthrax, smallpox, hemorrhagic fever viruses, plague, botulinum toxin and tularemia. The key points provided include incubation periods, symptoms, potential complications, diagnostic tests and the importance of isolation and supportive care for infected individuals.
For the students studying Medical Microbiology like MSC BSC MBBS DENTAL BPTH Nursing DMLT Pharmacy etc and also for those who are preparing for exams such as NEET
Leptospirosis is a worldwide public health problem. In humid tropical and subtropical areas, where most developing
countries are found, it is a greater problem than in those with a temperate climate. The magnitude of the problem in
tropical and subtropical regions can be largely attributed to climatic and environmental conditions but also to the
great likelihood of contact with a Leptospira-contaminated environment caused by, for example, local agricultural
practices and poor housing and waste disposal, all of which give rise to many sources of infection. In countries with
temperate climates, in addition to locally acquired leptospirosis, the disease may also be acquired by travellers
abroad, and particularly by those visiting the tropics.
Leptospirosis is a potentially serious but treatable disease. Its symptoms may mimic those of a number of other
unrelated infections such as influenza, meningitis, hepatitis, dengue or viral haemorrhagic fevers. Some of these
infections, in particular dengue, may give rise to large epidemics, and cases of leptospirosis that occur during such
epidemics may be overlooked. For this reason, it is important to distinguish leptospirosis from dengue and viral
haemorrhagic fevers, etc. in patients acquiring infections in countries where these diseases are endemic. At present,
this is still difficult, but new developments may reduce the technical problems in the near future. It is necessary,
therefore, to increase awareness and knowledge of leptospirosis as a public health threat.
For the students studying Medical Microbiology like MSC BSC MBBS DENTAL BPTH Nursing DMLT Pharmacy etc and also for those who are preparing for exams such as NEET
Leptospirosis is a worldwide public health problem. In humid tropical and subtropical areas, where most developing
countries are found, it is a greater problem than in those with a temperate climate. The magnitude of the problem in
tropical and subtropical regions can be largely attributed to climatic and environmental conditions but also to the
great likelihood of contact with a Leptospira-contaminated environment caused by, for example, local agricultural
practices and poor housing and waste disposal, all of which give rise to many sources of infection. In countries with
temperate climates, in addition to locally acquired leptospirosis, the disease may also be acquired by travellers
abroad, and particularly by those visiting the tropics.
Leptospirosis is a potentially serious but treatable disease. Its symptoms may mimic those of a number of other
unrelated infections such as influenza, meningitis, hepatitis, dengue or viral haemorrhagic fevers. Some of these
infections, in particular dengue, may give rise to large epidemics, and cases of leptospirosis that occur during such
epidemics may be overlooked. For this reason, it is important to distinguish leptospirosis from dengue and viral
haemorrhagic fevers, etc. in patients acquiring infections in countries where these diseases are endemic. At present,
this is still difficult, but new developments may reduce the technical problems in the near future. It is necessary,
therefore, to increase awareness and knowledge of leptospirosis as a public health threat.
Journal Club - Mortality after Fluid Bolus in African Children with Severe In...Farooq Khan
Critical Appraisal of:
Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med 2011;364:2483-95
Research in International Emergency Medicine: Scope, Impact and Challenges
EBM Topic: Subgroup Analysis
Journal Club - Utility of Absolute and Relative Changes in Cardiac Troponin C...Farooq Khan
Critical Appraisal of:
Reichlin et al. Utility of Absolute and Relative Changes in Cardiac Troponin Concentrations in the Early Diagnosis of Acute Myocardial Infarction.Circulation. 2011;124:136-145
Novel High-sensitivity Troponin Assays
EBM topic: ROC curves
Journal club - Disease progression in hemodynamically stable patients present...Farooq Khan
Critical appraisal of:
Glickman SW et al. Disease Progression in Hemodynamically Stable Patients Presenting to the Emergency Department With Sepsis. Acad Emerg Med. 2010 17:383-90
Interactive quiz on early goal-directed therapy, surviving sepsis guidelines and EBM topic of prognosis studies.
Journal Club - EMS - "Effect of adrenaline on survival in out-of-hospital car...Farooq Khan
Summary and Critical Appraisal of:
Jacobs et al,"Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial" Resuscitation 82 (2011) 1138– 1143
Introduction to Injury Prevention - An interactive discussion for senior and ...Farooq Khan
Introducing concepts of Injury Prevention to mid-level Emergency Care Providers in the District Hospital setting in rural Sub-Saharan Africa.
An interactive lecture made for the Global Emergency Care Collaborative.
Emerging and Re-emerging Infectious DiseasesFarooq Khan
Overview of literature around the following emerging and re-emerging infectious diseases relevant to Canadian Emergency Physicians in terms of their epidemiology, recognition, and treatment:
- Community-acquired MRSA
- Non-vaccine serotype Pneumococcus
- Fusobacterium Necrophorum
Approach to evaluating patients' fitness to drive during an ED encounter.
Review of health advocacy and legal obligations from a Quebec standpoint
Audience: Medical students and residents in a small group environment
Approach to Fever in the Returning TravelerFarooq Khan
Quick diagnostic approach to return travelers presenting to the ED with fever.
Audience: Medical Students and Junior Residents in a small group environment
Approach to fever in the transplant patientFarooq Khan
Quick Approach to solid organ transplant patients presenting to the ED with fever to guide initial work-up and managment.
Audience: Medical students and junior residents in a small group environment
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERY
Infectious agents of bioterrorism handout
1. Adapted from Kman NE and Nelson RN, Infectious Agents of Bioterrorism: A Review for Emergency Physicians, Emerg Med Clin N Am 26 (2008) 517–547
Infectious Agents of Bioterrorism
30 potential biological weapons classified A, B and C by the CDC, see the 6 category A agents above.
Details below.
Farooq Khan MDCM
PGY3 FRCP-EM
McGill University
November 14
th
2011
2. Adapted from Kman NE and Nelson RN, Infectious Agents of Bioterrorism: A Review for Emergency Physicians, Emerg Med Clin N Am 26 (2008) 517–547
Anthrax
Time dependent therapy: mortality doubles if time to diagnosis goes from 2 to 4.8 days. Potential for meningitis in all types.
Cutaneous:
Contact with contaminated hides of goats/sheep/cows that ingest spores through soil, 2000 cases worldwide
Spores in skin incubate for 5 days [1-12 days], then germinate causing edema and eventually painless black eschar ×2
weeks with lymphadenopathy/edema
Eschars Ddx: tularemia, scrub typhus, rickettsial spotted fevers, rat bite fever, arachnid bites, vasculitides, and
ecthyma gangrenosum
Low mortality
GI:
least common, ingestion of contaminated undercooked meat.
Oral-pharyngeal anthrax causes lip, oral, or esophageal ulcers and leads to lymphadenopathy, edema, and sepsis
Anthrax infection of the lower GI tract can present with nausea, vomiting, malaise, or bloody diarrhea.
Infection can ultimately lead to ascites, acute abdomen, or fulminant sepsis.
Pulmonary: Wool sorters disease, ↑bioterrorism potential
spores are inhaled and deposited on the alveolar surface where they are phagocytosed by macrophages.
Surviving spores are transported to mediastinal lymph nodes where they germinate (2-43 days)
The bacteria multiply and produce exotoxins that quickly cause mediastinal edema and necrosis followed by bacteremia, toxemia, sepsis, and death.
first symptoms of inhalational anthrax are nonspecific
fever, dyspnea, cough, headache, chills, vomiting, weakness, or chest pain, may have tachycardia and hypoxemia
N°/v°, pallor/cyanosis, diaphoresis, AMS, HR > 110 beats/min, temp > 100.9°F, and ↑Hct all predict inhalational anthrax over similar diseases
Diagnosis
Aerobic blood culture of gram+ bacilli, ↑liver enzymes, CXR showing infiltrates with mediastinal widening and pleural effusions, CT chest, clinical mediastinitis
Treatment
Cutaneous: oral cipro/doxy ×60 days
Inhalational: cipro/doxy + vanco/clinda/rifampin/clarithromycin/imipenem ×60 days (IV in limited casualty, PO in mass casualty)
Steroids for pulmonary edema, resp failure and meningitis (use cipro + chloramphenicol/rifampin/pen for better CNS penetration)
3. Adapted from Kman NE and Nelson RN, Infectious Agents of Bioterrorism: A Review for Emergency Physicians, Emerg Med Clin N Am 26 (2008) 517–547
Public health concerns
Vaccine for at risk workers (6 doses over 18 months)
PEP: 60 days cipro/doxy vs 100 days +/- 3 doses of vaccine
Standard universal precautions, no respiratory isolation needed
Contaminated surfaces can be cleaned with sodium hypochlorite (extreme cases biocidal gases or radiation are needed to kill resistant spores)
Smallpox
Variola minor and major (fatality rate of 30% in epidemics) eradicated by vaccine programs in 1977. Vaccination ended in 1980. Stockpiled at CDC in Atlanta and
institutes of virus preparation in Moscow. Potential for bioterrorism
Droplet and contact transmission. Highly contagious (1 index case→10-20 secondary cases)
Incubation: Enters body through oral nasal mucosa, travels to regional LN, replicates then seeds to the skin and all organs. asymptomatic (10-15 days)
Prodromal: after 8 days, secondary replication in bone marrow and spleen: high fever, toxemia, malaise, vomiting, headache, backache, and myalgias. (3 days)
Fulminant: Rash for 7-10 days, most infectious. Later wanes but Infectivity can remain even after death.
Enanthem: erythematous papules and erosions.
Exanthem: raised indurated erythematous macules → firm pearly umbilicated vesicles → pustular
confluent → thick crusting scabs with scars.
Centrifugal from face down, legs and abdomen affected last, palms/soles spared
All in similar stages of development
Complications
Panophthalmitis, blindness, keratitis, corneal ulcers, osteomyelitis, arthritis, orchitis, and encephalitis
Death most commonly occurs from bronchitis, pneumonitis, pulmonary edema, associated bacterial pneumonia, and sepsis
Diagnosis: clinical suspicion, number of cases. Rare occurrence of hemorrhagic (meningococcemia-like illness) or malignant (rapid fulminant onset) variants.
Index case should be confirmed by electron microscopy in level 4 biosafety lab, further diagnosis is clinical.
Treatment: Supportive only. No recommended antivirals
Public Health concerns : Outbreak →Vaccine (ACAM2000) for all hospital employees and other high risk groups, designated hospital, negative pressure
isolation, aggressive linen/surface decon (virus can live 24h). Home quarantine, vaccination of patients within 4 days of exposure reduces fatal outcome.
4. Adapted from Kman NE and Nelson RN, Infectious Agents of Bioterrorism: A Review for Emergency Physicians, Emerg Med Clin N Am 26 (2008) 517–547
Hemorrhagic fever viruses
Transmission: fine droplet aerosol
Direct contact with blood, tissue or secretions of infected patients/animals/dead bodies. Can be inhaled aerosols in animal feces or urine, or
contaminated food. Can be mosquito bite
Needlestick injuries are almost always fatal.
5. Adapted from Kman NE and Nelson RN, Infectious Agents of Bioterrorism: A Review for Emergency Physicians, Emerg Med Clin N Am 26 (2008) 517–547
Transmission rarely occurs before onset of symptoms
Airborne is less common
Clinical. Virus attacks vascular system leading to ↑permeability and hemorrhaging
See table for prodromes and clinical patterns
When the bleeding occurs, it may manifest as petechiae, mucous membrane or conjunctival hemorrhage, hematuria, hematemesis, or melena.
Disease progression can lead to DIC, hypotension, and circulatory shock. Signs of CNS dysfunction, such as delirium, seizures, or coma → poor prognosis
Complications: virus dependent
Ebola/marburg mortality within 6-9 days
rift valley and yellow fever: jaundice
rift valley and lassa fever: less hemorrhagic complications
Death from viral hemorrhagic fever is preceded by hemorrhagic diathesis, shock, sepsis, or multisystem organ failure.
Patients who survive this disease may be left with hearing or vision loss, impaired motor coordination, transverse myelitis, uveitis, pericarditis, orchitis,
parotitis, hepatitis, or pancreatitis
Ddx: Influenza, viral hepatitis, staphylococcal or gram-negative sepsis, meningococcemia, salmonellosis, shigellosis, malaria, dengue, rickettsial diseases, and
Hantavirus. Non infectious: DIC, ITP/TTP, HUS, Stevens-Johnson syndrome, acute leukemia, and collagen vascular diseases
Diagnosis: clincial suspicion, travel, number of patients
WHO surveillance standards:
Fever >38.3° <3 weeks duration
≥2 Hemorrhagic symptoms: hemorrhagic or purple rash, epistaxis, hematemesis, hemoptysis, blood in stools
No alternate Dx
CBC, liver enzymes, coags, fibrin slplit products, firbinogen. Sample sent to biosafety level 4 facility.
Treatment: aggressive support +/- ribavirin × loading dose of 30 mg/kg IV, then 16 mg/kg IV q6h ×4 days, then 8 mg/kg IV q8h ×6 days, or in outbreaks: 2000
mg po ×1, then 1200 mg/d po divided bid ×10 days
Public health concern: strict isolation, surveillance of contacts over 21 days period and subsequent isolation if symptomatic . outbreak over after 2
consecutive incubation periods (i.e. 42 days) if no additional cases
6. Adapted from Kman NE and Nelson RN, Infectious Agents of Bioterrorism: A Review for Emergency Physicians, Emerg Med Clin N Am 26 (2008) 517–547
Strict barrier protection, hand hygiene, double glove, impermeable gowns, N95 mask/air purifying respirators, negative pressure isolation rooms, leg and
shoe coverings, face shields and eye protection, restricted access to all nonessential staff, dedicated disposable (or single use) medical equipment, and
EPA-approved disinfectant.
Community health education: Radio broadcasts, Churches, schools, military units, and markets informed, Contact tracing, clinical management, infection
control in health facilities, and rapid on-site laboratory diagnosis.
No vaccines for most, except rift valley but not available in sufficient quantities
Plague
Yersinia Pestis, gram– coccbacillus, rare naturally occurring cases mostly bubonic, 2% pneumonic
Animal reservoir in rodents, lagomorphs and cats, flea vector
Person to person transmission via contact with infected tissues, body fluids, respiratory droplets
Natural epidemics are more bubonic with preceding rodent deaths.
Bioweapon to consider if non endemic population has pneumonic plague and no animal deaths
Clinical
Bubonic: flea bite→infection of local LN (2-8 dayslater )→ fever chills weakness → formation of buboes (1-10 cm, extremely painful, erythematous, and
associated with surrounding edema and warmth) at LN in groin/axilla/cervical region due to resistance of bacteria to destruction (1 days later) → Necrosis of
buboe causing pneumonia, bacteremia , and sepsis, with DIC, necrosis of small vessels, purpuric skin leasions and gangrene
Primary pneumonic : 2 -4 days sudden onset of a productive cough, chills, headache, body aches, and dyspnea, nausea, vomiting, abdominal pain, and
diarrhea
Diagnosis:
Clincial suspicion
Outbreak/terrorism: large number of previously healthy patients presenting with fever, cough, tachypnea, dyspnea, chest pain, pneumonia, and a
fulminant course leading to sepsis or death. It is unlikely these patients would present with buboes
CXR: bilateral infiltrates or consolidation
Antigen detection, IgM enzyme immunoassay, immunostaining, and PCR are available on a limited basis
Leukocytosis with toxic granulations, coagulation abnormalities, aminotransferase elevations, azotemia, and other evidence of multiorgan failure
Gram stain of sputum or blood may reveal gram-negative bacilli or coccobacilli.
A Wright, Giemsa, or Wayson stain may show bipolar staining
Cultures of blood, sputum, or bubo aspirate should demonstrate growth in 24 to 48 hours. Cultures sent out are confirmed in specialty laboratories by
immunostaining and immunoassay
Treatment
Do not delay >24h, or mortality↑
7. Adapted from Kman NE and Nelson RN, Infectious Agents of Bioterrorism: A Review for Emergency Physicians, Emerg Med Clin N Am 26 (2008) 517–547
Fluid resuscitation, pressors, monitoring mechianical ventilation
IV/IM streptomycin × 10 days, or genta in contained casualty
Mass casualty cipro or doxy po
Public health concern
Isolate droplet precaution
In outbreak, all patients with temp >38.5°C or a new cough should start Abx
HCW and Asymptomatic close contacts of pneumonic plague patients should take PEP of doxy ×7 days (if refusing meds should be obersved ×7 days)
Vaccine not effective against pneumonic plaqgue
Botulinum toxin
(see chemical terrorism antidotes update handout)
Clinical diagnosis
(1) symmetric, descending flaccid paralysis with prominent bulbar palsies in
(2) an afebrile patient with
(3) a clear sensorium.
The bulbar palsies can be summarized as the ‘‘4 D’s’’: diplopia, dysphagia, dysarthria, and dysphonia.
Tests not helpful to rule in, can be used to rule out other causes
Ddx: GBS, myasthenia, stroke, tick paralysis
Treatment: supportive, mechanical ventilation and antitoxin (see chemical terrorism antidotes update handout)
Public Health concerns: proper food storage and consumption, surveillance for contaminated food. Standard precautions handwashing
Tularemia
bacterial zoonosis caused by Francisella tularensis, extremely hardy aerobic, intracellular, gram-negative coccobacillus that can survive for weeks in water, soil,
animal carcasses, hides, frozen meat, and hay or straw.
Natural transmission through insect (tick) bite, no person to person, weaponized form is inhaled
Clinical:
8. Adapted from Kman NE and Nelson RN, Infectious Agents of Bioterrorism: A Review for Emergency Physicians, Emerg Med Clin N Am 26 (2008) 517–547
Incubation 3-5d, abrupt onset of fever, chills, headache, coryza, sore throat, myalgia, arthralgia, and fatigue
Severity, type of symptoms, and time to onset depend on route, dose, and virulence of organism
6 clinical syndromes: Can overlap
Ulceroglandular: 75% to 85%. bite→papule→ulcer→eschar. Regional LN → bacteremia
Glandular: 5-10%m fever and tender lymphadenopathy with no evidence of cutaneous involvement
Oculoglandular: 1-2% after inoculation of the eye with contaminated fingers or with accidental inoculation with infected matter. Painful purulent
unilateral conjunctivitis with cervical and preauricular LN
Oropharyngeal: acquired by drinking contaminated water, eating contaminated food or undercooked meat, and, less commonly, by inhaling infectious
droplets, pharyngitis, tonsillitis, or stomatitis with cervical LN. They may also manifest GI symptoms of abdo pain, na°, v°, d°, intestinal ulcerations, GI
bleeding, and mesenteric LN
Typhoidal: rare, severe, systemic symptoms without skin, mucosal, or lymphatic involvement, → SIRS, sepsis, DIC, ARDS, multisystem organ failure
Pneumonic: atypical pneumonias, fever and non-productive cough, dyspnea, and pleuritic chest pain. Likely in terrorist attack.
Complications : may spread hematogenously to cause meningitis, pericarditis, pneumonia, hepatitis, peritonitis, endocarditis, ataxia, osteomyelitis, sepsis,
rhabdomyolitis, and acute renal failure
Diagnosis: clinical, labs non-specific, CXRL pneumonia like +/- pleural effusions, medastinal LN, cavitary lesions.
ELISA serologic test positive if 4-fold higher than convalescent titer, or single titer >1:160
Cultures can be grown from pharyngeal washings, sputum specimens, and from blood
Antigen detection assays, PCR, EIA, immunoblotting, and electrophoresis are available in research and reference laboratories
Treament
Isolated cases: streptomycin 1 g IM bid ×10 days/ gentamicin 5 mg/kg IM/IV qd ×10 days
Mass casualty: cipro 500mg po bid ×10 days/doxy 100 mg po bid ×10-14 days. Can be used in peds (benefits outweight risks), cipro for pregnancy
Public health concern: no human-human spread, caution when handling animals/around insects
PEP: 14 days of cipro/doxy within 24h
Fever watch for contacts
Vaccine only for lab workers
Decontamination of exposed surfaces and objects can occur with 10% bleach solution followed in 10 minutes by 70% alcohol solution