B IOT ERROR I SM SYNDROMESIf you suspect disease from a potential bioterrorism event, call the Public Health Acute Communicable Disease Control Unit (ACDC)

IMMEDIATELY: Tel: (213) 240-7941 or after hours (213) 974-1234ACDC will arrange for specialized lab testing; guidelines for treatment, prophylaxis, and infection control; and activate local, state, and federal emergency response systems.

Inhalational AnthraxAbrupt onset of fever, chest pain,respiratory distress withoutradiographic findings of pneumonia,no history of trauma or chronicdisease, progression to shock anddeath within 24-36 hours.

Pneumonic PlagueApparent severe community-acquir edpneumonia but with hemoptysis,cyanosis, gastrointestinal symptoms,shock.

Ricin (aerosolized)Acute onset of fever, chest pain andcough, progressing to respiratorydistress and hypoxemia; notimproved with antibiotics; death in36-72 hours.

Staphylococcal Enterotoxin BAcute onset of fever, chills,headache, nonproductive cough andmyalgia (influenza-like illness) with aNORMAL chest x- ray.

SmallpoxPapular rash with fever that begins on theface and extremities and uniformlyprogresses to vesicles and pustules;headache, vomiting, back pain, anddelirium common.

Viral Hemorrhagic Fever(e. g., Ebola)Fever with mucous membranebleeding, petechiae, thrombocytopeniaand hypotension in a patient withoutunderlying malignancy.

BotulismAcute bilateral descending flaccidparalysis beginning with cranialnerve palsies.

Encephalitis (Venezuelan,Eastern, Western, West Nile)Encephalopathy with fever andseizures and/or focal neurologicdeficits.

BrucellosisIrregular fever, chills, malaise,headache, weight loss, profoundweakness and fatigue. Arthralgias,sacroiliitis, paravertebral abscesses.Anorexia, nausea, vomiting,diarrhea, hepatosplenomegal y. Mayhave cough and pleuritic chest pain.

Tularemia (Typhoidal, Pneumonic)Fever, chills, rigors, headache,myalgias, coryza, sore throat initially;followed by weakness, anorexia,weight loss. Substernal discomfort, drycough if pneumonic disease.

Chest x-ray with widened mediastinum;pleural effusion; gram-positive bacilli inblood or pleural fluid; definitive testingavailable at the LAC Public HealthLaboratory, (562) 658-1300

Gram-negative bacilli or coccobacilli insputum, blood or lymph node; safety-pin appearance with Wright or Giemsastain; definitive testing available at theLAC Public Health Laboratory,

Chest x-ray with pulmonary edema.Consult with ACDC regardingspecimen collection and diagnostictesting procedures.

Primarily clinical diagnosis. Consult withACDC regarding specimen collectionand diagnostic testing procedures.

Clinical with laboratory confirmation;vaccinated, gowned and gloved personobtains specimens (scabs or swabs ofvesicular or pustular fluid). Call ACDCimmediately before obtaining specimen;definitive testing available through CDC.

Definitive testing available throughpublic health laboratory network--callACDC immediately.

CSF protein normal; EMG with repetitivenerve stimulation shows augmentationof muscle action potential; toxin assaysof serum, feces, or gastric aspirateavailable at the LAC Public HealthLaboratory. Call ACDC to request testing.

Serologic testing available at the LACPublic Health Laboratory, (562) 658-1300

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iny slow-growing, faintly-staining,gram-negative coccobacilli in blood orbone marr culture. Leukocyte countnormal or low Anemia, thrombocytopeniapossible. CXR nonspecific: normalbronchopneumonia, abscesses, singlor miliar nodules, enlarged hilarnodes, effusions. Ser ogic testing andcultur e available at the LAC PublicHealth Laborator (562) 658-1300 or

Small, faintly-staining, slow-growing,gram-negative coccobacilli in smearsor cultur es of sputum, blood. CXR mayshow infiltrate, hilar adenopathy, effusion.Definitive testing available at the LACPublic Health Laboratory, (562) 658-1300

For routine disease reporting, continue to call Communicable Disease Reporting System (CDRS)Hotline: (888) 397-3993 • Faxline: (888) 397-3778

www.publichealth.lacounty.gov

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Dissecting aortic aneurysm,pulmonary embolism,influenza, community-acquired pneumonia

Community-acquiredpneumonia, Hantaviruspulmonary syndrome,meningococcemia,rickettsiosis, influenza

Plague, Q fever,staphylococcal enterotoxin B,phosgene, tularemia,influenza

Influenza, adenovirus,mycoplasma

Varicella, disseminatedherpes zoster, vaccinia,monkeypox, cowpox

Meningococcemia, malaria,typhus, leptospirosis,borreliosis, thromboticthrombocytopenic purpura(TTP), hemolytic uremicsyndrome (HUS)

Guillain-Barré syndrome,myasthenia gravis, midbrainstroke, tick paralysis, Mg++intoxication,organophosphate, carbonmonoxide, paralyticshellfish, or belladonna-likealkaloid poisoning, polio,Eaton-Lambert myasthenicsyndrome

Herpes simplex,post-infectious, other viral encephalitides

Numerous diseases,including Q Fever,brucellosis

Call ACDC. Alert your laboratory topossibility of anthrax. No person-to-person transmission.

Infection control: standard precautions.

Call hospital infection contro l and ACDC.Ask family members/close contacts ofpatient to stay at the hospital (if alreadypresent) for public healthinterview/chemoprophylaxis; get detailedaddress and phone number information.Alert laboratory of possibility of plague.

Infection control: droplet precautions inaddition to standard precautions.

Call ACDC.

Infection control: standard precautions.

Call ACDC.

Infection control: standard precautions.

Call hospital infection contro l and ACDCimmediately. Ask family members/closecontacts of patient to stay at the hospital(if already present) for public healthinterview and vaccination; get detailedaddress and phone number information.

Infection control: airborne and contactprecautions in addition to standardprecautions.

Call hospital infection contro l and ACDCimmediately. Ask family members/closecontacts of patient to stay at the hospital (ifalready present) for public health interviewand follow-up; get detailed address andphone number information.

Infection control: contact precautions inaddition to standard precautions.

Request botulinum antitoxin from ACDC.

Infection control: standard precautions.

Call ACDC.

Infection control: standard precautions.

Notify your laboratory if brucellosissuspected --microbiological testing shouldbe done in a biological safety cabinet toprevent lab-acquired infection. Call ACDC.

Infection control: standard precautions.

Notify your laboratory if tularemiasuspected --microbiological testing shouldbe done in a biological safety cabinet toprevent lab-acquired infection. Call ACDC.

Infection control: standard precautions.

Adapted from California State and Local Health Department Bioterrorism Surveillance and Epidemiology Working Group, 2001. Rev. 8/30/12

Syndrome Differential diagnosisBioterrorism threat disease description PictureInitial laboratory & other

diagnostic test resultsImmediate public health & infection

control actions

or (562) 658-1330.

(562) 658-1300 or (562) 658-1330.

(562) 658-1330.

or (562) 658-1330.

or (562) 658-1330.