BIOTERRORISM SYNDROMES - Emergency Preparedness · 2020-01-03 · BIOTERRORISM SYNDROMES If you...
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BIOTERRORISM SYNDROMES If 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) 974-1234 ACDC will arrange for specialized lab testing; guidelines for treatment, prophylaxis, and infection control; and activate local, state, and federal emergency response systems. Inhalational Anthrax Abrupt onset of fever, chest pain, respiratory distress without radiographic findings of pneumonia, no history of trauma or chronic disease, progression to shock and death within 24-36hours. Pneumonic Plague Apparent severe community-acquir ed pneumonia but with hemoptysis, cyanosis, gastrointestinal symptoms, shock. Ricin (aerosolized) Acute onset of fever, chest pain and cough, progressing to respiratory distress and hypoxemia; not improved with antibiotics; death in 36-72 hours. Staphylococcal Enterotoxin B Acute onset of fever, chills, headache, nonproductive cough and myalgia (influenza-like illness) with a NORMAL chest x- ray . Smallpox Papular rash with fever that begins on the face and extremities and uniformly progresses to vesicles and pustules; headache, vomiting, back pain, and delirium common. Viral Hemorrhagic Fever (e. g., Ebola) Fever with mucous membrane bleeding, petechiae, thrombocytopenia and hypotension in a patient without underlying malignancy. Botulism Acute bilateral descending flaccid paralysis beginning with cranial nerve palsies. Encephalitis (Venezuelan, Eastern, Western, West Nile) Encephalopathy with fever and seizures and/orfocal neurologic deficits. Brucellosis Irregular fever, chills, malaise, headache, weight loss, profound weakness and fatigue. Arthralgias, sacroiliitis, paravertebral abscesses. Anorexia, nausea, vomiting, diarrhea, hepatosplenomegal y. May have 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, dry cough if pneumonic disease. Chest x-ray with widened mediastinum; pleural effusion; gram-positive bacilli in blood or pleural fluid; definitive testing available at the LAC Public Health Laboratory, (562) 658-1300 Gram-negative bacilli or coccobacilli in sputum, blood or lymph node; safety- pin appearance with Wright or Giemsa stain; definitive testing available at th e LAC Public Health Laboratory, Chest x-ray with pulmonary edema. Consult with ACDC regarding specimen collection and diagnostic testing procedures. Primarily clinical diagnosis. Consult with ACDC regarding specimen collection and diagnostic testing procedures. Clinical with laboratory confirmation; vaccinated, gowned and gloved person obtains specimens (scabs or swabs of vesicular or pustular fluid). Call ACDC immediately before obtaining specimen; definitive testing available through CDC. Definitive testing available through public health laboratory network--call ACDCimmediately. CSF protein normal; EMGwith repetitive nerve stimulation shows augmentation of muscle action potential; toxin assays of serum, feces, or gastric aspirate available at the LAC Public Health Laboratory. Call ACDC to request testing. Serologic testing availableat the LAC Public Health Laboratory, (562) 658-1300 T , ow . , e y ol y, iny slow-growing, faintly-staining, gram-negative coccobacilli in blood or bone marr culture. Leukocyte count normal or low Anemia, thrombocytopenia possible. CXR nonspecific: normal bronchopneumonia, abscesses, singl or miliar nodules, enlarged hilar nodes, effusions. Ser ogic testing and culture available at the LAC Public Health Laborator (562) 658-1300 or Small, faintly-staining, slow-growing, gram-negative coccobacilli in smears or cultures of sputum, blood. CXR may show infiltrate, hilaradenopathy, effusion. Definitive testing available at the LAC Public 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 Acute Respiratory Distress with Fever Acute Rash with Fever Neurologic Syndromes Influenza-Like Illness Dissecting aortic aneurysm, pulmonary embolism, influenza, community- acquired pneumonia Community-acquired pneumonia, Hantavirus pulmonary syndrome, meningococcemia, rickettsiosis, influenza Plague, Q fever, staphylococcal enterotoxin B, phosgene, tularemia, influenza Influenza, adenovirus, mycoplasma Varicella, disseminated herpes zoster, vaccinia, monkeypox, cowpox Meningococcemia, malaria, typhus, leptospirosis, borreliosis, thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS) Guillain-Barré syndrome, myasthenia gravis, midbrain stroke, tick paralysis, Mg ++ intoxication, organophosphate, carbon monoxide, paralytic shellfish, or belladonna-like alkaloid poisoning, polio, Eaton-Lambert myasthenic syndrome Herpes simplex, post-infectious, other viral encephalitides Numerous diseases, including Q Fever, brucellosis Call ACDC.Alert your laboratory to possibility of anthrax. No person-to- person transmission. Infection control: standard precautions. Call hospital infection contro l and ACDC. Ask family members/close contacts of patient to stay at the hospital (if already present) for public health interview/chemoprophylaxis; get detailed address and phone number information. Alert laboratory of possibility of plague. Infection control: droplet precautions in addition to standard precautions. Call ACDC. Infection control: standard precautions. Call ACDC. Infection control: standard precautions. Call hospital infection contro l and ACDC immediately. Ask family members/close contacts of patient to stay at the hospital (if already present) for public health interview and vaccination; get detailed address and phone number information. Infection control: airborne and contact precautions in addition to standard precautions. Call hospital infection contro l and ACDC immediatel y. Ask family members/close contacts of patient to stay at the hospital (if already present) for public health interview and follow-up; get detailed address and phone number information. Infection control: contact precautions in addition to standard precautions. Request botulinum antitoxin from ACDC. Infection control: standard precautions. Call ACDC. Infection control: standard precautions. Notify your laboratory if brucellosis suspected --microbiological testing should be done in a biological safety cabinet to prevent lab-acquired infection. Call ACDC. Infection control: standard precautions. Notify your laboratory if tularemia suspected --microbiological testing should be done in a biological safety cabinet to prevent 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 diagnosis Bioterrorism threat disease description Picture Initial laboratory & other diagnostic test results Immediate 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.
Transcript of BIOTERRORISM SYNDROMES - Emergency Preparedness · 2020-01-03 · BIOTERRORISM SYNDROMES If you...
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.
