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Microbiology - Agents of Bioterrorism
- 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. 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. Key Indicators of a Potential Bioterror or Biocrime Event
- 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. 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. 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. 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. Structure of the Laboratory Response Network
- 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. Agents of Bioterror Specimen collection Swabs from black eschar Blood sample from inhalation and gastrointestinal anthrax • Colonies have medusa-head morphology Nonhemolytic
- 11. Morphology of Anthrax on Blood Agar, Gram Stain, and Spore Stain
- 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. 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. 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. Agents of Bioterror Direct examination and culture Plump gram-negative rods Bipolar staining • Safety pin appearance
- 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
- 18. Agents of Bioterror Clinical manifestations Symptoms • Fever with chills • Headaches • Cough • Chest pain • Lesions at site of entry Occasionally respiratory disease
- 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. 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. 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. 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. Agents of Bioterror Smallpox Two major forms • Variola major 30% mortality in unvaccinated 3% in vaccinated • Variola minor Similar but much less severe disease
- 25. Agents of Bioterror Viral hemorrhagic fevers Ebola, Marburg, Lassa fever, Crimean-Congo, Rift Valley fever, Hantavirus Transmission Direct contact Urine, semen
- 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. Agents of Bioterror Toxins Clostridium botulinum toxin Staphylococcal enterotoxins Ricin • Contamination of food or water sources