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article-28991_0 | Inferior Shoulder Dislocations -- Continuing Education Activity | The glenohumeral joint of the shoulder is the most commonly dislocated joint in the body and accounts for approximately 50% of all major dislocations seen in the emergency department. Most shoulder dislocations are anterior, and inferior shoulder dislocations occur are much lower frequencies. Inferior dislocations are ... | Inferior Shoulder Dislocations -- Continuing Education Activity. The glenohumeral joint of the shoulder is the most commonly dislocated joint in the body and accounts for approximately 50% of all major dislocations seen in the emergency department. Most shoulder dislocations are anterior, and inferior shoulder dislocat... |
article-28991_1 | Inferior Shoulder Dislocations -- Continuing Education Activity | Objectives: Identify the etiology of inferior shoulder dislocations. Describe the presentation of a patient with an inferior shoulder dislocation. List the treatment and management options available for inferior shoulder dislocations. Explain the importance of enhancing care coordination amongst interprofessional team ... | Inferior Shoulder Dislocations -- Continuing Education Activity. Objectives: Identify the etiology of inferior shoulder dislocations. Describe the presentation of a patient with an inferior shoulder dislocation. List the treatment and management options available for inferior shoulder dislocations. Explain the importan... |
article-28991_2 | Inferior Shoulder Dislocations -- Introduction | The glenohumeral joint of the shoulder is the most commonly dislocated joint in the body and accounts for approximately 50% of all major dislocations seen in the emergency department. While anterior dislocations are very common and frequently seen in presentation, inferior shoulder dislocations have an incidence of abo... | Inferior Shoulder Dislocations -- Introduction. The glenohumeral joint of the shoulder is the most commonly dislocated joint in the body and accounts for approximately 50% of all major dislocations seen in the emergency department. While anterior dislocations are very common and frequently seen in presentation, inferio... |
article-28991_3 | Inferior Shoulder Dislocations -- Etiology | This type of dislocation is commonly referred to as luxatio erecta which means "erect dislocation" in Latin. This name derives from the typical way in which the arm is usually fully abducted and held above the head on presentation. [4] [5] [6] | Inferior Shoulder Dislocations -- Etiology. This type of dislocation is commonly referred to as luxatio erecta which means "erect dislocation" in Latin. This name derives from the typical way in which the arm is usually fully abducted and held above the head on presentation. [4] [5] [6] |
article-28991_4 | Inferior Shoulder Dislocations -- Etiology | The majority are traumatic such as when the rider falls and tumbles off a motorbike. The humerus neck is pushed against the acromion and there is usually inferior capsule tears. Soft tissue injury or fractures are common with inferior shoulder dislocation. In addition, neurovascular injury, including axillary nerve dam... | Inferior Shoulder Dislocations -- Etiology. The majority are traumatic such as when the rider falls and tumbles off a motorbike. The humerus neck is pushed against the acromion and there is usually inferior capsule tears. Soft tissue injury or fractures are common with inferior shoulder dislocation. In addition, neurov... |
article-28991_5 | Inferior Shoulder Dislocations -- Epidemiology | Although it accounts for less that one percent of all shoulder dislocations, when luxatio erecta occurs, it is much more frequent in men than in women with a reported ratio of approximately 10:1. | Inferior Shoulder Dislocations -- Epidemiology. Although it accounts for less that one percent of all shoulder dislocations, when luxatio erecta occurs, it is much more frequent in men than in women with a reported ratio of approximately 10:1. |
article-28991_6 | Inferior Shoulder Dislocations -- Pathophysiology | The upper extremity articulates with the axial skeleton through the joints of the shoulder girdle which includes the glenohumeral joint. The glenohumeral joint is a ball-and-socket joint that has the largest range of motion of any joint in the body. The glenoid fossa is about 1/3 the size of the humeral head articular ... | Inferior Shoulder Dislocations -- Pathophysiology. The upper extremity articulates with the axial skeleton through the joints of the shoulder girdle which includes the glenohumeral joint. The glenohumeral joint is a ball-and-socket joint that has the largest range of motion of any joint in the body. The glenoid fossa i... |
article-28991_7 | Inferior Shoulder Dislocations -- History and Physical | A patient who has suffered an inferior dislocation usually will present with severe pain and the evaluation begins with a good history and physical exam. Details of the mechanism of injury may be important to determine other injuries to the soft tissues surrounding the shoulder. If the injury occurred in a high force t... | Inferior Shoulder Dislocations -- History and Physical. A patient who has suffered an inferior dislocation usually will present with severe pain and the evaluation begins with a good history and physical exam. Details of the mechanism of injury may be important to determine other injuries to the soft tissues surroundin... |
article-28991_8 | Inferior Shoulder Dislocations -- History and Physical | An inspection usually will reveal the classic appearance of the arm being fully abducted above the head with the elbow flexed at a 90-degree angle. You will want to assess for any distal neurovascular injuries, including assessment of the axillary nerve along with the radial and ulnar distributions of the brachial plex... | Inferior Shoulder Dislocations -- History and Physical. An inspection usually will reveal the classic appearance of the arm being fully abducted above the head with the elbow flexed at a 90-degree angle. You will want to assess for any distal neurovascular injuries, including assessment of the axillary nerve along with... |
article-28991_9 | Inferior Shoulder Dislocations -- Evaluation | The diagnosis is confirmed with standard radiographs of the shoulder. Pre- and post-procedure anterior-posterior (AP) and scapular "Y" view radiographs should be obtained. Axillary views, while helpful in anterior and posterior dislocations, will not show the humeral head to glenoid relationship; an overlapping of thos... | Inferior Shoulder Dislocations -- Evaluation. The diagnosis is confirmed with standard radiographs of the shoulder. Pre- and post-procedure anterior-posterior (AP) and scapular "Y" view radiographs should be obtained. Axillary views, while helpful in anterior and posterior dislocations, will not show the humeral head t... |
article-28991_10 | Inferior Shoulder Dislocations -- Treatment / Management | Treatment will usually require procedural sedation to get adequate muscle relaxation and facilitate a closed reduction via traction-counter-traction. In some cases, a "buttonhole" deformity exists (humeral head is trapped in a tear of the inferior capsule), in which case open reduction is required. To reduce an inferio... | Inferior Shoulder Dislocations -- Treatment / Management. Treatment will usually require procedural sedation to get adequate muscle relaxation and facilitate a closed reduction via traction-counter-traction. In some cases, a "buttonhole" deformity exists (humeral head is trapped in a tear of the inferior capsule), in w... |
article-28991_11 | Inferior Shoulder Dislocations -- Treatment / Management | After reduction, bring the abducted arm into adduction against the body while supinating the forearm. Alternatively, a two-step closed reduction technique can be utilized. Here, the inferior dislocation is first converted into an anterior dislocation before being reduced. One hand is on the shaft of the dislocated hume... | Inferior Shoulder Dislocations -- Treatment / Management. After reduction, bring the abducted arm into adduction against the body while supinating the forearm. Alternatively, a two-step closed reduction technique can be utilized. Here, the inferior dislocation is first converted into an anterior dislocation before bein... |
article-28991_12 | Inferior Shoulder Dislocations -- Treatment / Management | Once back into anatomical position the arm should be placed in a shoulder immobilizer to avoid recurring dislocation as the soft tissue and muscle stabilizers are injured and will be lax. After reduction is achieved another thorough neurovascular exam should be performed, most neuropraxia will resolve after reduction. ... | Inferior Shoulder Dislocations -- Treatment / Management. Once back into anatomical position the arm should be placed in a shoulder immobilizer to avoid recurring dislocation as the soft tissue and muscle stabilizers are injured and will be lax. After reduction is achieved another thorough neurovascular exam should be ... |
article-28991_13 | Inferior Shoulder Dislocations -- Differential Diagnosis | Clavicular fracture Frozen shoulder Fracture of the humerus Rotator cuff tear | Inferior Shoulder Dislocations -- Differential Diagnosis. Clavicular fracture Frozen shoulder Fracture of the humerus Rotator cuff tear |
article-28991_14 | Inferior Shoulder Dislocations -- Prognosis | The majority of individuals who suffer inferior shoulder dislocation are young. A significant number of them will suffer a recurrent dislocation in the future. Rotator cuff tear is often the key pathology. Minor trauma accounts for the majority of recurrent dislocations. Some patients with pain may not be able to retur... | Inferior Shoulder Dislocations -- Prognosis. The majority of individuals who suffer inferior shoulder dislocation are young. A significant number of them will suffer a recurrent dislocation in the future. Rotator cuff tear is often the key pathology. Minor trauma accounts for the majority of recurrent dislocations. Som... |
article-28991_15 | Inferior Shoulder Dislocations -- Complications | Fracture Neurovascular injury Frozen shoulder Soft tissue injury | Inferior Shoulder Dislocations -- Complications. Fracture Neurovascular injury Frozen shoulder Soft tissue injury |
article-28991_16 | Inferior Shoulder Dislocations -- Pearls and Other Issues | Inferior shoulder dislocation injuries when due to a traumatic mechanism are almost always accompanied by moderate to severe soft tissue injury, proximal humerus fractures, avulsion fractures of the greater tuberosity, fractures of the acromion, clavicle, coracoid process, or glenoid rim, and rotator cuff tears. Rotato... | Inferior Shoulder Dislocations -- Pearls and Other Issues. Inferior shoulder dislocation injuries when due to a traumatic mechanism are almost always accompanied by moderate to severe soft tissue injury, proximal humerus fractures, avulsion fractures of the greater tuberosity, fractures of the acromion, clavicle, corac... |
article-28991_17 | Inferior Shoulder Dislocations -- Enhancing Healthcare Team Outcomes | An inferior shoulder dislocation is best managed by an interprofessional team that includes the orthopedic nurses and therapists. While the diagnosis of an inferior shoulder dislocation is relatively simple, clinicians should assess for any distal neurovascular injuries, including assessment of the axillary nerve along... | Inferior Shoulder Dislocations -- Enhancing Healthcare Team Outcomes. An inferior shoulder dislocation is best managed by an interprofessional team that includes the orthopedic nurses and therapists. While the diagnosis of an inferior shoulder dislocation is relatively simple, clinicians should assess for any distal ne... |
article-28991_18 | Inferior Shoulder Dislocations -- Review Questions | Access free multiple choice questions on this topic. Click here for a simplified version. Comment on this article. | Inferior Shoulder Dislocations -- Review Questions. Access free multiple choice questions on this topic. Click here for a simplified version. Comment on this article. |
article-131243_0 | Comprehensive Review of Bioterrorism -- Continuing Education Activity | Bioterrorism involves the deliberate release of bioweapons to cause death or disease in humans, animals, or plants. Biological weapons may be developed or used as part of a government policy in biological warfare or by terrorist groups or criminals. Biological weapons can initiate large-scale epidemics with an unparall... | Comprehensive Review of Bioterrorism -- Continuing Education Activity. Bioterrorism involves the deliberate release of bioweapons to cause death or disease in humans, animals, or plants. Biological weapons may be developed or used as part of a government policy in biological warfare or by terrorist groups or criminals.... |
article-131243_1 | Comprehensive Review of Bioterrorism -- Continuing Education Activity | Objectives: Explain the definition of bioterrorism. Review the types of commonly used as well as potential bioweapons. Explain why health professionals need to be up to date in the workup and treatment of biological weapon-based attacks. Describe the types of bioterrorism events and discuss the role of the inter-profes... | Comprehensive Review of Bioterrorism -- Continuing Education Activity. Objectives: Explain the definition of bioterrorism. Review the types of commonly used as well as potential bioweapons. Explain why health professionals need to be up to date in the workup and treatment of biological weapon-based attacks. Describe th... |
article-131243_2 | Comprehensive Review of Bioterrorism -- Introduction | Biological weapons are devices or agents used or intended to be used in a deliberate attempt to disseminate disease-producing organisms or toxins using aerosol, food, water, or insect vectors. Their mechanism of action tends to be broadly through infection or intoxication. [1] Bioterrorism involves the deliberate relea... | Comprehensive Review of Bioterrorism -- Introduction. Biological weapons are devices or agents used or intended to be used in a deliberate attempt to disseminate disease-producing organisms or toxins using aerosol, food, water, or insect vectors. Their mechanism of action tends to be broadly through infection or intoxi... |
article-131243_3 | Comprehensive Review of Bioterrorism -- Introduction | Biological weapons may be developed or used as part of a government policy in biological warfare or by terrorist groups or criminals. Biological weapons can initiate large-scale epidemics with an unparalleled lethality, and nation-states and terrorist groups have used dangerous and destructive biological weapons in the... | Comprehensive Review of Bioterrorism -- Introduction. Biological weapons may be developed or used as part of a government policy in biological warfare or by terrorist groups or criminals. Biological weapons can initiate large-scale epidemics with an unparalleled lethality, and nation-states and terrorist groups have us... |
article-131243_4 | Comprehensive Review of Bioterrorism -- Introduction | Keeping in mind the horrific nature of these agents, the Geneva protocol, first signed in 1925, and currently signed by 65 out of 121 country states, prohibited the development, production, and use of biological weapons in war. [3] However, not being country states, biological weapons to wage bioterrorism tend to be a ... | Comprehensive Review of Bioterrorism -- Introduction. Keeping in mind the horrific nature of these agents, the Geneva protocol, first signed in 1925, and currently signed by 65 out of 121 country states, prohibited the development, production, and use of biological weapons in war. [3] However, not being country states,... |
article-131243_5 | Comprehensive Review of Bioterrorism -- Introduction | Healthcare professionals need to be aware of the essentials of bioterrorism and biological weapons, as these may be used as part of a terrorist attack in any part of the world. Thus, healthcare professionals need to be trained and prepared in case of a potentially catastrophic event, where quick action and decision-mak... | Comprehensive Review of Bioterrorism -- Introduction. Healthcare professionals need to be aware of the essentials of bioterrorism and biological weapons, as these may be used as part of a terrorist attack in any part of the world. Thus, healthcare professionals need to be trained and prepared in case of a potentially c... |
article-131243_6 | Comprehensive Review of Bioterrorism -- Function | The Centers for Disease Control and Prevention (CDC) have classified biological weapons into three categories based on various factors, including the morbidity and mortality caused by the disease in humans: [2] Category A: Highest priority. Pose a risk to national security. They are easily transmitted from person to pe... | Comprehensive Review of Bioterrorism -- Function. The Centers for Disease Control and Prevention (CDC) have classified biological weapons into three categories based on various factors, including the morbidity and mortality caused by the disease in humans: [2] Category A: Highest priority. Pose a risk to national secur... |
article-131243_7 | Comprehensive Review of Bioterrorism -- Function | For the purpose of this review, the biological weapons and agents which can be used in bioterrorism have been broadly classified as bacterial, viral, fungal, protozoal, and toxins. A brief overview of specific agents which have been used in prior attacks as well as have the potential to weaponized are discussed in this... | Comprehensive Review of Bioterrorism -- Function. For the purpose of this review, the biological weapons and agents which can be used in bioterrorism have been broadly classified as bacterial, viral, fungal, protozoal, and toxins. A brief overview of specific agents which have been used in prior attacks as well as have... |
article-131243_8 | Comprehensive Review of Bioterrorism -- Function | Bacterial: Bacillus anthracis (anthrax), Brucella species (brucellosis), Burkholderia mallei (glanders), Burkholderia pseudomallei (melioidosis), Franciscella tularensis (tularemia), Salmonella typhi (typhoid fever), and other Salmonella species (Salmonellosis), Shigella species (shigellosis), Vibrio cholerae (cholera)... | Comprehensive Review of Bioterrorism -- Function. Bacterial: Bacillus anthracis (anthrax), Brucella species (brucellosis), Burkholderia mallei (glanders), Burkholderia pseudomallei (melioidosis), Franciscella tularensis (tularemia), Salmonella typhi (typhoid fever), and other Salmonella species (Salmonellosis), Shigell... |
article-131243_9 | Comprehensive Review of Bioterrorism -- Issues of Concern | There have been numerous incidents in the past where bioweapons were used in biowarfare. The intentional use of biological weapons, including infectious agents during the war, led to a new and yet unknown threat. The initial and early attempts at using biological weapons in warfare date to the middle ages and included ... | Comprehensive Review of Bioterrorism -- Issues of Concern. There have been numerous incidents in the past where bioweapons were used in biowarfare. The intentional use of biological weapons, including infectious agents during the war, led to a new and yet unknown threat. The initial and early attempts at using biologic... |
article-131243_10 | Comprehensive Review of Bioterrorism -- Issues of Concern | One of the first reported instances of biological weapon use was as early as 600 BC. Solon used a purgative herb called hellebore during the siege of Krissa. [4] The ingestion of white hellebore (Veratrum Album L.) has been reported to cause nausea, vomiting, abdominal pain, bradycardia, and hypotension, with complete ... | Comprehensive Review of Bioterrorism -- Issues of Concern. One of the first reported instances of biological weapon use was as early as 600 BC. Solon used a purgative herb called hellebore during the siege of Krissa. [4] The ingestion of white hellebore (Veratrum Album L.) has been reported to cause nausea, vomiting, a... |
article-131243_11 | Comprehensive Review of Bioterrorism -- Issues of Concern | In 1155 AD, in Tortona, Italy, Emperor Barbarossa poisoned wells with human bodies. In 1346, the Tatar forces who were laying siege to the city of Kaffa (presently Feodosia, Ukraine) engaged in biological warfare by employing the use of catapulting people suffering from the bubonic plague over the walls of the city to ... | Comprehensive Review of Bioterrorism -- Issues of Concern. In 1155 AD, in Tortona, Italy, Emperor Barbarossa poisoned wells with human bodies. In 1346, the Tatar forces who were laying siege to the city of Kaffa (presently Feodosia, Ukraine) engaged in biological warfare by employing the use of catapulting people suffe... |
article-131243_12 | Comprehensive Review of Bioterrorism -- Issues of Concern | In the 18th century, smallpox was a popular choice for biological weapons. [7] During the French and Indian War between 1754 to 1767, the commander of British forces in North America, Sir Jeffrey Amherst, employed the deliberate use of smallpox to "reduce" the populations of the Native American tribes who were hostile ... | Comprehensive Review of Bioterrorism -- Issues of Concern. In the 18th century, smallpox was a popular choice for biological weapons. [7] During the French and Indian War between 1754 to 1767, the commander of British forces in North America, Sir Jeffrey Amherst, employed the deliberate use of smallpox to "reduce" the ... |
article-131243_13 | Comprehensive Review of Bioterrorism -- Issues of Concern | More recently, in the 20th century, biological weapons were reportedly used to a limited extent. Some evidence suggests that during World War I, Germany had developed a biological warfare program that planned on covert operations to infect the livestock and contaminate the animal feed, which was to be exported to the A... | Comprehensive Review of Bioterrorism -- Issues of Concern. More recently, in the 20th century, biological weapons were reportedly used to a limited extent. Some evidence suggests that during World War I, Germany had developed a biological warfare program that planned on covert operations to infect the livestock and con... |
article-131243_14 | Comprehensive Review of Bioterrorism -- Issues of Concern | During World War II, there were once again attempts made by various nation-states to indulge in the use of biological weapons. [1] Japan engaged in research related to biological weapons from 1932 until the end of World War II. The agents of interest to the Japanese biological weapons program included Bacillus anthraci... | Comprehensive Review of Bioterrorism -- Issues of Concern. During World War II, there were once again attempts made by various nation-states to indulge in the use of biological weapons. [1] Japan engaged in research related to biological weapons from 1932 until the end of World War II. The agents of interest to the Jap... |
article-131243_15 | Comprehensive Review of Bioterrorism -- Issues of Concern | Prisoners in Nazi concentration camps in Germany were deliberately infected with Rickettsia prowazekii , Plasmodium species, and hepatitis A virus to be treated with experimental drugs and vaccines. [7] In England, experiments involving weaponized spores of Bacillus anthracis were conducted off Scotland's coast, which ... | Comprehensive Review of Bioterrorism -- Issues of Concern. Prisoners in Nazi concentration camps in Germany were deliberately infected with Rickettsia prowazekii , Plasmodium species, and hepatitis A virus to be treated with experimental drugs and vaccines. [7] In England, experiments involving weaponized spores of Bac... |
article-131243_16 | Comprehensive Review of Bioterrorism -- Issues of Concern | In 1942, the United States initiated a biological warfare program. The program included research on B. anthracis and Brucella suis in various research facilities, including a development facility at Camp Detrick in Maryland, known today as the US Army Medical Research Institute of Infectious Diseases (USAMRIID). About ... | Comprehensive Review of Bioterrorism -- Issues of Concern. In 1942, the United States initiated a biological warfare program. The program included research on B. anthracis and Brucella suis in various research facilities, including a development facility at Camp Detrick in Maryland, known today as the US Army Medical R... |
article-131243_17 | Comprehensive Review of Bioterrorism -- Issues of Concern | Post World War II, various other nation-states and organizations dabbled in developing biological weapons. By the 1960s, the United States military developed a large biological weapons arsenal that consisted of various biological pathogens, toxins, and fungal plant pathogens that could induce crop failure and result in... | Comprehensive Review of Bioterrorism -- Issues of Concern. Post World War II, various other nation-states and organizations dabbled in developing biological weapons. By the 1960s, the United States military developed a large biological weapons arsenal that consisted of various biological pathogens, toxins, and fungal p... |
article-131243_18 | Comprehensive Review of Bioterrorism -- Issues of Concern | In 1978, a Bulgarian exile, Georgi Markov, was assassinated in London in what later came to be known as the “umbrella killing” due to the murder weapon being a device hidden inside an umbrella. A tiny pellet was discharged into Markov’s leg at a bus stop in London. The next day, he became severely ill and died 3 days a... | Comprehensive Review of Bioterrorism -- Issues of Concern. In 1978, a Bulgarian exile, Georgi Markov, was assassinated in London in what later came to be known as the “umbrella killing” due to the murder weapon being a device hidden inside an umbrella. A tiny pellet was discharged into Markov’s leg at a bus stop in Lon... |
article-131243_19 | Comprehensive Review of Bioterrorism -- Issues of Concern | In 1979, there was an outbreak of anthrax in the Russian city of Sverdlovsk (now Yekaterinburg). The outbreak occurred in people close to a Soviet military microbiology facility (called Compound 19). As well as humans, livestock in the area also died of anthrax. The unintentional release of anthrax spores was thought t... | Comprehensive Review of Bioterrorism -- Issues of Concern. In 1979, there was an outbreak of anthrax in the Russian city of Sverdlovsk (now Yekaterinburg). The outbreak occurred in people close to a Soviet military microbiology facility (called Compound 19). As well as humans, livestock in the area also died of anthrax... |
article-131243_20 | Comprehensive Review of Bioterrorism -- Issues of Concern | From 1990 to 1994, a Japanese religious cult calling themselves Aum Shinrikyo (presently called Aleph) made nine failed attempts to release anthrax spores as well as an aerosol containing botulinum toxin in Tokyo with the intent to murder innocent civilians. [1] However, in 1995, they succeeded in releasing a nerve gas... | Comprehensive Review of Bioterrorism -- Issues of Concern. From 1990 to 1994, a Japanese religious cult calling themselves Aum Shinrikyo (presently called Aleph) made nine failed attempts to release anthrax spores as well as an aerosol containing botulinum toxin in Tokyo with the intent to murder innocent civilians. [1... |
article-131243_21 | Comprehensive Review of Bioterrorism -- Issues of Concern | In 2001 in the United States, a series of letters containing anthrax spores were mailed to senators, journalists, and media buildings. There were 5 casualties and 22 people who were seriously injured. A large-scale investigation finally implicated a former United States scientist as the perpetrator. [3] Using letters i... | Comprehensive Review of Bioterrorism -- Issues of Concern. In 2001 in the United States, a series of letters containing anthrax spores were mailed to senators, journalists, and media buildings. There were 5 casualties and 22 people who were seriously injured. A large-scale investigation finally implicated a former Unit... |
article-131243_22 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax) | Bacillus anthracis is an aerobic or facultatively-anaerobic, encapsulated, gram-positive or gram-variable, spore-forming bacilli that grow well on blood agar in the form of large, irregular-shaped colonies. The word anthrax originates from "anthrakis" in Greek, meaning black, which refers to the necrotic lesions which ... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax). Bacillus anthracis is an aerobic or facultatively-anaerobic, encapsulated, gram-positive or gram-variable, spore-forming bacilli that grow well on blood agar in the form of large, irregular-shaped colonies. The word anthrax origi... |
article-131243_23 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax) | The pathogenesis of anthrax infections depend on the route of inoculation, with three routes reported in humans: Inhalational anthrax by the accumulation of B. anthracis spores initially in the lung alveoli followed by transport to the regional lymph nodes where it germinates, multiplies, and begins toxin production wi... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax). The pathogenesis of anthrax infections depend on the route of inoculation, with three routes reported in humans: Inhalational anthrax by the accumulation of B. anthracis spores initially in the lung alveoli followed by transport ... |
article-131243_24 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax) | Symptoms and Signs [11] | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax). Symptoms and Signs [11] |
article-131243_25 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax) | Inhalational anthrax has an incubation period of around 1 to 6 days following exposure. It presents with a non-specific prodromal phase, including fever, malaise, nausea, vomiting, chest pain, and cough. The second stage of bacterial replication follows this in the mediastinal lymph nodes, which causes hemorrhagic lymp... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax). Inhalational anthrax has an incubation period of around 1 to 6 days following exposure. It presents with a non-specific prodromal phase, including fever, malaise, nausea, vomiting, chest pain, and cough. The second stage of bacte... |
article-131243_26 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax) | Gastro-intestinal can have oropharyngeal and/or intestinal involvement. In oropharyngeal anthrax, ulcers may develop on the posterior oropharynx, which can cause dysphagia and regional lymphadenopathy. In intestinal anthrax, patients may have fever, nausea, vomiting, and diarrhea. They can also have acute abdomen-like ... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax). Gastro-intestinal can have oropharyngeal and/or intestinal involvement. In oropharyngeal anthrax, ulcers may develop on the posterior oropharynx, which can cause dysphagia and regional lymphadenopathy. In intestinal anthrax, pati... |
article-131243_27 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax) | Cutaneous anthrax, which is also called hide-porter's disease , can present one to 10 days following exposure with a pruritic and papular lesion which can progress over days into a painless ulcer. The primary lesion can have associated satellite vesicles that can progress to a necrotic center with non-pitting edema sur... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax). Cutaneous anthrax, which is also called hide-porter's disease , can present one to 10 days following exposure with a pruritic and papular lesion which can progress over days into a painless ulcer. The primary lesion can have asso... |
article-131243_28 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax) | The CDC recommends using PCR, gram stain, and bacterial cultures depending on clinical features from blood, pleural fluid, ulcer, cerebrospinal fluid, or stool. Routine diagnostic tests, including a complete blood count and chest x-ray, are also recommended. Chest X-ray in inhalational anthrax can show an enlarged medi... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax). The CDC recommends using PCR, gram stain, and bacterial cultures depending on clinical features from blood, pleural fluid, ulcer, cerebrospinal fluid, or stool. Routine diagnostic tests, including a complete blood count and chest... |
article-131243_29 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax) | The laboratory personnel must be adequately warned about the possibility of anthrax. All inhalational anthrax cases should be considered as a bioterrorism event, and decontamination is done appropriately. Anthrax is reportable and, if identified, should be immediately reported to local authorities and the CDC. | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax). The laboratory personnel must be adequately warned about the possibility of anthrax. All inhalational anthrax cases should be considered as a bioterrorism event, and decontamination is done appropriately. Anthrax is reportable an... |
article-131243_30 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax) | Treatment for inhalational anthrax involves a regimen using one bactericidal agent + one protein-synthesis inhibitor drug. Intravenous ciprofloxacin + clindamycin/linezolid is the preferred regimen. In meningitis, a three-drug regimen is preferred with the addition of a bactericidal agent from a different drug class, s... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax). Treatment for inhalational anthrax involves a regimen using one bactericidal agent + one protein-synthesis inhibitor drug. Intravenous ciprofloxacin + clindamycin/linezolid is the preferred regimen. In meningitis, a three-drug re... |
article-131243_31 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax) | Importance in Bioterrorism [3] | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax). Importance in Bioterrorism [3] |
article-131243_32 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax) | Anthrax has been used in bioterrorist attacks in the past, with the most prolific example being the ‘Anthrax letter’ attacks in the United States in 2001. It is a category A priority pathogen as per the CDC. It is highly stable in aerosolized form, making it one of the most popular biological weapons choices. | Comprehensive Review of Bioterrorism -- Issues of Concern -- Bacillus anthracis (Anthrax). Anthrax has been used in bioterrorist attacks in the past, with the most prolific example being the ‘Anthrax letter’ attacks in the United States in 2001. It is a category A priority pathogen as per the CDC. It is highly stable i... |
article-131243_33 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Brucella species (Brucellosis) | In humans, Brucellosis may be caused by four different species, including B. suis, B. abortus, B. melitensis, and B. canis. Brucella species are gram-negative, non-motile Cocco-bacilli, which are facultatively intracellular and do not form spores or toxins. [12] Symptoms and Signs [12] | Comprehensive Review of Bioterrorism -- Issues of Concern -- Brucella species (Brucellosis). In humans, Brucellosis may be caused by four different species, including B. suis, B. abortus, B. melitensis, and B. canis. Brucella species are gram-negative, non-motile Cocco-bacilli, which are facultatively intracellular and... |
article-131243_34 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Brucella species (Brucellosis) | Brucellosis can present with clinical features based on the underlying clinical syndrome, potentially including features of meningoencephalitis, myelitis, transaminitis, orchitis, epididymitis, endocarditis, sacroiliitis, spondylodiscitis, osteomyelitis, septic arthritis, epidural abscesses, and hepatic abscesses. Resp... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Brucella species (Brucellosis). Brucellosis can present with clinical features based on the underlying clinical syndrome, potentially including features of meningoencephalitis, myelitis, transaminitis, orchitis, epididymitis, endocarditis, sacroiliitis, spond... |
article-131243_35 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Brucella species (Brucellosis) | Investigations and Management [12] | Comprehensive Review of Bioterrorism -- Issues of Concern -- Brucella species (Brucellosis). Investigations and Management [12] |
article-131243_36 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Brucella species (Brucellosis) | Patients may have anemia, leukopenia, or even pancytopenia along with elevated inflammatory markers, serum lactate dehydrogenase, transaminases, and alkaline phosphatase. In spondylitis, disc space narrowing, sclerosis, and bone destruction may be visible on imaging. On liver biopsy, granulomas may be observed. Blood c... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Brucella species (Brucellosis). Patients may have anemia, leukopenia, or even pancytopenia along with elevated inflammatory markers, serum lactate dehydrogenase, transaminases, and alkaline phosphatase. In spondylitis, disc space narrowing, sclerosis, and bon... |
article-131243_37 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Importance in Bioterrorism | Brucella has been successfully engineered as a biological weapon by the United States and several other countries, although it has never been used during the war. Brucella can be easily aerosolized, and it survives well in the aerosol form. In a bioterrorist event using Brucella , treatment remains the same as for natu... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Importance in Bioterrorism. Brucella has been successfully engineered as a biological weapon by the United States and several other countries, although it has never been used during the war. Brucella can be easily aerosolized, and it survives well in the aero... |
article-131243_38 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Burkholderia mallei (glanders) and Burkholderia pseudomallei (melioidosis) | Glanders is caused by Burkholderia mallei which is a gram-negative, aerobic, non-motile bacillus. Melioidosis is caused by Burkholderia pseudomallei, which is also a gram-negative, aerobic bacillus but is motile. These two bacteria are related closely and can both present with the disease in humans. [14] | Comprehensive Review of Bioterrorism -- Issues of Concern -- Burkholderia mallei (glanders) and Burkholderia pseudomallei (melioidosis). Glanders is caused by Burkholderia mallei which is a gram-negative, aerobic, non-motile bacillus. Melioidosis is caused by Burkholderia pseudomallei, which is also a gram-negative, ae... |
article-131243_39 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs | The incubation period for glanders ranges between one to 21 days but can even be months to years. Glanders usually starts as fever, followed by pustules, abscesses, and pneumonia. Acute glanders is usually fatal within seven to ten days of onset. Chronic glanders causes death within months, and the survivors become car... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs. The incubation period for glanders ranges between one to 21 days but can even be months to years. Glanders usually starts as fever, followed by pustules, abscesses, and pneumonia. Acute glanders is usually fatal within seven to ten days of... |
article-131243_40 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs | Burkholderia pseudomallei can enter the human host through three modes: ingestion, inhalation, or direct inoculation. The incubation period of melioidosis is highly variable. It can range from two days to several years. Acute melioidosis presents with fever, cough, pleurisy, myalgia, arthralgia, headache, night sweats,... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs. Burkholderia pseudomallei can enter the human host through three modes: ingestion, inhalation, or direct inoculation. The incubation period of melioidosis is highly variable. It can range from two days to several years. Acute melioidosis p... |
article-131243_41 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management | Cultures can diagnose both organisms. In melioidosis, blood, sputum, urine, and throat swab cultures may be indicated. It is recommended to perform the laboratory work on these organisms under BSL-3 precautions. Latex agglutination, indirect hemagglutination, and direct immunofluorescence tests may be available based o... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management. Cultures can diagnose both organisms. In melioidosis, blood, sputum, urine, and throat swab cultures may be indicated. It is recommended to perform the laboratory work on these organisms under BSL-3 precautions. Latex agglutinat... |
article-131243_42 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management | In both diseases, patients with significant lungs' significant involvement can progress to respiratory failure and require mechanical ventilation. Sepsis may also occur. In glanders, the recommended treatment regimen includes imipenem and doxycycline for two weeks, which should be followed by doxycycline and azithromyc... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management. In both diseases, patients with significant lungs' significant involvement can progress to respiratory failure and require mechanical ventilation. Sepsis may also occur. In glanders, the recommended treatment regimen includes im... |
article-131243_43 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management | The mortality in melioidosis ranges between 20% to 50%. [16] This can exceed 90% in sepsis, but it may decrease to 10% in uncomplicated cases with appropriate antibiotic therapy. [14] The recommended treatment regimen in acute melioidosis includes intravenous ceftazidime. Carbapenems, including meropenem and imipenem, ... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management. The mortality in melioidosis ranges between 20% to 50%. [16] This can exceed 90% in sepsis, but it may decrease to 10% in uncomplicated cases with appropriate antibiotic therapy. [14] The recommended treatment regimen in acute m... |
article-131243_44 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Importance in Bioterrorism | As per the CDC, both B. pseudomallei and mallei are category B bioweapons. During World War I, German sympathizers in numerous countries infected horses meant for dispatch to conflict areas with B. mallei to induce glanders. This led to the combat operations being affected due to the infection of humans and horses. Jap... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Importance in Bioterrorism. As per the CDC, both B. pseudomallei and mallei are category B bioweapons. During World War I, German sympathizers in numerous countries infected horses meant for dispatch to conflict areas with B. mallei to induce glanders. This l... |
article-131243_45 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Importance in Bioterrorism | Francisella tularensis is a highly infectious gram-negative coccobacillus. Infection can occur through various entry points, including inhalation, direct contact with a break in the skin or mucous membranes, ingestion, or through ticks or fly vectors. Symptoms and Signs [19] | Comprehensive Review of Bioterrorism -- Issues of Concern -- Importance in Bioterrorism. Francisella tularensis is a highly infectious gram-negative coccobacillus. Infection can occur through various entry points, including inhalation, direct contact with a break in the skin or mucous membranes, ingestion, or through t... |
article-131243_46 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Importance in Bioterrorism | F. tularensis infections can cause distinct clinical syndromes based on the mode of exposure. Percutaneous inoculation usually causes ulceroglandular tularemia, which is characterized by a cutaneous ulcer at the inoculation site as well as tender regional lymphadenopathy. Inhalation can result in primary pneumonia. Ing... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Importance in Bioterrorism. F. tularensis infections can cause distinct clinical syndromes based on the mode of exposure. Percutaneous inoculation usually causes ulceroglandular tularemia, which is characterized by a cutaneous ulcer at the inoculation site as... |
article-131243_47 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Importance in Bioterrorism | Tularemia requires a high index of clinical suspicion as laboratory identification is difficult. Patients may have raised inflammatory markers or leukocytosis. The cornerstone of laboratory diagnosis relies on the serologic diagnosis. An initial titer of more than 1:160 or a four-fold increase in titers between the ini... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Importance in Bioterrorism. Tularemia requires a high index of clinical suspicion as laboratory identification is difficult. Patients may have raised inflammatory markers or leukocytosis. The cornerstone of laboratory diagnosis relies on the serologic diagnos... |
article-131243_48 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Importance in Bioterrorism | The recommended treatment regimen for tularemia consists of intravenous gentamicin for seven to 14 days. Fluoroquinolones such as ciprofloxacin also have a role in mild disease, but data of its use in the more virulent type A infections is limited. Bacteriostatic agents like tetracyclines should be avoided due to the h... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Importance in Bioterrorism. The recommended treatment regimen for tularemia consists of intravenous gentamicin for seven to 14 days. Fluoroquinolones such as ciprofloxacin also have a role in mild disease, but data of its use in the more virulent type A infec... |
article-131243_49 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Salmonella typhi (typhoid fever) and other Salmonella species (Salmonellosis) | Salmonella typhi is a gram-negative, flagellated bacillus that causes typhoid fever. It is usually contracted by ingesting contaminated water or food with an infectious dose ranging between 1000 and 1 million bacteria. Salmonella typhi can enter the small intestine submucosal layer by direct penetration into the epithe... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Salmonella typhi (typhoid fever) and other Salmonella species (Salmonellosis). Salmonella typhi is a gram-negative, flagellated bacillus that causes typhoid fever. It is usually contracted by ingesting contaminated water or food with an infectious dose rangin... |
article-131243_50 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs | In Typhoid fever, the incubation period ranges between seven to 14 days after initial inoculation. Following this, patients can present with fever and abdominal symptoms, including abdominal pain, nausea, vomiting, diarrhea, or constipation. A stepladder pattern of fever and relative bradycardia is classically associat... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs. In Typhoid fever, the incubation period ranges between seven to 14 days after initial inoculation. Following this, patients can present with fever and abdominal symptoms, including abdominal pain, nausea, vomiting, diarrhea, or constipatio... |
article-131243_51 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management | In Typhoid fever, a blood count can show either leukopenia or leukocytosis with a left shift. Relative anemia could be seen. Blood and stool cultures are recommended in the workup. Blood cultures may be positive in 40 to 80% of patients, while stool cultures could be positive in 30% to 40%. The most sensitive test rema... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management. In Typhoid fever, a blood count can show either leukopenia or leukocytosis with a left shift. Relative anemia could be seen. Blood and stool cultures are recommended in the workup. Blood cultures may be positive in 40 to 80% of ... |
article-131243_52 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management | For other Salmonella infections, the gold standard test for diagnosis is bacterial culture. Stool, blood, urine, bile, CSF, and bone marrow may be cultured based on the clinical syndrome. Due to the production of hydrogen sulfide, Salmonella forms black colonies on Hektoen Agar. PCR for specific Salmonella species is a... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management. For other Salmonella infections, the gold standard test for diagnosis is bacterial culture. Stool, blood, urine, bile, CSF, and bone marrow may be cultured based on the clinical syndrome. Due to the production of hydrogen sulfid... |
article-131243_53 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management | Salmonella is a category B bioweapon as per the CDC. It has been used in biowarfare by the Germans during World War I and in the infamous attack by the Rajneesh cult in Dallas, TX in the United States in 1986, where they contaminated salad bars in local restaurants with Salmonella to influence an upcoming election. | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management. Salmonella is a category B bioweapon as per the CDC. It has been used in biowarfare by the Germans during World War I and in the infamous attack by the Rajneesh cult in Dallas, TX in the United States in 1986, where they contami... |
article-131243_54 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Shigella species (shigellosis) and Escherichia coli O157:H7 | Shigella is a gram-negative, non-motile, facultatively anaerobic, and non-spore-forming bacillus which has 4 serotypes, including serotype A ( Shigella dysenteriae with 12 serotypes), serotype B ( Shigella flexneri with 6 serotypes), serotype C ( Shigella boydii with 23 serotypes), and serotype D ( Shigella soneii with... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Shigella species (shigellosis) and Escherichia coli O157:H7. Shigella is a gram-negative, non-motile, facultatively anaerobic, and non-spore-forming bacillus which has 4 serotypes, including serotype A ( Shigella dysenteriae with 12 serotypes), serotype B ( S... |
article-131243_55 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Shigella species (shigellosis) and Escherichia coli O157:H7 | Escherichia coli O157: H7 is a Shiga-like toxin-producing strain that is a food and waterborne pathogen. It is a gram-negative bacillus and belongs to the Enterobacteriaceae family. Naturally occurring infections occur through the fecal-oral route by consumption of contaminated food and water. Only a relatively low ino... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Shigella species (shigellosis) and Escherichia coli O157:H7. Escherichia coli O157: H7 is a Shiga-like toxin-producing strain that is a food and waterborne pathogen. It is a gram-negative bacillus and belongs to the Enterobacteriaceae family. Naturally occurr... |
article-131243_56 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs | Shigellosis can present with abdominal discomfort or severe diffuse colicky abdominal pain. There can be mucoid diarrhea that can precede dysentery. Fever, nausea, vomiting, lethargy, anorexia, and tenesmus are also common. Physical examination may indicate lethargic or toxic patients with fever and altered vital signs... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs. Shigellosis can present with abdominal discomfort or severe diffuse colicky abdominal pain. There can be mucoid diarrhea that can precede dysentery. Fever, nausea, vomiting, lethargy, anorexia, and tenesmus are also common. Physical examin... |
article-131243_57 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs | In E. coli O157: H7 infections, patients present with acute onset bloody diarrhea and abdominal cramping with or without fever. There may also be nausea, vomiting, and profuse diarrhea resulting in dehydration and decreased urine output. Abdominal tenderness may be elicited by virtue of Shiga-like toxin-induced intesti... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs. In E. coli O157: H7 infections, patients present with acute onset bloody diarrhea and abdominal cramping with or without fever. There may also be nausea, vomiting, and profuse diarrhea resulting in dehydration and decreased urine output. A... |
article-131243_58 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management | In shigellosis, a complete blood count can show leukocytosis with a shift to the left or leukopenia. Anemia and/or thrombocytopenia may be present. Inflammatory markers may be raised. Stool analysis can show fecal leukocytes and red blood cells. A stool culture can yield the growth of Shigella . Blood cultures may be p... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management. In shigellosis, a complete blood count can show leukocytosis with a shift to the left or leukopenia. Anemia and/or thrombocytopenia may be present. Inflammatory markers may be raised. Stool analysis can show fecal leukocytes and... |
article-131243_59 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management | In E. coli O157: H7 infections, complete blood count can show leukocytosis, anemia due to hemolysis, and thrombocytopenia. Metabolic profile is important, especially in dehydration, which can result in electrolyte disturbances and uremia. A stool culture may be positive for E. coli 0157:H7. Culturing the stool with sor... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management. In E. coli O157: H7 infections, complete blood count can show leukocytosis, anemia due to hemolysis, and thrombocytopenia. Metabolic profile is important, especially in dehydration, which can result in electrolyte disturbances a... |
article-131243_60 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Importance in Bioterrorism | During World War II, the Japanese bioweapon program studies the use of Shigella species. Many prisoners died due to experimental inoculation causing dysentery. [4] E. coli O157:H7 strain is considered a Category B priority pathogen by the CDC as it is a potential food safety threat. [27] Vibrio cholerae (cholera) [28] | Comprehensive Review of Bioterrorism -- Issues of Concern -- Importance in Bioterrorism. During World War II, the Japanese bioweapon program studies the use of Shigella species. Many prisoners died due to experimental inoculation causing dysentery. [4] E. coli O157:H7 strain is considered a Category B priority pathogen... |
article-131243_61 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Importance in Bioterrorism | Toxin-producing strains of Vibrio cholerae cause cholera. V. cholerae is a motile, comma-shaped, gram-negative rod that has a single polar flagellum. Cholera is transmitted through the fecal-oral route by contaminated water or food. | Comprehensive Review of Bioterrorism -- Issues of Concern -- Importance in Bioterrorism. Toxin-producing strains of Vibrio cholerae cause cholera. V. cholerae is a motile, comma-shaped, gram-negative rod that has a single polar flagellum. Cholera is transmitted through the fecal-oral route by contaminated water or food... |
article-131243_62 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs | Cholera presents with profuse painless diarrhea, abdominal discomfort, and vomiting but without fever. Severe cases can lead to hypovolemic shock as a result of massive fluid and electrolyte loss. Classical diarrhea consists of watery and foul-smelling mucous, which is described as "rice-water" stools. The rate of flui... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs. Cholera presents with profuse painless diarrhea, abdominal discomfort, and vomiting but without fever. Severe cases can lead to hypovolemic shock as a result of massive fluid and electrolyte loss. Classical diarrhea consists of watery and ... |
article-131243_63 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management | Laboratory tests usually reveal hypokalemia, hypocalcemia, and metabolic acidosis as a result of massive fluid loss, but hyponatremia may not be evident as salt is lost too. Confirmatory diagnosis of V. cholerae is by the isolation of bacteria in stool cultures, PCR, and other rapid tests. Stool cultures remain the gol... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management. Laboratory tests usually reveal hypokalemia, hypocalcemia, and metabolic acidosis as a result of massive fluid loss, but hyponatremia may not be evident as salt is lost too. Confirmatory diagnosis of V. cholerae is by the isolat... |
article-131243_64 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management | Oral rehydration therapy (ORT) remains the mainstay in the treatment of acute cholera. The degree of fluid replacement may be determined by the degree of hypovolemia ascertained by a physical exam. Rehydration must be started as soon as cholera is suspected. In patients with severe hypovolemia, intravenous replacement ... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management. Oral rehydration therapy (ORT) remains the mainstay in the treatment of acute cholera. The degree of fluid replacement may be determined by the degree of hypovolemia ascertained by a physical exam. Rehydration must be started as... |
article-131243_65 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management | Similar to Shigella , the Japanese bioweapon program during World War II experimented with cholera. Numerous prisoners died due to experimental inoculation using Vibrio cholerae . | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management. Similar to Shigella , the Japanese bioweapon program during World War II experimented with cholera. Numerous prisoners died due to experimental inoculation using Vibrio cholerae . |
article-131243_66 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Yersinia pestis (plague) | Yersinia pestis is a gram-negative, non-motile bacillus with a bipolar staining pattern with Giemsa, Wright, or Wayson staining. [29] As a result of the lymph nodes' pathophysiologic involvement, more than 80 to 95% of Y. pestis infections usually present with suppurative adenitis, known as the bubonic plague. Other pr... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Yersinia pestis (plague). Yersinia pestis is a gram-negative, non-motile bacillus with a bipolar staining pattern with Giemsa, Wright, or Wayson staining. [29] As a result of the lymph nodes' pathophysiologic involvement, more than 80 to 95% of Y. pestis infe... |
article-131243_67 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs | The most common presentation is the bubonic plague which has a two to eight-day incubation period. Symptoms include sudden fever, chills, headache, and malaise. A bubo develops within a day or so, starting as intense pain and swelling in the regional lymph node area, commonly inguinal, followed by axillary or cervical ... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs. The most common presentation is the bubonic plague which has a two to eight-day incubation period. Symptoms include sudden fever, chills, headache, and malaise. A bubo develops within a day or so, starting as intense pain and swelling in t... |
article-131243_68 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs | Pneumonic plague commonly occurs following the hematogenous spread of the organism from the bubo and can present with fever, cough, chest pain, and hemoptysis. It can also occur without buboes. Primary pneumonic plague can occur following inhalational exposure to another patient having a cough. Rarely, patients may pre... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs. Pneumonic plague commonly occurs following the hematogenous spread of the organism from the bubo and can present with fever, cough, chest pain, and hemoptysis. It can also occur without buboes. Primary pneumonic plague can occur following ... |
article-131243_69 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management | Suspected patients should be immediately isolated along with droplet precautions for at least 48 hours following initiation of antibiotic therapy. Laboratory personnel should also be informed to allow for precautions while handling samples. In all presentations, a high degree of clinical suspicion is required. In the s... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management. Suspected patients should be immediately isolated along with droplet precautions for at least 48 hours following initiation of antibiotic therapy. Laboratory personnel should also be informed to allow for precautions while handl... |
article-131243_70 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management | Rapid initiation of antibiotics is necessary for effective treatment due to the rapid progression. Aminoglycosides such as streptomycin or gentamicin are considered first-line treatment for seven to ten days. The alternative agents include tetracycline or doxycycline and tetracycline for 14 days. Co-trimoxazole has dec... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management. Rapid initiation of antibiotics is necessary for effective treatment due to the rapid progression. Aminoglycosides such as streptomycin or gentamicin are considered first-line treatment for seven to ten days. The alternative age... |
article-131243_71 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management | Plague is a category A bioweapon as per the CDC. Epidemiology of plague in the event of a bioterrorist attack would be significantly different from natural infections. It would likely be an aerosol leading to a pneumonic plague outbreak. Patients would initially present with symptoms similar to other severe respiratory... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management. Plague is a category A bioweapon as per the CDC. Epidemiology of plague in the event of a bioterrorist attack would be significantly different from natural infections. It would likely be an aerosol leading to a pneumonic plague ... |
article-131243_72 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Rickettsial Infections | The CDC has included four rickettsial organisms, including Coxiella burnetii (Q fever), Rickettsia prowazekii (typhus fever), Rickettsia rickettsii (Rocky Mountain spotted fever), and Chlamydia psittaci (Psittacosis), as potential biological weapons. [31] [32] | Comprehensive Review of Bioterrorism -- Issues of Concern -- Rickettsial Infections. The CDC has included four rickettsial organisms, including Coxiella burnetii (Q fever), Rickettsia prowazekii (typhus fever), Rickettsia rickettsii (Rocky Mountain spotted fever), and Chlamydia psittaci (Psittacosis), as potential bio... |
article-131243_73 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Rickettsial Infections | Coxiella burnetii is an obligate intracellular, gram-negative, pleomorphic bacteria that causes Q fever. C. burnetii exhibits a form of antigenic shift, namely, phase variation, where it exists as a highly infectious phase I form in animals and as a non-infectious phase II form when it is subcultured. [33] Rickettsia p... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Rickettsial Infections. Coxiella burnetii is an obligate intracellular, gram-negative, pleomorphic bacteria that causes Q fever. C. burnetii exhibits a form of antigenic shift, namely, phase variation, where it exists as a highly infectious phase I form in an... |
article-131243_74 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Rickettsial Infections | Chlamydia psittaci is an obligate intracellular, gram-negative bacteria that can infect both mammals and avians, having multiple genotypes. Birds are the major epidemiological reservoir, while human-to-human transmission is rare. [36] | Comprehensive Review of Bioterrorism -- Issues of Concern -- Rickettsial Infections. Chlamydia psittaci is an obligate intracellular, gram-negative bacteria that can infect both mammals and avians, having multiple genotypes. Birds are the major epidemiological reservoir, while human-to-human transmission is rare. [36] |
article-131243_75 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs | The severity of Q fever may range from being completely asymptomatic to serious illness. The incubation period ranges between two to six weeks. The usual spectrum involves a febrile illness which is usually associated with a headache. The illness plateaus in two to four days, and the patient returns to normal in five t... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs. The severity of Q fever may range from being completely asymptomatic to serious illness. The incubation period ranges between two to six weeks. The usual spectrum involves a febrile illness which is usually associated with a headache. The ... |
article-131243_76 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs | For Rickettsia prowazekii, the incubation period ranges between one to two weeks. Symptoms include high fever (105 to 106 F), severe headache, myalgias, delirium, dry cough, stupor, and an erythematous rash which begins on the trunk and spreads peripherally with sparing of the palms and soles. The disease can progress ... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs. For Rickettsia prowazekii, the incubation period ranges between one to two weeks. Symptoms include high fever (105 to 106 F), severe headache, myalgias, delirium, dry cough, stupor, and an erythematous rash which begins on the trunk and sp... |
article-131243_77 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs | Rocky Mountain spotted fever occurs four to ten days following exposure to the Rickettsia rickettsii . The symptoms classically include a triad of fever, headache, and a maculopapular or petechial rash. The rash begins as a maculopapular rash on the wrists and ankles, which can later progress to petechia. Other symptom... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs. Rocky Mountain spotted fever occurs four to ten days following exposure to the Rickettsia rickettsii . The symptoms classically include a triad of fever, headache, and a maculopapular or petechial rash. The rash begins as a maculopapular r... |
article-131243_78 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs | Psittacosis has an average incubation period of five to 14 days. Symptoms are mainly respiratory, but the system involvement can vary tremendously. The organism can spread hematogenously to other organ systems after initial respiratory replication. The symptoms initially include fever, chills, headache, and cough. Sign... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Symptoms and Signs. Psittacosis has an average incubation period of five to 14 days. Symptoms are mainly respiratory, but the system involvement can vary tremendously. The organism can spread hematogenously to other organ systems after initial respiratory rep... |
article-131243_79 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management | C. burnetii can be isolated on cell culture media, but as there is a risk of lab transmission, culture should only be attempted in BSL 3 labs. Serology remains the mainstay in the diagnosis of Q fever, with indirect immunofluorescence being the reference test. Patients with acute Q fever can have normal leukocyte count... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management. C. burnetii can be isolated on cell culture media, but as there is a risk of lab transmission, culture should only be attempted in BSL 3 labs. Serology remains the mainstay in the diagnosis of Q fever, with indirect immunofluore... |
article-131243_80 | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management | Serology is the mainstay in diagnosing Rickettsia prowazekii infections. A four-fold increase between the acute and convalescent titers is considered diagnostic. Indirect fluorescence antibody tests, agglutination tests, and enzyme immunoassays are commonly employed. Patients can have an initial IgM response followed b... | Comprehensive Review of Bioterrorism -- Issues of Concern -- Investigations and Management. Serology is the mainstay in diagnosing Rickettsia prowazekii infections. A four-fold increase between the acute and convalescent titers is considered diagnostic. Indirect fluorescence antibody tests, agglutination tests, and enz... |
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