中文版18-1n.PDF

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1 Biological and Chemical Terrorism Biological and Toxic Weapons ConventionBWC 143 Weapon of Mass DestructionWMD Iran Iraq Sudan Cuba Libya Syria WMD K. Alibekov 1992 Stepnogorsk Soviet Preparat anthrax smallpox plague Marburg

2 tularemia Q-feverQ typhus VEE glanders Sverdlovsk 66 Alibekov Yelktsin aflatoxin Office of Technological Assessment 1993 WMD anthrax spores WHO , , kg aerosolized Yersinia pestis ,000 36, Kg Francisella tularensis ,000 19, smallpox AIDS

3 terrorism Terrorism is the unlawful use of force or violence against person or property to intimidate or coerce a government, the civilian population or any segment there-of, in furtherance of political or social objectives

4 Dalles Rajneesh sarin Shoko Asahara sarin

5 sarin Marburg virus CDC 1999 category A 1.Variola major Smallpox 2.Bacillus anthracis Anthrax 3.Yersinia pestis Plague 4.Francisella tularensis Tularemia 5.Botulinum toxin Botulism 6.Filoviruses and Arenaviruses Viral hemorrhagic fevers category B 1.Coxiella burnetii Q fever 2.Brucella spp. 3.Burkholderia mallei 4.Burkholderia pseudomallei 5.Alphaviruses 6.Rickettsia prowazekii

6 Toxins: ricin staph enterotoxin B Clostridium perfringence toxin 8.Chlamydia psittaci 9. category C Nipah virushantavirustick-borne haemorrhagic fevers Bunyaviridae Flaviviridae mustard gas 1918 phosgene gas 1925 Geneva Protocol Halabja Cameroon Mustard agents

7 Hydrogen cyanide cytochrome C oxidase iron Arsinesarsenic compounds Psychotomimetic agentslsd, etc. Toxins Nerve agent 1.Tabun, GA 2.Sarin, GB 3.Soman, GD 4.GF aerosol 5.VX Tabun atropin sulfate1-2 mg per dose 3-PAMC1 600 mgpralidoximevx AC- Hydrogen cyanide HCNAK- Cyanogen chloride CNCL iv 3% sodium nitrate 10 ml 25% thiosulfate 50 ml Variola virus 1DNA virus family Poxviridaegenus Orthopoxvirus 200 nm monkeypoxvaccinia variola viruses Monkeypox Vaccinia 2Variola virus variola major 30% variola

8 minoralastrim 1% chorioallantoic membrane WHO asymptomatic viremia Hemorrhagic malignant variola Variola minor 6 varicella BSL-4 4 HSVVZV 5 PCR restriction fragment-length polymorphism

9 vaccinia immune globulinvig Vaccinia virus % 6 Variola virus vaccinia virus 7 scab 35 65% 26 10% 12 8

10 Bacillus anthracis 1 obligate aerobic anthrax Anthrax = virulent avirulent strainsvirulent strain px01 px02 plasmidspx02 antiphagocytic capsulepolydiglutamic acid px01 protective antigen PAedema factoref lethal factorlf 4 cattlesheephorseswine Ames strain 1 cutaneous anthrax macrophage

11 % 20% 1% 2 respiratory anthrax biphasic 24 X WBC 3 gastrointestinal anthrax % 4 oropharyngeal form meningitis 1 2 blood agar nutrient agar ELISA capsular antigen Electrophoretic immunotransblot test PA exotoxin 5 anthrax 6 Differential Diagnosis tularemia plague glanders orf parapoxvirus

12 cat-scratch disease localized herpes echthyma gangrenosum 1 penicillin 7-10 penicillin7-10 IV ciprofloxacin 500 mg q8-12h erythromycin tetracycline doxycycline chloramphenicol ciprofloxacin streptomycin 2 contact isolation 3 paraformaldehyde vapor 5% hypochlorite 5% phenol carbolic acid chlorine dioxide chlorine 500 PPM 1 vaccine exotoxin component 92.5% booster inoculation 2 doxycycline500 mgbid ciprofloxacin 500 mgbid Yersinia pestis JAMA. 2000;283: pleomorphic facultative anaerobic C Lactose nonfermenter urease indole negative Enterobacteriaceae

13 family 2 virulent 72-kilobase plasmid V-W antigens plasmid 3 28 C coagulase bacteriocinpesticin 4 ground squirrels 5 fleaxenopsylla cheopis % bubonic plague 50-60% septicemic plague endotoxic shock disseminated intravascular coagulationdic 20% secondary pneumonic plague primary pneumonic plague pharyngeal plague DIC 3

14 X WBC %13%2% 14%22%57% 1 safety pin 2fluorecsent antibody test antigen-capture ELISA 3 fraction I antigen 4Blood agarmacconkey agar WHO 2 isolation drainage/secretion precautions strict isolation 48 3 concurrent disinfection 4 quarantine 7 quarantine 7 5 tetracycline15-30mg/kg/day chloramphenicol 30 mg/kg/day 6

15 gentamicin 2.0 mg/kgivloading dose 1.7 mg/kgq8h iv streptomycin 1.0 gmq12him or iv doxycycline 100 mg po or ivbid Madagascar 13% plasmid-mediated multi-drug resistance chloramphenicol 500 mgqidpo or iv ciprofloxacin levofloxacin ofloxacin gentamicin sulfathiazole, 56 sulfadiazine sulfamerazine trimethoprim-sulfamethoxazole killed bacteria vaccine 1-3 Francisella tularensis JAMA. 2001;285: coccobacillus Tulare County Pastereulla tularensis tularemia Jellison type AF. tularensis biovar tularensi s glycerol citrulline ornithinerabbit LD bacteria Jellison type BF. tularensis biovar palaearctica rabbit LD 50 >10 7 bacteria 2 3 cattlehard ticks

16 rabbit rodent-mosquito cycle 4 DermacantorAmblyomma ticksdeer fly Chrysops Aedes nosocomial infections C 7 1 type A type B ulceroglandular type glandular type oropharyngeal type typhoidal type 30-60% 2% pleuropulmonary type hilar lymphadenopathy oculoglanduar type 2Jellison type A 5-15% Type B type B26% 12% 31% 9%

17 % erythema multiformeerythema nodosum 4 influenza atypical pneumonia anthrax plague 1 tube agglutination >1:160 microagglutination titer >1:128 Brucella 2 3 cysteine-glucose blood agar chocolate agar cysteine heart blood agar buffered charcoal-yeast agarthioglycollate broth plaguestaphylococcal or streptococcal infection cat-scratch feversporotrichosis 1Streptomycin mg/kgq12him or iv mgq12him7 gentamicin 3-5 mg/kg/dayiv7-14 ciprofloxacin 500 mg pobid doxycycline tetracycline chloramphenicoltetracycline doxycycline chloramphenicol bacteriostatic 14 2 meningitis chloramphenicol 500 mgpo or ivq6h 3 vaccine 4 drainage/secretion precautions %

18 Clostridium botulinum toxin JAMA. 2001;285: neurotoxin botulism 2 zinc proteinase neuromuscular junction acetylcholine 100 C20 80 C biological toxins botulinum toxin cervical torticollisblepharospasm associated with dystonia strabismusmigraine headachechronic low back painstroketraumatic brain injurycerebral palsyachalasia dystonias 4 A-G ABE FType A type B type E type F 5 foil-wrapped baked potatoyogurtcream cheesegarlic in oilsauteed onion 1 cholinergic synapses neuromuscular and autonomic acetylcholine neurotransmitter Synapse presynaptic axon

19 synapse acetylcholine 2 cranial neuropathies 3 food-borne botulism infant botulism wound botulism Food-borne botulism Autonomic dysfunction type BE toxins Type A toxin cranial nerve dysfunction Infant botulism colonization constipationhypotonia feeding difficulty increased drooling weak cry 1-2 achlorhydria C. baratiic. butyricum Wound botulism spore sinusitiscocaine inhalation 1 myasthenia gravis Lambert-Eaton myasthenic

20 syndromelems autonomic dysfunction= tick paralysis Dermacantor tick acute inflammatory polyneuropathyaipnguillain-barre syndrome areflexic= cranial neuropathy= pupillary dysfunction= poliomyelitis magnesium intoxication Organophosphate poisoning brain stem infarction diphtheria 2 anti-toxin 3 75% Mouse bioassaygel hydrolysiselisa 4Electrophysiologic studysingle fiber electromyography LEMS 1 2Trivalent equine antitoxin types ABE urticariaserum sickness 3 Penicillin MU/daymetronidazole 500 mg qid amoxicillin 500 mgpoaminoglycosides tetracyclines neuron infant botulism polyvalent antitoxin ventilatory support mortality 70% 10% 7 ph 4 or less germination of

21 spores autopsy

23 CDC guidelines AMA consensus reports 2.ProMed EIN 3.The New Terrorism, by Walter Laqueur, Oxford, New York, Living Terrors, by M.T. Osterholm and J. Schwartz, Dell, New York, Biohazard, by Ken Alibek and S. Handelman, Dell, New York, Six Nightmares, by Anthony Lake, Little Brown, Boston, Terrorism, by John Pynchon Holms and T. Burke, Kensington, New York, 2001

24 LCt 50 LD 50 mg. min/m 3 mg/ Tabun Sarin Soman VX days days 2-4 days <14

25 Total no. of specimen % 30% 25% 20% 15% 10% 5% 0% 1999/3/1-14 4/26-5/9 Total specimen no. 6/21-7/4 8/ / /5-18 1/23-2/5 3/19-4/1 5/ /9-22 9/ /29-11/11 12/ / /8-21 6/3-16 7/29-8/11 9/23-10/6 11/18-12/1 1/13-26 Pan-EV(%)

26 Coxsackie A Coxsackie B Echo % 7% 6% 5% 4% 3% 2% 1% 0% 1999/3/1-14 4/ /24-6/6 Echo(%) CA(%) CB(%) 7/5-18 8/ /27-10/10 11/ / /23-2/5 3/5-18 4/ /28-6/10 7/9-22 8/20-9/2 10/1-14 Sabin vaccine virus EV / / /29-2/10 3/ /22-5/5 6/3-16 7/ /26-9/8 10/ /18-12/1 1/1-5 5% 4% 3% 2% 1% 0% 1999/3/1-14 4/ /24-6/6 S-polio(%) 7/5-18 8/ /27-10/10 11/ / /23-2/5 3/5-18 4/ /28-6/10 7/9-22 8/20-9/2 10/ / / /29-2/10 3/ /22-5/5 6/3-16 7/ /26-9/8 10/7-20 EV71(%) 11/18-12/1 1/1-5

27 Inf-A Inf-B % 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 1999/3/1-14 4/ /24-6/6 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 1999/3/1-14 4/ /24-6/6 Total specimen no. Inf-A(%) Inf-B(%) 7/5-18 8/ /27-10/10 11/ / /23-2/5 3/5-18 4/ /28-6/10 7/9-22 8/20-9/2 10/1-14 Adeno RSV Total specimen no. Adeno(%) RSV(%) 7/5-18 8/ /27-10/10 11/ / /23-2/5 3/5-18 4/ / / /29-2/10 3/ /22-5/5 6/3-16 7/ /26-9/8 10/ /18-12/1 1/ /28-6/10 7/9-22 8/20-9/2 10/ / / /29-2/10 3/ /22-5/5 6/3-16 7/ /26-9/8 10/ /18-12/1 1/

Microsoft Word - 1-炭疽病-102.01.doc

Microsoft Word - 1-炭疽病-102.01.doc 炭疽病 (Anthrax) 一疾病概述 (Disease description) 炭疽病是一種由炭疽桿菌引起的人畜共通傳染病主要是發生在草食性的家畜野生動物如山羊綿羊牛馬及豬等人類感染通常是因為接觸到受感染的動物動物製品, 絕大部分的傳染