Biological, chemical, and radiological terrorism: emergency by Alan Melnick

By Alan Melnick

Emergency preparedness for the first care healthcare professional -- organic terrorism -- Chemical terrorism -- Radiological terrorism -- psychological healthiness and terrorism -- the first care physician's position in aiding the general public overall healthiness reaction to organic, chemical, and radiological terrorism

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10 Clinical presentation and diagnosis of pneumonic plague Epidemiology Incubation period Clinical signs Sudden appear1–7 days, usually ance of many 2–4 days persons with fever, cough, dyspnea, hemoptysis, and chest pain Gastrointestinal symptoms are common (nausea, vomiting, abdominal pain, and diarrhea) Patients have fulminant course with high mortality Acute onset of cough with hemoptysis Tachypnea, dyspnea and cyanosis Diagnostic studies Pulmonary infiltrates or consolidation on chest radiograph Pathology Lobular exudation, bacillary aggregation and areas of necrosis in pulmonary parenchyma Sepsis, shock, Sputum, blood, or and organ lymph node failure aspirate for culture and Infrequent presgram stain ence of a cervical bubo Gram negative purpuric bacilli with skin lesions bipolar (safety and necrotic pin) staining digits only on Wright, in advanced Giemsa, or disease Wayson stain Rapid diagnostic tests available only at some health departments, the CDC and military labs Source: Reprinted with permission from Inglesby et al.

Pneumonic Plague Pneumonic plague can occur in two ways: as a complication of septicemic plague (secondary pneumonic plague) or by direct inhalation of plague bacilli, usually from an animal or other human with plague pneumonia (primary pneumonic plague). Secondary pneumonic plague occurs when the organism spreads hematogenously to the lungs (22,23). Although primary pneumonic plague rarely occurs in the United States, it is the most likely form to be associated with a terrorist attack, because an aerosolized form of plague is the most efficient way to cause mass casualties.

Investigators classified the association between prophylaxis and serious side effects in four of these seven patients as definite or probable, while the evidence for an association in the other three was nonexistent or not assessable. Of the four likely cases, two were associated with systemic symptoms, including a diffuse rash, while the other two were associated with swelling of the face and neck. While most side effects were mild, the frequency of side effects from ciprofloxacin in this population was more than double that reported in the ciprofloxacin literature.

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