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Bioweapons Tularemia as A Biological Weapon Danette L. Sutton, BS, DC, QME Incubation Tularemia (Francisella tularensis) has a slower progression and a lower case-fatality rate than either the inhalation plague or anthrax. There are two types - Type A which is more virulent, and Type B which is considered less virulent. Tularemia can be found in widely diverse animal hosts and habitats as well as contaminated food, soil and water. Arthropod vectors such as ticks, fleas and mosquitos can infect other small mammals including voles, mice, water rats, squirrels, rabbits and hares. Traditionally, hunters, farmers, trappers and butchers became infected by it either through direct contact, bites of infected arthropods or the ingestion of contaminated water, food or soil. Inhalation of an infective aerosol occurs predominantly among laboratory workers and also as a weapon of bioterrorism. The Japanese used tularemia as a germ warfare research weapon between 1932 and 1945; outbreaks of tularemia occured among Soviet and German soldiers during WWll thought to be by intentional use. The USA stockpiled tularemia up until the 1970's when it was destroyed by executive order. The Soviet Union continued to produce tularemia as a biological weapon engineering strains that are resistant to antibiotics and vaccines. Incubation range 1-14 days although the abrupt onset of acute, nonspecific febrile illness begins between 3-5 days with pleuropneumonitis developing in the following days and weeks. In the beginning stages it may appear like influenza or atypical pneumonias however the rapid progression from upper respiratory symptoms and bronchitis to life-threatening pleuropneumonits and systemic infection in an unexpected section of the public (not handling animals) should alert public health officials to the threat of bioterrorism. Humans with inhalation exposures develop hemorrhagic inflammation of the airways early in the course of the illness which may develop to bronchopneumonia. Onset is abrupt with a fever
between 102-104 degrees Farenheit Dry or slightly productive cough and substernal pain or tightness frequently occur without objective signs of pneumonia i.e. purulent sputum, dyspnea, tachypnea, pleuritic pain or hemoptysis. Nausea, vomiting and diarrhea sometimes occur. Sweats, fever and chills, progressive weakness, malaise, anorexia and weight loss occur if the illness continues. Any form of tularemia may be complicated by hematogenous spread resulting in secondary pleuropneumonia, sepsis and rarely meningitis. Ulceroglandular tularemia - from handling contaminated carcass. Local papule at inoculation site at time of onset of generalized symptoms. Becomes pustular, ulcerates within a few days of its first appearance. Ulcer is tender, indolent in character and covered by an eschar (a scab caused by a burning, thick, coagulated crust). Regional lymph nodes enlarge and become tender and may rupture even with treatment. Oculoglandular tularemia follows direct contamination of the eye and causes ulceration of the conjucntiva. Orophayrngeal tulaermia - is acquired by drinking contaminated water, ingesting contaminated food and by inhaling contaminated droplets or aerosols. Persons develop stomatitis, exudative pharyngitis or tonsillitis, or ulceration. Pneumonia - Tularemia pneumonia can be from inhaling contaminated aerosols or from secondary hematogenous spread. Inhalation exposures commonly have an initial clinical picture of systemic illness without prominent signs of respiratory disease. The earliest radiographic findings are peribronchial infiltrates advancing to bronchopneumonia in one or more lobes and accompanied by pleural effusions and hilar lymphadenopathy. Sepsis - can occur early in the disease and may be severe and fatal. Nonspecific findings include fever, abdominal pain, diarrhea and vomiting early in the disease. the patient may develop confusion and coma. Rubrics (These rubrics were found on Hompath Academic, a computer program published in India) 1. SPECIAL - PNEUMONIA - SPUTUM- SCANTY 2. SPECIAL - PNEUMONIA - COUGH - DRY 3. CHILLS - SHAKING, SHIVERING RIGORS 4. SPECIAL - PNEUMONIA - TEMPERATURE: DISCREPANCY BETWEEN TEMPERATURE AND PULSE 5. CHEST - INFLAMMATION - LUNGS - PLEURA PNEUMONIA 6. GENERALITIES - SEPTICEMIA 7. PERSPIRATION - PROFUSE 8. SPECIAL - PNEUMONIA - TEMPERATURE - HIGH OVER 103*F Pyrogenium *SRP Disparity between the
pulse rate and the temperature Baptisia Rapid onset of septic state Lobelia inflata Dyspnea Antimonium tartaricum Pulmonary conditions with great
congestion and catarrh Crotalus horridus Motionless if not disturbed,
active at night Lachesis General agg from suppressed
discharges, lying on left side Arnica montana Septic conditions, putrid
phenomena Phosphorus Debility and collapse states Arsenicum album Great restlessness < lying
down Carbo veg Air hunger Kali carbonicum Profuse sweat 3-4 am Hepar Chilly and agg from cold |
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