Tularemia as a biological weapon

Tularemia is a bacterial disease caused by Francisella tularensis. It occurs primarily in North America and Eurasia. Spread does not occur from human to human. The disease is contracted by contact with infected animals, eating infected meat, and from arthropod bites. During WWII, the Japanese infected prisoners of war with the organism for research purposes and after the war, the Soviet Union, Canada, Great Britain, and the United States incorporated it into battlefield weapons.
Symptoms begin with headache, muscle aches, chills, sore throat, nasal congestion, and fever. Without treatment symptoms may last for months and can progress to sepsis, bronchopneumonia, and meningitis. The antibiotic of choice for treatment is streptomycin, but gentamicin, tetracycline, doxycycline, ciprofloxacin, and chloramphenicol may also be effective. A live vaccine is under investigation at the US Army Medical Research Institute of Infectious Diseases at Fort Detrick, Maryland, but the FDA has not approved it.
A bioterrorist attack with tularemia would most likely come as an aerosol. Patients would present to the ER three to five days after exposure with fever and pleuropneumonitis.

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Botulism

Botulinum toxin causes paralysis by blocking the release of acetylcholine from neurons at the neuromuscular junction. It is one of the most poisonous substances known to man. The bacteria, Clostridium Botulinum, C. baratii, and C. butyricum, produce this substance, which causes the disease known as botulism. These organisms live in soil. Ingestion of contaminated, poorly cooked, food may lead to absorption of the toxin from the gastrointestinal tract into the circulation with delivery to the nervous system.
Typical culprits are vegetables such as beans, carrots, peppers, corn, baked potatoes, potato salad, sautéed onions, and garlic in oil. Cheese sauce, fish, yogurt, cream cheese, and jarred peanuts may also cause botulism. The toxin may enter the body through the lung or via an open wound. Seventy-two percent of cases occur in newborns and infants.
The disease is not transmitted from person to person
Botulinum toxin causes bilateral descending flaccid paralysis, starting with the cranial nerves. Weakness of the diaphragm and other respiratory muscles may necessitate mechanical ventilation to prevent death. The patient remains mentally alert and has no fever.
During WWII, the Japanese fed C. botulinum to prisoners of war in Manchuria causing deaths. Members of the Japanese cult Aum Shinrikyo sprayed an aerosol containing the toxin at an airport in Tokyo and at U.S. military bases in Japan between 1990 and 1995. Fortunately, no one became ill.
The only therapy for botulism is specific neutralization of circulating toxin, which requires immediate intravenous injection of the appropriate antiserum. This binds with circulating toxin but has no effect upon toxin that has already bound to tissue. Thus it does not reverse paralysis that has already occurred.

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Plague

Plague is a disease found mainly in rats, ground squirrels, and prairie dogs caused by a Gram-negative bacillus. It is normally transmitted by a fleabite except in its respiratory form when it passes from human to human by respiratory droplets. In 541 A.D. it killed 50 to 60% of the population of North Africa, Europe, and central and southern Asia. The Black Death, which began in 1346 and lasted 130 years, killed 20 to 30 million people in Europe (about 1/3 of the population). The Tatars used plague as a weapon in 1345 against Genoese settlements in the Crimea, and the Japanese dropped plague-infected fleas over a town in China, killing 392 people during WWII. They planned to spread the disease in California in 1945 but surrendered before completing the mission.

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Pakistani nuclear weapons

Aljazeera reports that Taliban fighters overtook a naval base in Karachi, Pakistan yesterday. Although the Pakistani forces recaptured the base after seventeen hours, this incident draws attention to the potential vulnerability of that countries nuclear weapons. Even if the weapons are secure, the U.S. State Department just last year expressed concerns for the safety of nuclear material in Pakistani laboratories. Most sources suggest that Pakistan now possesses between ninety and 110 active nuclear warheads. With a large portion of the population expressing militant views and with militant groups controlling portions of the country, the long-term security of these weapons is in doubt. This fear is enhanced by the fact that one of the founders of the nation’s nuclear program, A. W. Khan in 2004 admitted to selling nuclear technology on the black market to North Korea, Libya, and Iran.

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Anthrax as a biological weapon

Anthrax makes an effective biological weapon because Bacillus anthracis forms spores that can survive for decades and which are highly resistant to antibiotics, certain forms of radiation, and extremes of temperature. These spores can be delivered in an aerosol and thus lodge in the alveoli of the lungs.
Inhalational anthrax begins with flu-like symptoms one to six days after exposure, with apparent remission after a few days, but with subsequent shortness of breath, high fevers, pleural effusions, and shock. Five out of eleven patients who developed inhalational anthrax following the attacks of 2001 in the United States succumbed to the disease.
The antibiotics of choice are ciprofloxacin and doxycycline. In cases of bioterrorism, this treatment should be continued for sixty days.

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Introduction to High Tech Terror

One of the perplexing problems faced by first line defenders against a bioterrorist attack is the incubation period between exposure and manifestation of symptoms.  Thus victims exposed to an organism at one locality may move to another area, even another country, before they seek medical assistance.  As a result, the physician who sees a patient may look upon his case as an isolated incident and be unaware of the multitude of individuals who present to different emergency rooms with similar symptoms.

Certain conditions listed below should raise suspicion for a biological attack.

1. A patient presents with an illness that is not endemic to the local area.

2. Many patients develop the same disease.

3. Many patients develop the same infectious disease in a short segment of time.

4. Patients are infected by an organism with unusual resistance to antibiotics.

5. A “point-source outbreak” of infectious disease occurs in which the victims appear to have contracted the disease from the same geographic location.

6. The organism appears to have spread by an aerosol.

7. A disease exhibits a higher morbidity and mortality than would be normally expected.

8. The disease is restricted to patients in a localized area.

9. Dead birds or animals appear in the area in which patients contract the disease.

10. Patients develop a vector-borne disease in a region that does not contain the vector.

11. Patients with a well-known disease have an unusual clinical course.

12. An endemic disease rapidly appears at an atypical time of year.

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