Aerosols infection

Caution Both glanders and melioidosis may occur in an acute localized form, as an acute pulmonary infection, or as an acute fulminant, rapidly fatal, sepsis. Combinations of these syndromes may occur in human cases. In addition, melioidosis may remain asymptomatic after initial acquisition, and remain quiescent for decades, but these patients may display active melioidosis years later which is often associated with an immune-compromising state. Aerosol infection produced by a biological weapon containing either glanders (B. mallei) or melioidosis (B. pseudomallei) could produce any of these syndromes... 

Probable Form of Dissemination Aerosol infected vectors (carrier organism). Detection in the Field None. 

Ha S-J, Jeon B-Y, Kim S-C, et al. (2003). Therapeutic effect of DNA vaccines combined with chemotherapy in a latent infection model after aerosol infection of mice with Mycobacterium tuberculosis. Gene Ther. 10(18) 1592-1599. 

McCrumb FR Jr. Aerosol infection of man with Pasteurella tularensis. Bacteriol Rev. 1961 25 262-267. 

Despite the eradication of naturally occurring smallpox and the availability of a vaccine, the potential weaponization of variola virus continues to pose a military threat. This threat can be attributed to the aerosol infectivity of the virus, the relative ease of large-scale production, and an increasingly Orthopoxvirus-naive human populace. 

Stein, A., Louveau, C., Lepidi, H., Ricci, F., Baylac, P., Davoust, B., et al. (2005) Q fever pneumonia virulence of Coxiella burnetii pathovars in a murine model of aerosol infection. Infect. Immun. 73, 2469-2477. 

Sastaw, S. and H.N. Carlisle. 1966. Aerosol infection of monkeys with Rickettsia rickett-sii. Bacteriol. Rev. 30 636-645. 

The two highest concentrations of tannic acid (0.051 and 0.034%) resulted in a linear increase of virus titer up to 21 days after inoculation, even though the reduction of starch lesion formation was 91 and 64%, respectively. Thus, the virus must have replicated beyond the limitation of starch lesions. Further experiments indicated that a systemic spread of the virus into the primary leaves in cucumber plants could be obtained by daily brushing the noninoculated primary leaves (only the cotyledons were inoculated) with tannic acid following a vacuum infiltration of whole plants with 0.051% tannic acid 24 hours after virus inoculation. Primary leaves were shielded by tinfoil during the inoculation of the cotyledons to prevent accidental infection. Aerosol O.T. (0.1%) was incorporated in tannic... 

CORTICOSTEROID INHALANTS. The inhalers, particularly die corticosteroid or mast cell aerosols, may cause tiiroat irritation and infection with Candida albicans. The nurse instructs the patient to use strict oral hygiene, cleanse die inhaler as directed in die package directions, and use die proper technique when taking an inhalation. These interventions will decrease die incidence of candidiasis and help to soodie die throat. Occasionally an antifungal drug may be prescribed by die primary health care provider to manage the candidiasis. 

Propagated outbreaks of infection relate to the direct transmission of an infective agent from a diseased individual to a healthy, susceptible one. Mechanisms of such transmission were described in Chapter 4 and include inhalation of infective aerosols (measles, mumps, diphtheria), direct physical contact (syphilis, herpes virus) and, where sanitation standards are poor, through the introduction of infected faecal material into drinking water (cholera, typhoid). The ease oftransmission, and hence the rate of onset of an epidemic (Fig. 16.3) relates not only to the susceptibility status, and general state of health of the individuals but also to the virulence properties of the organism, the route oftransmission, the duration of the infective period associated with the disease. 

O The most common route of infection for endemic fungi is via the respiratory tract, where conidia aerosolized from contaminated soil are inhaled into the lung. 

Aerosols of Cellulube 220 produced deaths associated with severe dyspnea and mild diarrhea in one of two rabbits exposed to 2,000 mg/m3 for <4 hours/day, 5 days/week for 11 or 22 days (Carpenter et al. 1959). Continuous exposure for 30-160 days to aerosols of a triaryl phosphate U.S. military hydraulic fluid (see Table 3-2), at concentrations <110 mg/m3, produced no deaths in dogs or rats, but deaths associated with severe neurotoxic symptoms occurred in chickens exposed to concentrations >23 mg/m3 and in rabbits exposed to 102 mg/m3 (Siegel et al. 1965). Aerosols of Durad MP280 or Fyrquel 220 (continuous exposure for 90 days) produced no deaths in rats or hamsters exposed to 100 mg/m3. Deaths associated with lethargy, cachexia, and head droop occurred in rabbits exposed to 101 mg/m3 Durad MP280, but not in rabbits exposed to 100 mg/m3 Fyrquel 220 (MacEwen and Vemot 1983). Some of the Durad MP280-exposed rabbits were also infected with Pasteurella, which may have contributed to neurological symptoms. No deaths occurred in rats exposed to cyclotriphosphazene at 990 mg/m3, 6 hours/day,... 

The use of the aerosol route for delivery of antibiotics for pulmonary infections remains controversial. The majority of pediatric studies have been conducted in children with cystic fibrosis. In these patients distribution of the antibiotic to the desired tissue site is impeded because of the viscosity of the sputum in patients with acute exacerbations of their pulmonary infections [91,92], Long-term studies have demonstrated preventive benefits of aerosolized antibiotics in children with cystic fibrosis who are colonizing Pseudomonas aeruginosa in their lungs but are not acutely ill [93,94], Cyclic administration of tobramycin administered by nebulizer has received FDA approval [95],... 

The anthrax bioterrorist attacks that followed the events of September 11th 2001 resulted in a renewed interest BadUus anthracis, the causative agent of this disease. Research has focused on the development of better vaccines than the one currently available. It has been estimated that the aerosolized release of 100 kg of anthrax spores upwind of Washington DC would cause mortalities of 130,000-3,000,000 [63]. Nonetheless, wild-type Bacillus anthracis is susceptible to conventional antibiotics, including penicillin, oxyfloxacin and ciprofloxacin. The problem lies not with the bacterial infection itself, but with three proteins released by the bacteria - protective antigen (PA, 83 kDa), lethal factor (LF, 90 kDa) and edema factor (EF, 89 kDa) -known as anthrax toxins [63]. 

Some diseases caused by bacteria are communicable and easily transferred from an infected individual to anyone in close proximity. Typically, this occurs when the infected individual coughs or sneezes creating an infectious aerosol. These aerosols enter the body of a new host through inhalation and /or contact of the aerosol with the mucous membranes of the eyes, nose, or mouth. In addition, although intact skin is an effective barrier against most pathogens, abrasions, or lacerations circumvents this protective barrier and allows entry of the pathogen into the body. 

Infected individuals Unless the individual is reporting directly from the scene of an attack (e.g., "anthrax" letter, aerosol release, etc.) then decontamination is not necessary. Use standard protocols for individuals that may be infected with a communicable disease transmissible via an aerosol. 

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