Bioterrorism treatment

Case Example Because public health officials suspect a stealth bioterror attack, they request that hospitals secretly test all of their new patients for the suspected contagious disease. The patient is to be notified only if he or she tests positively for the disease, and he/she will be offered standard medical treatment. Reports are to go directly to public health officials. Can a nurse legally or ethically participate in such a program ... 

In the event of a public health crisis resulting from a bioterror attack, there may be a public health need to screen the population for a disease. The MSEHPA would allow medical examinations and testing performed by any qualified person authorized by the public health authority (MSEHPA, 2002, 602(a)). Persons who refuse the medical examination or treatment could be isolated or quarantined (MSEHPA, 2002, 602(c)). The authors of the MSEHPA recognize that testing can cause harm to particular individuals and, thus, require that the tests must not be such as are reasonably likely to lead to serious harm to the affected individual (MSEHPA, 2002, 602(b)). It is not clear who would make this determination. It may be that this would be left to the discretion of the health professional administering the test. On the other hand, it may be that the public health authority (such as the state health department) would issue exceptions for particular classes of individuals (MSEHPA, 2002). 

Rosenfield, R., Bernardo, L. (2001). Pediatric implications in bioterrorism. Part II Postexposure diagnosis and treatment. International Journal of Trauma Nursing, 7, 133-136. 

General research needs lie in the areas of detection, decontamination, and treatment. Better and cheaper methods need to be developed for the rapid detection and measurement of mycotoxin levels be it in food or tissues. In regard to bioterrorism, better methods need to be developed for the identification and measurement of mycotoxins in human and animal tissues, body fluids, and feces. Availability of mycotoxin reference samples to provide comparability of analytical results obtained between laboratories within a country as well as in different parts of the world would be helpful. 

Bitoscanate (phenylene 1,4-diisothiocyanate) enjoyed some clinical interest in the treatment of hookworm infection in around 1975 (1), but it proved highly dangerous, and deaths have occurred with as little as 300 mg. Most of the publicity that it has had in recent years relates to its listing as an extremely hazardous substance, and the US Office of Homeland Security has actually regarded it as a possible tool for bioterrorism. 

Table 2.7 Inhalational treatment protocol for contained casualty situation, similar to that associated with the October 2001 bioterrorism attack... 

In recent years concerns associated with food produced with antibiotics or hormones or by biotechnology or treatment with irradiation have increased. Mad cow disease and other prion-related diseases have created great fear and economic havoc. The terrorist events of 2001 have shocked the food industry, government, and consumer into recognizing the possibility that some form of bioterrorism may be transmitted through food and water. 

B. anthracis typically is susceptible to penicillin, amoxicillin, erythromycin, doxycycline, ciprofloxacin, and chloramphenicol. The bioterrorism-related strain was susceptible to the fluoroquinolones, rifampin, tetracycline, vancomycin, imipenem, meropenem, chloramphenicol, clindamycin, and the aminoglycosides. However, the strain was resistant to third-generation cephalosporins and trimethoprim-sulfamethoxazole. Ciprofloxacin or doxycycline plus one or two of the aforementioned antibiotics is the currently recommended regimen for the treatment of inhalational anthrax, but doxycycline is not recommended for the treatment of anthrax meningitis owing to poor CNS penetration and recent in vitro resistance. ... 

Immunohistochemical staining of Bacillus anthracis with monoclonal antibodies against cell wall and capsule antigens has been successfully used in the recognition of bioterrorism-related anthrax cases and is an important step in early diagnosis and treatment (Fig. 3.26A-C). Gram staining and culture isolation of... 

Kadivar H, Adams S (1991). Treatment of chemical and bioterrorism warfare injuries insights derived from the 1984 Iraqi attack on Majnoon Island. Military Med. 156 170. 

Get immediate medical attention To prevent illness, a person who has been exposed to pneumonic plague must receive antibiotic treatment without delay. If an exposed person becomes ill, antibiotics must be administered within 24 hours of their first symptoms to reduce the risk of death. Notify authorities Immediately notify local or state health departments. so they can begin to investigate and control the problem right away. If bioterrorism is suspected, the health departments will notify the CDC, FBI, and other appropriate authorities. 

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