"Bioterrorism and Infectious Agents: A New Dilemma for the 21st Century" by I.W. Fong, Kenneth Alibek

Compiled by two of the leading experts in the field, Bioterrorism and Infectious Agents provides the specialist and trainee in microbiology, infectious disease, infection control, and epidemiology with a concise, timely, and authoritative review of some of the most problematic infections of the new century. This volume will foster a better understanding of the issues and new ideas for preventing and controlling infectious diseases.






This volume in the series Emerging Infectious Diseases of the 21st Century provides the most up-to-date and comprehensive information available on bioterrorism agents such as:
-Anthrax, smallpox, plague, and SARS
-Vaccine development
-New anti-viral drug development
-Treatment and protection
-Threat analysis and response
-Biological and chemical agents


Contents
Chapter 1 Anthrax: A Disease and a Weapon - Kenneth Alibek, Catherine Lobanova, and Serguei Popov
1. History of Anthrax
1.1. Anthrax in the United States
2. Anthrax as a Biological Weapon
3. The Organism
4. Pathogenesis of Anthrax Infection
5. Clinical Manifestation of Anthrax Infection
5.1. Cutaneous Anthrax
5.2. Systemic Anthrax
5.2.1. General Symptoms of Anthrax Infection
5.2.2. Respiratory Symptoms and Findings
5.2.3. Neurological Symptoms and Signs
5.2.4. Cardiovascular Symptoms and Signs
5.2.5. Gastrointestinal Symptoms and Signs
5.2.6. Miscellaneous
5.2.7. Findings—Autopsies
6. Considerations on Clinical Manifestations of Systemic Anthrax
7. Laboratory Diagnosis
8. Vaccination
9. Postexposure Prophylaxis
10. Treatment of Anthrax Infection
11. Protection
12. Isolation
13. Afterward
Acknowledgments
References
Chapter 2 Plague as a Biological Weapon - David T. Dennis
1. History of Plague and Its Potential as a Weapon of Bioterrorism
1.1. Pandemic History and Epidemic Potential
1.2. Plague as a Weapon of Biological Warfare
1.3. US Countermeasures to Plague as a Weapon of Terrorism
1.4. Preparedness and Response to a Possible Plague Attack
2. Plague Microbiology and Pathogenesis
2.1. The Agent
2.1.1. General Characteristics
2.1.2. Molecular Genetics
2.2. Pathogenicity of Y. pestis
2.2.1. Virulence Factors
2.2.2. Pathology of Infection
3. Clinical Spectrum
3.1. Bubonic Plague
3.2. Septicemic Plague
3.3. Pneumonic Plague
3.4. Other Clinical Syndromes
3.5. Pediatric Plague
3.6. Plague in Pregnancy
4. Diagnosis
4.1. Laboratory Diagnosis
4.1.1. Laboratory Response Capabilities
4.1.2. Collection and Processing of Specimens
4.2. Recognizing a Plague Outbreak Resulting from Intentional Release
4.3. Detection of Y. pestis in the Environment
5. Medical Management of Plague Patients
5.1. Antimicrobial Treatment of Acute Illness in Naturally Occurring Plague
5.2. Postexposure Prophylaxis
5.3. Treatment of Cases and Case Contacts in a Bioterrorism Event
6. Infection Control
6.1. Hospital Infection Control
6.2. The Role of Isolation and Quarantine
7. Prevention
7.1. Prevention and Control of Naturally Occurring Plague
7.1.1. General Guidelines
7.2. Plague Vaccine
8. Research Directions
References
Chapter 3 Tularemia and Bioterrorism - Lisa Hodges and Robert L. Penn
1. Introduction
2. Microbiology
2.1. Taxonomy
2.2. Virulence
3. Pathogenesis
3.1. Pathophysiology
3.2. Host Immunity
3.2.1. Humoral Immunity
3.2.2. Cellular Immunity
3.2.3. Immune Responses in the Lungs
4. Epidemiology
5. Clinical Manifestations
5.1. Nonpneumonic Tularemia
5.2. Pneumonic Tularemia
5.3. Spectrum of Disease following Intentional Release of F. tularensis
5.4. Complications
6. Diagnosis
7. Treatment
7.1. Treatment of Endemic Tularemia
7.2. Treatment of Tularemia Resulting from Bioterrorism
8. Infection Control
9. Prevention
9.1. Antibiotic Prophylaxis
9.2. Vaccination
10. Future Directions
References
Chapter 4 Melioidosis and Glanders as Possible Biological Weapons - David Allan Brett Dance
1. Introduction
2. History, Distribution, and Epidemiology
2.1. Melioidosis
2.2. Glanders
3. Microbiology and Pathogenesis
3.1. Taxonomy
3.2. Characteristics
3.2.1. General
3.2.2. Antigenic Structure
3.3. Ecology and Environmental Survival
3.4. Antibiotic Susceptibility
3.5. Genomics
3.6. Typing Systems
3.7. Bacterial Virulence
3.7.1. Endotoxin and Lipids
3.7.2. Capsule
3.7.3. Flagella
3.7.4. Exotoxins and Enzymes
3.7.5. Secretion Systems
3.7.6. Siderophores
3.7.7. Adhesion
3.7.8. Intracellular Growth
3.8. Host Defense
3.8.1. Humoral Immunity
3.8.2. Intrinsic and Cellular Immunity
3.8.3. Immunopathogenesis
4. Clinical Spectrum
4.1. Melioidosis
4.1.1. Mild and Subclinical Infections
4.1.2. Latent Infections
4.1.3. Clinical Disease
4.2. Glanders
5. Animal Models
5.1. Melioidosis
5.2. Glanders
6. Potential as a Biological Weapon
6.1. Glanders
6.2. Melioidosis
7. Diagnosis and Treatment
7.1. Clinical Diagnosis
7.2. Laboratory Diagnosis
7.2.1. Microscopy and Culture
7.2.2. Serological Methods
7.2.3. Molecular Diagnosis
7.3. Treatment
7.3.1. General
7.3.2. Specific Chemotherapy
7.3.3. Adjunctive Treatments
7.3.4. Outcome and Follow-up
8. Infection Control Measures
8.1. Secondary Spread and Isolation
8.2. Environmental Contamination
8.3. Antibiotic Prophylaxis and Vaccines
9. Future Direction
References
Chapter 5 Smallpox as a Weapon for Bioterrorism - J. Michael Lane
1. Introduction
2. Virology
3. Pathogenesis
4. Clinical Disease
5. Diagnosis
6. Epidemiology
6.1. Surveillance and Containment Strategy
7. Patient Management and Infection Control
8. Potential as a Bioweapon
9. Prevention
9.1 Vaccination Policy
10. Future Directions
References
Chapter 6 Hemorrhagic Fever Viruses as Biological Weapons - Allison Groseth, Steven Jones, Harvey Artsob, and Heinz Feldmann
1. Introduction
2. Epidemiology
2.1. Filoviridae: Ebola and Marburg viruses
2.2. Arenaviridae: Lassa Fever, Junin, Machupo, Guanarito, and Sabia
2.3. Bunyaviridae: Rift Valley Fever and Crimean-Congo Hemorrhagic Fever
3. Patient Management
3.1. Clinical Recognition
3.2. Laboratory Diagnosis
3.3. Treatment
4. Vaccines
5. Public Health Measures
5.1. Infection Control
5.2. Environmental Decontamination
6. Ongoing Research and Proposed Agenda
7. Conclusions
Acknowledgments
References
Chapter 7 Botulism as a Potential Agent of Bioterrorism - Thomas P. Bleck, MD, FCCM
1. Introduction
2. History of Botulism
3. Botulinum Toxin as a Weapon
4. Diagnosis
5. Treatment
6. Management
References
Chapter 8 Ricin: A Possible, Noninfectious Biological Weapon - Maor Maman, MD, and Yoav Yehezkelli, MD
1. Introduction
2. History
2.1. The Story of a “Death Umbrella”
3. The Toxin
3.1. Toxicity
4. Ricin as a Potential Bioweapon
5. Clinical Presentation
5.1. Prognosis
5.2. Diagnosis
6. Treatment
7. Prevention and Vaccine
8. Medical Use of Ricin
9. Conclusion
Acknowledgments
References
Chapter 9 Bioterrorism Alert for Health Care Workers - Theodore J. Cieslak, MD, George W. Christopher, MD, and Edward M. Eitzen, Jr., MD, MPH
1. Introduction
2. Step 1. Maintain a Healthy “Index of Suspicion” (Or, “How to Recognize Illness Due to Biological Weapons”)
3. Step 2. Protect Thyself First
3.1. Physical Protection
3.2. Chemical Protection
3.3. Immunologic Protection (Including “Pros and Cons of Mass Vaccination”)
4. Step 3. Save the Patient’s Life (“The Primary Assessment”)
5. Step 4. Disinfect or Decontaminate as Appropriate
6. Step 5. Establish a Diagnosis (“The Secondary Assessment”)
7. Step 6. Provide Prompt Therapy
8. Step 7. Institute Proper Infection Control Measures
9. Step 8. Alert the Proper Authorities (“Which Agency Should One
Notify for Suspicious Cases?”)
10. Step 9. Conduct an Epidemiologic Investigation (and Manage the Medical and Psychological Aftermath of a Bioterror Attack)
11. Step 10. Maintain a Level of Proficiency
Acknowledgments
References
Chapter 10 The Economics of Planning and Preparing for Bioterrorism - Martin I. Meltzer
1. Introduction
2. How Many Resources?: Basic Concept
3. Refining the Basic Concept: Being More Realistic
3.1. Cost of Deploying a Planned Intervention
3.2. A Special Case: Optimal Amount for Pre-event Protective Interventions
3.3. Example 1: Annual “Premiums” for Pandemic Influenza Preparations
3.4. Example 2: Annual “Premiums” to Reduce Probability
of Losses Due to Anthrax Attack
4. Categories of Interventions
4.1. Postevent Medical Interventions (Reaction Interventions)
4.2. Pre-event Medical Interventions (Reaction Interventions)
4.3. Pre-event Protective Interventions: Reducing the Probability of Attack
4.4. Calculating the Savings in Post-event Interventions Due to Pre-event Interventions
5. Selecting Interventions for Evaluation for Funding
6. Calculating the Number of Casualties and Casualties Averted
6.1. Types of Mathematical Models
6.1.1. Increasing Complexity
6.1.2. Deterministic Mathematical Models
6.1.3. Stochastic Models
6.2. Model Limitations
6.2.1. Size of Attack
6.2.2. Numbers Initially Infected and Implicit Assumptions
6.2.3. Why Not Use “Worst Case?”
6.3. Realistic Expectations and Keeping It Simple
6.3.1. Sensitivity Analyses and Policy Levers
7. Calculating the Value of Casualties and Other Losses Averted
8. Probability of an Event Occurring
9. Selecting Between the Options
10. Summary
References