Bioterrorism Agents

1
Bioterrorism Agents PlagueLesson 7

• Information for Veterinarians

2
Objectives

• Symptoms of plague in animals
• Public health significance of plague in animals
• Medication options

3
Overview

• Plague acute, bacterial infection that affects
  both human and animals. Caused by Y. pestis
• Affects both domestics and peri-domestics
• Natural transmission in western US
• Occasional outbreaks in rodents
• Some species do not have clinical signs

4
Domestic Cats

• Highly susceptible
• Transmission to humans
• Bites or scratches
• Infectious exudates
• Inhalation of respiratory droplets
• Transport infected fleas
• 25 cat-to-human cases since 1977
• 7 in veterinarians or assistants
• 5 primary pneumonic

5
Dogs and Ungulates

• Dogs
• Can become infected
• Sometimes clinical signs
• Greatest threat transport of fleas
• Ungulates
• Rarely identified in US
• Relatively little risk to humans
• Examine if after known plague in area

6
Rodents, Rabbits and Others

• Likely susceptible
• Bioterror exposure depends on where kept in
  relation to release
• Domestic ferrets relatively resistant
• Birds, reptiles, fish completely resistant

7
The Domestic FelineA Detailed Look

• Eidson, 1991
• 53 - bubonic
• 8 - septicemic
• 10 - plague pneumonia
• 29 - unknown, septicemic?
• Airborne release would result in primary
  pneumonic plague among exposed cats

8
The Domestic FelineBubonic Plague

• Incubation 2 to 3 days
• Symptoms
• 75 submandibular lymphadenitis
• Fever, lethargy, anorexia common
• Oral lesions can be present
• Progression
• DIC
• Multi-organ failure
• 38 of untreated cases fatal

9
The Domestic FelinePneumonic Plague

• Incubation 3 to 4 days
• Symptoms
• Serious, rapidly progressing
• Fever
• Cough
• Bloody sputum
• Significant risk to
• owners and
• veterinarians!

10
Plague Management AnimalsPublic Health Issues

• Important to collect samples
• Keep chilled, not frozen
• Notify public health veterinary surveillance team
  immediately
• Assist with follow-up investigations
• Preventive measures

11
Laboratory Specimen CollectionAntemortem

• Available Tests
• Fluorescent antibody
• Culture
• Specimens to Collect
• Lesions
• Serology acute and convalescent
• Pharyngeal swabs use culturettes
• Obtain prior to antibiotics

12
Laboratory Specimen CollectionPostmortem

• Available Tests
• Fluorescent antibody
• Culture
• Specimens to Collect
• Lymph node aspirate
• Tissue Samples lymph node, liver, spleen, lung,
  long bones from decaying caracasses
• Whole blood
• Place in clean container and keep chilled
• Do NOT use formalin or alcohol

13
Laboratory Specimen CollectionProcedures

• Lymph node aspirates
• Be sure bubo itself is aspirated
• If little or no fluid, 1cc non-bacteriostatic
  saline
• Serology
• Acute and convalescent
• 0.5ml at least 14 days apart
• Retrospective confirmation only
• Pharyngeal swab use culturettes

14
Laboratory Specimen CollectionHandling

• Keep chilled, not frozen
• Submit as quickly as possible
• Request instructions from public health
• Leave aspirates in syringe or transfer to
  culturette

15
Plague TreatmentAnimals

• Radiographs to check for pneumonia
• Start antibiotics immediately
• Preferred Streptomycin
• Sulfonamides can be tried if other drugs not
  available

Gentamicin 2-3mg/kg TID, IM or SQ
Doxycycline 5mg/kg BID, PO
Tetracycline 22mg/kg TID, PO
Chloramphenicol 50mg/kg BID PO
16
Infection ControlVeterinary Clinic

• Maintain in isolation until improvement
• Thought to be noninfectious after 48 hrs
• Apply flea control to cat and premises
• Potential risk for humans
• Pneumonic respiratory spread
• Bubonic contact with infectious tissues,
  exudates or fleas
• Cat fleas poor vectors of plague

17
Infection ControlVeterinary Clinic

• Exudates and oral cavity infectious
• Disinfect any material used for treatment
• Pneumonic plague close patient contact
• Wear mask and gloves
• Well-fitted N95 rated mask preferred, but
  surgical mask might offer some protection

18
Infection ControlVeterinary Clinic

• Consult public health after exposure to infected
  cat
• Get to doctor immediately if febrile illness
  after exposure
• Incubation in Humans 2 to 6
• days, but can be as short
• as one day
• Early treatment is critical

19
Infection ControlAnimal Owners

• Refer owners to public health
• Use following precautions
• Confine pets as much as possible
• Apply flea control
• Do not share sleeping area with animals
• Get any ill animals to veterinarian
• Intentional plague release keep all animals
  indoors

20
Plague Review QuestionsLesson 7

• Information for Veterinarians

21
Plague Review QuestionLesson 7, Question 1

• Domestic feline patient
• Sick for several days
• Suspicion of plague
• What do you base your initial findings on?

22
Plague Review QuestionLesson 7, Question 1

• What do you base your initial findings on?
• Anorexia, oral lesions, fever
• History of roaming, submandibular lymphadenitis
• Clinic in western US
• All of the above

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Plague Review QuestionLesson 7, Question 1

• What do you base your initial findings on?
• All of the above
• Anorexia, oral lesions, fever
• Roaming, submandibular lymphadenitis
• Clinic in western US

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Plague Review QuestionLesson 7, Question 2

• Domestic feline patient
• Thorough physical exam
• Radiographs to look for pneumonia
• Collection of lab samples
• What do you start your patient on?

25
Plague Review QuestionLesson 7, Question 2

• What do you start your patient on?
• Streptomycin
• Ampicillin
• Amoxicillin
• Clavamox

26
Plague Review QuestionLesson 7, Question 2

• What do you start your patient on?
• A. Streptomycin

27
Plague Review QuestionLesson 7, Question 3

• Domestic feline patient
• Suspected plague
• Clinic is located in New Jersey
• What is the significance of this finding?

28
Plague Review QuestionsLesson 7, Question 3

• What is the significance of this finding?
• Its just an anomaly
• One expects plague in New Jersey
• Could indicate a bioterrorist event
• Animals get sick after humans do

29
Plague Review QuestionsLesson 7, Question 3

• What is the significance of this finding?
• C. Could indicate a bioterrorist event