Variola major Smallpox v Bacillus anthracis Anthrax v
熱門的生物戰物質 Variola major (Smallpox) v 炭疽病 Bacillus anthracis (Anthrax) v 鼠疫 Yersinia pestis (Plague) v 兔熱病 Francisella tularensis (Tularemia) v 肉毒桿菌 Botulinum toxin (Botulism) v 病毒性出血熱 Filoviruses and Arenaviruses (Viral hemorrhagic fevers) v 天花
生物恐怖主義攻擊 v 飛沫傳染: anthrax, plague, tularemia, Q fever, brucella variola major, VHF, viral encephalitides v 皮膚傳染 Trichothecene mycotoxins v 呼吸飛沫、食物以及飲水感染 Botulinum toxin, ricin, staph enterotoxin B, clostridium epsilon toxin salmonella, shigella, E. coli O 157, cholera
天花:併發症 v 腦炎Encephalitis 1 in 2, 000 cases Variola minor 1 in 500 cases Variola major v 結膜炎或角膜潰爛 導致 1% 眼盲 v 懷孕時的感染 高妊娠死亡率 先天性感染
天花的免疫球蛋白 (VIG) v 用於治療天花疫苗接種後的一些不良反應( adverse reactions,簡寫成AR) 大概 25 AR’s/100, 000 接種人* AR 的比例在現代社會可能會更高,因為有更多的免疫機 能不全的人 *Ström J. , Zetterberg B. , ed. (1966) Smallpox outbreak and vaccination problems in Stockholm, Sweden, 1963. Acta Medica Scandinavica, supplementum, 464: 1 -171
天花疫苗的運用 v 接觸後的預防 懷孕的病人 (VIG + Vaccinia vaccine) 濕疹 Eczema (VIG + Vaccina vaccine) 免疫機能不全的病人,目前的治療尚無定論 (VIG alone vs. VIG + Vaccinia vaccine? ) v 現在的天花疫苗有限 Ström J. , Zetterberg B. , ed. (1966) Smallpox outbreak and vaccination problems in Stockholm, Sweden, 1963. Acta Medica Scandinavica, supplementum, 464: 1 -171
敗血症的鼠疫 Septicemic Plague v 可以是原發性的或是次發性的主要是因為 bubonic or pneumonic 如果沒有治療100% 死亡率 v Systemic inflammatory response syndrome v 休克或是瀰漫性血管內凝血 (DIC) v 成人呼吸窘迫症 (ARDS)
鼠疫的鑑別診斷 v Bubonic –Staph/streptococcal adenitis –Glandular tularemia –Cat scratch disease v Pneumonic –Other bioterrorism threats Anthrax l Tularemia l Melioidosis –Other pneumonias (CAP, influenza, HPS) –Hemorrhagic leptospirosis l v Septicemic – Other gram-negative sepsis – Meningococcemia – Rocky Mountain Spotted Fever (RMSF) – Thrombotic Thrombocytopenic Purpura (TTP)
肺部型的兔熱病鑑別診斷 v Community acquired pneumonia (CAP) – 非典型肺炎 CAP (退伍軍人病,黴漿病) – Streptococcal pneumonia, Influenza, H. influenza v 其他的寄生蟲疾病( Zoonoses) – Brucellosis – Q Fever – Pneumonic plague – Histoplasmosis – Inhalational Anthrax – Hantavirus Pulmonary Syndrome (HPS)
病毒性出血熱(VHF): 概論 v 由許多不同的病毒所引起 –Filoviruses (Ebola, Marburg) –Arenaviruses (Lassa, Junin, Machupo, Sabia, Guanarito) –Bunyaviruses –Flaviviruses v 病毒需要依靠天然媒介 –齧齒類, 蚊子, 壁蝨(ticks) v No natural occurrence in U. S.
VHF的鑑別診斷 v 細菌性 Typhoid fever, meningococcemia, rickettsioses, leptospirosis v 原蟲性 Falciparum malaria v 其他 血管炎, TTP, Hemolytic Uremic Syndrome (HUS), 熱中暑
肉毒桿菌的鑑別診斷 v 神經肌肉疾病 中風 Stroke syndrome 重症肌無力 Myasthenia gravis Guillain-Barre syndrome (Miller-Fisher variant) Tick paralysis Atropine 中毒 Paralytic shellfish/puffer fish poisoning
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