0071643192.pdf

EMS AND DISASTER MEDICINE^904

A rabbit hunter shows up in a rural Arkansas ED complaining of a sore on

his right finger that will not heal even though his wife has been tending to

it. The patient also complains of swollen lymph nodes in the same arm

pit. What is the likely diagnosis?

Ulceroglandular tularemia. Tularemia is commonly called “rabbit fever” due

to its association with lagamorphs and rodents. Diagnosis can be made on clini-

cal findings, but confirmed with antibody titers or PCR. Streptomycin is the

antibiotic of choice.

BIOLOGICAL WEAPONS OF MASS DESTRUCTION

Typically divided into three groups: Bacteria, viruses, and toxins. All share the

ability for aerosol dispersal.

The agents considered to have the most severe potential (Class A agents) include:

■ Bacillus anthracis(anthrax)

■ Yersinia pestis (plague)

■ Variola major(smallpox)

■ Francisella tularensis(tularemia)

■ Clostridium botulinum (botulism): See “Botulism” in Chapter 8.

■ Filoviruses and arenaviruses (viral hemorrhagic fevers)

Anthrax

Organism:B. anthracis, a Gram-positive spore-forming bacterium

■ Appears as long chains, resembling bamboo or boxcars (see Figure 20.4)

Anthrax is found worldwide in grass-eating mammals that ingest or inhale the

spores while feeding. In normal circumstances, humans may become infected

by eating infected animals or through contact (skin or inhalation) with spores

on the fur or hide of animals (eg, woolsorter’s disease).

FIGURE 20.4. Bacillus anthracis.

(Reproduced, with permission, from Grey MR, Spaeth KR,The Bioterrorism Sourcebook.

New York: McGraw-Hill, 2006:194.)