PUBHLTH 122 Lecture Notes - Lecture 13: Public Health Emergency Preparedness, International Health Regulations, Emerging Infectious Disease

Investigation of Possible Bioterrorism-Related Activity

Patient History:

A 38-year-old woman who resided in the Northeast was admitted to the hospital with fever, myalgia, and weakness, which progressed over 3 days to respiratory failure requiring mechanical ventilation. On day 22, after 3 weeks of intensive care, the patient was still febrile. Cultures of blood were negative.

Hospital personnel interviewed family members who reported no history of traditional risk factors for fever of unknown origin (e.g., relevant food, infected animal contact, or travel history). On day 24, the patient's family reported to hospital personnel that the patient's illness might have been caused by exposure to laboratory flasks and cultures kept in her apartment by her boyfriend. He was described as a foreign national studying biology, but recently he had returned to his country of citizenship. On day 25, the patient's family brought laboratory flasks, Petri dishes, and culture media to the hospital from the patient's apartment. Several contained an unidentified clear liquid. The patient’s unresponsiveness and the acknowledged potential for some bacterial species to be used as bioterrorist agents raised concerns among the infection control staff that this case might be associated with a bioterrorist event or unintentional exposure to contaminated materials in the patient's home. The hospital contacted local law enforcement, the Department of Public Health, and the Federal Bureau of Investigation about the unusual circumstances surrounding the case.

On day 30, under the authority of state communicable disease statutes and in cooperation with the local police department, fire department, and hazardous materials unit, NHDHHS personnel entered the patient's apartment to assess any possibility of an ongoing public health hazard. Remaining flasks were removed and cultured. After 48 hours, growth of a translucent, pinpoint, and smooth colony appeared on blood agar and chocolate agar.

Gram stain of the colonies revealed faintly staining Gram-negative rods that were catalase positive, oxidase positive, and rapidly urea positive. On day 33, the patient began to get better after extensive antibiotic therapy.

Early detection is essential to ensure a prompt response to a biological terrorist event. Local public health authorities must rely on clinicians to recognize and report suspicious or unusual presentations of disease. However, correlating suspicious cases originating from diverse locations or discerning an increase in common presentations above the normal baseline is difficult. As in this case, public health practitioners coordinating disease surveillance may be able to receive reports of rare diseases and to determine whether they are occurring at a higher than normal rate in a large surveillance area.

The CDC, in collaboration with local, state, and territorial health departments, is enhancing existing disease surveillance systems for specific diseases that are normally rare in the United States but thought to have a high potential for public health impact if used as biological terrorism agents. This is being accomplished by improving training of clinical, laboratory, and public health personnel in recognizing suspicious disease presentations and by expanding of existing, disease-specific surveillance infrastructure. In addition, surveillance is being improved for disease presentations, such as acute respiratory distress, hemorrhagic, or meningeal symptoms normally caused by common infectious agents, but that could indicate an increase in illnesses caused by a biological agent used in terrorism. Surveillance mechanisms to rapidly assess changes in rates of disease include monitoring of calls to local emergency medical systems, regularly reviewing emergency department discharge diagnoses, and linking infection control practitioner networks.

Assignment:

For this case study, write a 1-page report that describes the possible agent of bioterrorism along with pathogenesis, treatment, and prevention. Include a brief discussion of sentinel labs and their role in recognizing potential episodes of bioterrorism.

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