Botulinum Toxin Ricin Toxin Staph Enterotoxin B

Total Page:16

File Type:pdf, Size:1020Kb

Botulinum Toxin Ricin Toxin Staph Enterotoxin B Botulinum Toxin Ricin Toxin Staph Enterotoxin B Source Source Source Clostridium botulinum, a large gram- Ricinus communis . seeds commonly called .Staphylococcus aureus, a gram-positive cocci positive, spore-forming, anaerobic castor beans bacillus Characteristics Characteristics .Appears as grape-like clusters on Characteristics .Toxin can be disseminated in the form of a Gram stain or as small off-white colonies .Grows anaerobically on Blood Agar and liquid, powder or mist on Blood Agar egg yolk plates .Toxin-producing and non-toxigenic strains Pathogenesis of S. aureus will appear morphologically Pathogenesis .A-chain inactivates ribosomes, identical interrupting protein synthesis .Toxin enters nerve terminals and blocks Pathogenesis release of acetylcholine, blocking .B-chain binds to carbohydrate receptors .Staphylococcus Enterotoxin B (SEB) is a neuro-transmission and resulting in on the cell surface and allows toxin superantigen. Toxin binds to human class muscle paralysis complex to enter cell II MHC molecules causing cytokine Toxicity release and system-wide inflammation Toxicity .Highly toxic by inhalation, ingestion Toxicity .Most lethal of all toxic natural substances and injection .Toxic by inhalation or ingestion .Groups A, B, E (rarely F) cause illness in .Less toxic by ingestion due to digestive humans activity and poor absorption Symptoms .Low dermal toxicity .4-10 h post-ingestion, 3-12 h post-inhalation Symptoms .Flu-like symptoms, fever, chills, .24-36 h (up to 3 d for wound botulism) Symptoms headache, myalgia .Progressive skeletal muscle weakness .18-24 h post exposure .Nausea, vomiting, and diarrhea .Symmetrical descending flaccid paralysis .Fever, cough, chest tightness, dyspnea, .Nonproductive cough, chest pain, .Can be confused with stroke, Guillain- cyanosis, gastroenteritis and necrosis; and dyspnea Barre syndrome or myasthenia gravis death in ~72 h .SEB can cause toxic shock syndrome + + + Gram stain Lipase on Ricin plant Castor beans S. aureus Gram stain Growth on egg yolk plates Blood Agar Botulinum Toxin Ricin Toxin Staph Enterotoxin B Transmission Transmission Transmission .Aerosol release .Aerosol release .Aerosol release .Food contamination .Food contamination .Food contamination .Wound contamination .Injection .Toxin not transmitted person to person .Toxin not transmitted person to person .Toxin not transmitted person to person Clinical Specimens Clinical Specimens Clinical Specimens .Serum: > 5 ml (10 ml preferred) .Serum to test for circulating antibody .5-10 ml blood in EDTA .Feces and gastric contents: >10 g (>5ml) (Tested at CDC) .Urine: > 5 ml (10 ml preferred) .Clinical swab specimens: Place swabs in .Urine: >5 ml (10 ml preferred) .Respiratory secretions, or nasal swabs an anaerobic transport media .Storage: Room temperature, in plastic .Bacterial isolates .Autopsy: contents from small and large containers (do not use glass) .Storage: Refrigerate intestines .Note: Ricin toxin can be denatured by .Storage: Refrigerate, preferably in plastic freezing or excess heat containers Environmental Samples Environmental Samples Environmental Samples .All environmental samples: 100 ml or 2 g .All environmental samples: 100 ml or 2 g .All environmental samples: 100 ml or 2 g .Food, drinks: Send entire item .Food, drinks: Send entire item .Food, drinks: Send entire item .Storage: Room temperature, in plastic .Storage: Refrigerate .Storage: Refrigerate, preferably in plastic containers (do not use glass) containers .Note: Ricin toxin can be denatured by freezing or excess heat Detection Detection Detection .Time-resolved fluorescence (TRF) .Mouse neutralization assay Time-resolved fluorescence (TRF) .Gel diffusion assay .Enzyme-linked immunosorbent assays . PCR .Latex agglutination test (ELISA) . Ricinine detection by chemical analysis .PCR .PCR . If any of these toxins are suspected immediately contact the Wadsworth Center, NYSDOH to refer the specimen/sample 518 - 474 - 4177 if within the 5 boroughs of NYC, please call (212) 447-1091 6/06.
Recommended publications
  • The Food Poisoning Toxins of Bacillus Cereus
    toxins Review The Food Poisoning Toxins of Bacillus cereus Richard Dietrich 1,†, Nadja Jessberger 1,*,†, Monika Ehling-Schulz 2 , Erwin Märtlbauer 1 and Per Einar Granum 3 1 Department of Veterinary Sciences, Faculty of Veterinary Medicine, Ludwig Maximilian University of Munich, Schönleutnerstr. 8, 85764 Oberschleißheim, Germany; [email protected] (R.D.); [email protected] (E.M.) 2 Department of Pathobiology, Functional Microbiology, Institute of Microbiology, University of Veterinary Medicine Vienna, 1210 Vienna, Austria; [email protected] 3 Department of Food Safety and Infection Biology, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, P.O. Box 5003 NMBU, 1432 Ås, Norway; [email protected] * Correspondence: [email protected] † These authors have contributed equally to this work. Abstract: Bacillus cereus is a ubiquitous soil bacterium responsible for two types of food-associated gastrointestinal diseases. While the emetic type, a food intoxication, manifests in nausea and vomiting, food infections with enteropathogenic strains cause diarrhea and abdominal pain. Causative toxins are the cyclic dodecadepsipeptide cereulide, and the proteinaceous enterotoxins hemolysin BL (Hbl), nonhemolytic enterotoxin (Nhe) and cytotoxin K (CytK), respectively. This review covers the current knowledge on distribution and genetic organization of the toxin genes, as well as mechanisms of enterotoxin gene regulation and toxin secretion. In this context, the exceptionally high variability of toxin production between single strains is highlighted. In addition, the mode of action of the pore-forming enterotoxins and their effect on target cells is described in detail. The main focus of this review are the two tripartite enterotoxin complexes Hbl and Nhe, but the latest findings on cereulide and CytK are also presented, as well as methods for toxin detection, and the contribution of further putative virulence factors to the diarrheal disease.
    [Show full text]
  • Toxic Shock Syndrome Contributors: Noah Craft MD, Phd, Lindy P
    ** no patient handout Toxic shock syndrome Contributors: Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH SynopsisToxic shock syndrome (TSS) is a severe exotoxin-mediated bacterial infection that is characterized by high fevers, headache, pharyngitis, vomiting, diarrhea, and hypotension. Two subtypes of TSS exist, based on the bacterial etiology: Staphylococcus aureus and group A streptococci. Significantly, the severity of TSS can range from mild disease to rapid progression to shock and end organ failure. The dermatologic manifestations of TSS include the following: • Erythema of the palms and soles that desquamates 1-3 weeks after the initial onset • Diffuse scarlatiniform exanthem that begins on the trunk and spreads toward the extremities • Erythema of the mucous membranes (strawberry tongue and conjunctival hyperemia) TSS was identified in and most commonly affected menstruating young white females using tampons in the 1980s. Current TSS cases are seen in post-surgical interventions in men, women, and children, as well as in other settings, in addition to cases of menstrual TSS, which have declined with increased public education on tampon usage and TSS. One study in Japanese patients found the highest TSS incidence to occur among children with burns, as Staphylococcus colonization is high in this subgroup and antibody titers are not yet sufficient to protect children from the exotoxins causing TSS. Staphylococcal TSS is caused by S. aureus strains that can produce the toxic shock syndrome toxin-1 (TSST-1). TSST-1 is believed to cause disease via direct effects on end organs, impairing clearance of gut flora derived endotoxins, with TSST-1 acting as a superantigen leading to massive nonspecific activation of T-cells and subsequent inflammation and vascular leakage.
    [Show full text]
  • Rapid and Simultaneous Detection of Ricin, Staphylococcal Enterotoxin B
    Analyst PAPER View Article Online View Journal | View Issue Rapid and simultaneous detection of ricin, staphylococcal enterotoxin B and saxitoxin by Cite this: Analyst,2014,139, 5885 chemiluminescence-based microarray immunoassay† a a b b c c A. Szkola, E. M. Linares, S. Worbs, B. G. Dorner, R. Dietrich, E. Martlbauer,¨ R. Niessnera and M. Seidel*a Simultaneous detection of small and large molecules on microarray immunoassays is a challenge that limits some applications in multiplex analysis. This is the case for biosecurity, where fast, cheap and reliable simultaneous detection of proteotoxins and small toxins is needed. Two highly relevant proteotoxins, ricin (60 kDa) and bacterial toxin staphylococcal enterotoxin B (SEB, 30 kDa) and the small phycotoxin saxitoxin (STX, 0.3 kDa) are potential biological warfare agents and require an analytical tool for simultaneous detection. Proteotoxins are successfully detected by sandwich immunoassays, whereas Creative Commons Attribution-NonCommercial 3.0 Unported Licence. competitive immunoassays are more suitable for small toxins (<1 kDa). Based on this need, this work provides a novel and efficient solution based on anti-idiotypic antibodies for small molecules to combine both assay principles on one microarray. The biotoxin measurements are performed on a flow-through chemiluminescence microarray platform MCR3 in 18 minutes. The chemiluminescence signal was Received 18th February 2014 amplified by using a poly-horseradish peroxidase complex (polyHRP), resulting in low detection limits: Accepted 3rd September 2014 2.9 Æ 3.1 mgLÀ1 for ricin, 0.1 Æ 0.1 mgLÀ1 for SEB and 2.3 Æ 1.7 mgLÀ1 for STX. The developed multiplex DOI: 10.1039/c4an00345d system for the three biotoxins is completely novel, relevant in the context of biosecurity and establishes www.rsc.org/analyst the basis for research on anti-idiotypic antibodies for microarray immunoassays.
    [Show full text]
  • Saxitoxin Poisoning (Paralytic Shellfish Poisoning [PSP])
    Saxitoxin Poisoning (Paralytic Shellfish Poisoning [PSP]) PROTOCOL CHECKLIST Enter available information into Merlin upon receipt of initial report Review information on Saxitoxin and its epidemiology, case definition and exposure information Contact provider Interview patient(s) Review facts on Saxitoxin Sources of poisoning Symptoms Clinical information Ask about exposure to relevant risk factors Type of fish or shellfish Size and weight of shellfish/puffer fish or other type of fish Amount of shellfish/puffer fish or other type of fish consumed Where the shellfish/puffer fish or other type of fish was caught or purchased Where the shellfish/puffer fish or other type of fish was consumed Secure any leftover product for potential testing Restaurant meals Other Contact your Regional Environmental Epidemiologist (REE) Identify symptomatic contacts or others who ate the shellfish/puffer fish or other type of fish Enter any additional information gathered into Merlin Saxitoxin Poisoning Guide to Surveillance and Investigation Saxitoxin Poisoning 1. DISEASE REPORTING A. Purpose of reporting and surveillance 1. To gather epidemiologic and environmental data on saxitoxin shellfish, Florida puffer fish or other type of fish poisoning cases to target future public health interventions. 2. To prevent additional cases by identifying any ongoing public health threats that can be mitigated by identifying any shellfish or puffer fish available commercially and removing it from the marketplace or issuing public notices about the risks from consuming molluscan shellfish from Florida and non-Florida waters, such as from the northern Pacific and other cold water sources. 3. To identify all exposed persons with a common or shared exposure to saxitoxic shellfish or puffer fish; collect shellfish and/or puffer fish samples for testing by the Florida Fish and Wildlife Conservation Commission (FWC) and the U.S.
    [Show full text]
  • The Role of Streptococcal and Staphylococcal Exotoxins and Proteases in Human Necrotizing Soft Tissue Infections
    toxins Review The Role of Streptococcal and Staphylococcal Exotoxins and Proteases in Human Necrotizing Soft Tissue Infections Patience Shumba 1, Srikanth Mairpady Shambat 2 and Nikolai Siemens 1,* 1 Center for Functional Genomics of Microbes, Department of Molecular Genetics and Infection Biology, University of Greifswald, D-17489 Greifswald, Germany; [email protected] 2 Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, CH-8091 Zurich, Switzerland; [email protected] * Correspondence: [email protected]; Tel.: +49-3834-420-5711 Received: 20 May 2019; Accepted: 10 June 2019; Published: 11 June 2019 Abstract: Necrotizing soft tissue infections (NSTIs) are critical clinical conditions characterized by extensive necrosis of any layer of the soft tissue and systemic toxicity. Group A streptococci (GAS) and Staphylococcus aureus are two major pathogens associated with monomicrobial NSTIs. In the tissue environment, both Gram-positive bacteria secrete a variety of molecules, including pore-forming exotoxins, superantigens, and proteases with cytolytic and immunomodulatory functions. The present review summarizes the current knowledge about streptococcal and staphylococcal toxins in NSTIs with a special focus on their contribution to disease progression, tissue pathology, and immune evasion strategies. Keywords: Streptococcus pyogenes; group A streptococcus; Staphylococcus aureus; skin infections; necrotizing soft tissue infections; pore-forming toxins; superantigens; immunomodulatory proteases; immune responses Key Contribution: Group A streptococcal and Staphylococcus aureus toxins manipulate host physiological and immunological responses to promote disease severity and progression. 1. Introduction Necrotizing soft tissue infections (NSTIs) are rare and represent a more severe rapidly progressing form of soft tissue infections that account for significant morbidity and mortality [1].
    [Show full text]
  • Clostridium Perfringens Enterotoxin: the Toxin Forms Highly Cation-Selective Channels in Lipid Bilayers Roland Benz, Michel Popoff
    Clostridium perfringens Enterotoxin: The Toxin Forms Highly Cation-Selective Channels in Lipid Bilayers Roland Benz, Michel Popoff To cite this version: Roland Benz, Michel Popoff. Clostridium perfringens Enterotoxin: The Toxin Forms Highly Cation- Selective Channels in Lipid Bilayers. Toxins, MDPI, 2018, 10 (9), pp.341. 10.3390/toxins10090341. pasteur-02448636 HAL Id: pasteur-02448636 https://hal-pasteur.archives-ouvertes.fr/pasteur-02448636 Submitted on 22 Jan 2020 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Distributed under a Creative Commons Attribution| 4.0 International License toxins Article Clostridium perfringens Enterotoxin: The Toxin Forms Highly Cation-Selective Channels in Lipid Bilayers Roland Benz 1 ID and Michel R. Popoff 2,* 1 Department of Life Sciences and Chemistry, Jacobs University, Campusring 1, 28759 Bremen, Germany; [email protected] 2 Bacterial Toxins, Institut Pasteur, 28 rue du Dr Roux, 75015 Paris, France * Correspondence: [email protected] Received: 30 July 2018; Accepted: 14 August 2018; Published: 22 August 2018 Abstract: One of the numerous toxins produced by Clostridium perfringens is Clostridium perfringens enterotoxin (CPE), a polypeptide with a molecular mass of 35.5 kDa exhibiting three different domains.
    [Show full text]
  • Investigation of Anthrax Associated with Intentional Exposure
    October 19, 2001 / Vol. 50 / No. 41 889 Update: Investigation of Anthrax Associated with Intentional Exposure and Interim Public Health Guidelines, October 2001 893 Recognition of Illness Associated with the Intentional Release of a Biologic Agent 897 Weekly Update: West Nile Virus Activity — United States, October 10–16, 2001 Update: Investigation of Anthrax Associated with Intentional Exposure and Interim Public Health Guidelines, October 2001 On October 4, 2001, CDC and state and local public health authorities reported a case of inhalational anthrax in Florida (1 ). Additional cases of anthrax subsequently have been reported from Florida and New York City. This report updates the findings of these case investigations, which indicate that infections were caused by the intentional release of Bacillus anthracis. This report also includes interim guidelines for postexposure pro- phylaxis for prevention of inhalational anthrax and other information to assist epidemi- ologists, clinicians, and laboratorians responding to intentional anthrax exposures. For these investigations, a confirmed case of anthrax was defined as 1) a clinically compatible case of cutaneous, inhalational, or gastrointestinal illness* that is laboratory confirmed by isolation of B. anthracis from an affected tissue or site or 2) other labora- tory evidence of B. anthracis infection based on at least two supportive laboratory tests. A suspected case was defined as 1) a clinically compatible case of illness without isola- tion of B. anthracis and no alternative diagnosis, but with laboratory evidence of B. anthracis by one supportive laboratory test or 2) a clinically compatible case of an- thrax epidemiologically linked to a confirmed environmental exposure, but without cor- roborative laboratory evidence of B.
    [Show full text]
  • Toxic Shock-Like Syndrome Associated with Necrotizing Streptococcus Pyogenes Infection
    Henry Ford Hospital Medical Journal Volume 37 Number 2 Article 5 6-1989 Toxic Shock-like Syndrome Associated with Necrotizing Streptococcus Pyogenes Infection Thomas J. Connolly Donald J. Pavelka Eugene F. Lanspa Thomas L. Connolly Follow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournal Part of the Life Sciences Commons, Medical Specialties Commons, and the Public Health Commons Recommended Citation Connolly, Thomas J.; Pavelka, Donald J.; Lanspa, Eugene F.; and Connolly, Thomas L. (1989) "Toxic Shock- like Syndrome Associated with Necrotizing Streptococcus Pyogenes Infection," Henry Ford Hospital Medical Journal : Vol. 37 : No. 2 , 69-72. Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol37/iss2/5 This Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Henry Ford Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons. Toxic Shock-like Syndrome Associated with Necrotizing Streptococcus Pyogenes Infection Thomas J. Connolly,* Donald J. Pavelka, MD,^ Eugene F. Lanspa, MD, and Thomas L. Connolly, MD' Two patients with toxic shock-like syndrome are presented. Bolh patients had necrotizing cellulitis due to Streptococcus pyogenes, and both patients required extensive surgical debridement. The association of Streptococcus pyogenes infection and toxic shock-like syndrome is discussed. (Henry Ford Hosp MedJ 1989:37:69-72) ince 1978, toxin-producing strains of Staphylococcus brought to the emergency room where a physical examination revealed S aureus have been implicated as the cause of the toxic shock a temperature of 40.9°C (I05.6°F), blood pressure of 98/72 mm Hg, syndrome (TSS), which is characterized by fever and rash and respiration of 36 breaths/min, and a pulse of 72 beats/min.
    [Show full text]
  • Biological Toxins Fact Sheet
    Work with FACT SHEET Biological Toxins The University of Utah Institutional Biosafety Committee (IBC) reviews registrations for work with, possession of, use of, and transfer of acute biological toxins (mammalian LD50 <100 µg/kg body weight) or toxins that fall under the Federal Select Agent Guidelines, as well as the organisms, both natural and recombinant, which produce these toxins Toxins Requiring IBC Registration Laboratory Practices Guidelines for working with biological toxins can be found The following toxins require registration with the IBC. The list in Appendix I of the Biosafety in Microbiological and is not comprehensive. Any toxin with an LD50 greater than 100 µg/kg body weight, or on the select agent list requires Biomedical Laboratories registration. Principal investigators should confirm whether or (http://www.cdc.gov/biosafety/publications/bmbl5/i not the toxins they propose to work with require IBC ndex.htm). These are summarized below. registration by contacting the OEHS Biosafety Officer at [email protected] or 801-581-6590. Routine operations with dilute toxin solutions are Abrin conducted using Biosafety Level 2 (BSL2) practices and Aflatoxin these must be detailed in the IBC protocol and will be Bacillus anthracis edema factor verified during the inspection by OEHS staff prior to IBC Bacillus anthracis lethal toxin Botulinum neurotoxins approval. BSL2 Inspection checklists can be found here Brevetoxin (http://oehs.utah.edu/research-safety/biosafety/ Cholera toxin biosafety-laboratory-audits). All personnel working with Clostridium difficile toxin biological toxins or accessing a toxin laboratory must be Clostridium perfringens toxins Conotoxins trained in the theory and practice of the toxins to be used, Dendrotoxin (DTX) with special emphasis on the nature of the hazards Diacetoxyscirpenol (DAS) associated with laboratory operations and should be Diphtheria toxin familiar with the signs and symptoms of toxin exposure.
    [Show full text]
  • Biological Toxins As the Potential Tools for Bioterrorism
    International Journal of Molecular Sciences Review Biological Toxins as the Potential Tools for Bioterrorism Edyta Janik 1, Michal Ceremuga 2, Joanna Saluk-Bijak 1 and Michal Bijak 1,* 1 Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland; [email protected] (E.J.); [email protected] (J.S.-B.) 2 CBRN Reconnaissance and Decontamination Department, Military Institute of Chemistry and Radiometry, Antoniego Chrusciela “Montera” 105, 00-910 Warsaw, Poland; [email protected] * Correspondence: [email protected] or [email protected]; Tel.: +48-(0)426354336 Received: 3 February 2019; Accepted: 3 March 2019; Published: 8 March 2019 Abstract: Biological toxins are a heterogeneous group produced by living organisms. One dictionary defines them as “Chemicals produced by living organisms that have toxic properties for another organism”. Toxins are very attractive to terrorists for use in acts of bioterrorism. The first reason is that many biological toxins can be obtained very easily. Simple bacterial culturing systems and extraction equipment dedicated to plant toxins are cheap and easily available, and can even be constructed at home. Many toxins affect the nervous systems of mammals by interfering with the transmission of nerve impulses, which gives them their high potential in bioterrorist attacks. Others are responsible for blockage of main cellular metabolism, causing cellular death. Moreover, most toxins act very quickly and are lethal in low doses (LD50 < 25 mg/kg), which are very often lower than chemical warfare agents. For these reasons we decided to prepare this review paper which main aim is to present the high potential of biological toxins as factors of bioterrorism describing the general characteristics, mechanisms of action and treatment of most potent biological toxins.
    [Show full text]
  • Detection of ESKAPE Pathogens and Clostridioides Difficile in Simulated
    bioRxiv preprint doi: https://doi.org/10.1101/2021.03.04.433847; this version posted March 4, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. 1 Detection of ESKAPE pathogens and Clostridioides difficile in 2 Simulated Skin Transmission Events with Metagenomic and 3 Metatranscriptomic Sequencing 4 5 Krista L. Ternusa#, Nicolette C. Keplingera, Anthony D. Kappella, Gene D. Godboldb, Veena 6 Palsikara, Carlos A. Acevedoa, Katharina L. Webera, Danielle S. LeSassiera, Kathleen Q. 7 Schultea, Nicole M. Westfalla, and F. Curtis Hewitta 8 9 aSignature Science, LLC, 8329 North Mopac Expressway, Austin, Texas, USA 10 bSignature Science, LLC, 1670 Discovery Drive, Charlottesville, VA, USA 11 12 #Address correspondence to Krista L. Ternus, [email protected] 13 14 1 bioRxiv preprint doi: https://doi.org/10.1101/2021.03.04.433847; this version posted March 4, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. 15 1 Abstract 16 Background: Antimicrobial resistance is a significant global threat, posing major public health 17 risks and economic costs to healthcare systems. Bacterial cultures are typically used to diagnose 18 healthcare-acquired infections (HAI); however, culture-dependent methods provide limited 19 presence/absence information and are not applicable to all pathogens.
    [Show full text]
  • Medical Management of Biologic Casualties Handbook
    USAMRIID’s MEDICAL MANAGEMENT OF BIOLOGICAL CASUALTIES HANDBOOK Fourth Edition February 2001 U.S. ARMY MEDICAL RESEARCH INSTITUTE OF INFECTIOUS DISEASES ¨ FORT DETRICK FREDERICK, MARYLAND 1 Sources of information: National Response Center 1-800-424-8802 or (for chem/bio hazards & terrorist events) 1-202-267-2675 National Domestic Preparedness Office: 1-202-324-9025 (for civilian use) Domestic Preparedness Chem/Bio Help line: 1-410-436-4484 or (Edgewood Ops Center - for military use) DSN 584-4484 USAMRIID Emergency Response Line: 1-888-872-7443 CDC'S Bioterrorism Preparedness and Response Center: 1-770-488-7100 John's Hopkins Center for Civilian Biodefense: 1-410-223-1667 (Civilian Biodefense Studies) An Adobe Acrobat Reader (pdf file) version and a Palm OS Electronic version of this Handbook can both be downloaded from the Internet at: http://www.usamriid.army.mil/education/bluebook.html 2 USAMRIID’s MEDICAL MANAGEMENT OF BIOLOGICAL CASUALTIES HANDBOOK Fourth Edition February 2001 Editors: LTC Mark Kortepeter LTC George Christopher COL Ted Cieslak CDR Randall Culpepper CDR Robert Darling MAJ Julie Pavlin LTC John Rowe COL Kelly McKee, Jr. COL Edward Eitzen, Jr. Comments and suggestions are appreciated and should be addressed to: Operational Medicine Department Attn: MCMR-UIM-O U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) Fort Detrick, Maryland 21702-5011 3 PREFACE TO THE FOURTH EDITION The Medical Management of Biological Casualties Handbook, which has become affectionately known as the "Blue Book," has been enormously successful - far beyond our expectations. Since the first edition in 1993, the awareness of biological weapons in the United States has increased dramatically.
    [Show full text]