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File: 123096_sep96_decls23_0044.txt
Subject: DIAGNOSIS AND TREATMENT OF DISEASES OF IMPORTANCE
Unit: OTSG
Parent Organization: HSC
Box ID: BX003203
Folder Title: DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS
Document Number: 1
Folder Seq #: 88
ray will also be absent. Patients with plague or tularemia pneumonia will have pulmonary
infiltrates and clinical signs of pneumonia (usually absent in nthm). mild to moderate: up to 6% of recipients will experience mild discomfort at the insulation
3. S=ific @bQEgtQU Diagnosis: Bacillus mthmcis will be readily detectable by site for up to 72 hours (tenderness, erythema, edema, pruritus), while a smaller proportion
blood culture with routine media. Smears and cultures of pleural fluid and abnormal ( < I %) will experience mom severe local reactions (potentially limiting use of the extremity
cerebrospinal fluid may also be positive. impression smears of mediastinal lymph nodes and for 1-2 days); modest systemic reactions (myalgia, malaise, low-grade fever) are uncommon,
spleen from fatal cases should be positive. Toxemia is sufficient to permit mthr@ toxin and severe systemic reactions (maphylaxis, which precludes additional vaccination) are rare.
detection in blood by immunoas@ys, and such assays will be available in field-deployed The vaccine should be stored at refrigerator temperature (nZ frown),
laboratories (see Section III). I TI ; Choice of antibiotics for prophylaxis is guided by the same
principles as that for treatment; i.e., it is relatively easy to produce a penicillin-resistant
induce
Almost all cases of inhalation @thrm where treatment was begun after patients were tetracycline resistance. Therefore, if there is information indicating that a biological weapon
symptomatic have been fatal, regardless of treatment. Historically, penicillin has been attack is imminent, prophylaxis with ciprofloxacin (500 mg po bid), or doxycycline (100 mg
regarded as the treatment of choice, with 2 million units given intravenously every 2 hours. po bid) should begin. If unvaccinated, a single 0.5 ml dose of vaccine should also be given
Tetracycline and erythromycin have been recommended in penicillin-sensitive patients, The subcutaneously. Should the attack be Confirmed as anthrax, antibiotics should be continued
for at least 4 weeks in all exposed. In addition, two 0.5 ml doses of vaccine should be given
vast majority of wthr@ strains are sensitive In to penicillin. However, penicillin 2 weeks apart in the unvaccinated; those previously vaccinated with fewer than three doses
resistant strains exist naturally, and one has been recovered from a fatal human case. should receive a single 0.5 ml b@ster, while vaccination probably is not necessary for those
Moreover, it is not difficult to induce resistance to penicillin, tetracycline, erythromycin, and who have received the entire thrm-dose primary series. Upon discontinuafion of antibiotics,
many other antibiotics through laboratory manipulation of organisms. All natu@ly-occurn'ng patients should be closely observed; if clinical signs of mthm occur, patients should be
thromycin, chlommphenicol, gentamicin, and treated as indicated above. If vaccine is not available, antibiotics should be continued
ciprofloxacin. In the current setting, treatment should be instituted at the earliest signs of beyond 4 weeks until the patient cm be closely observed upon discontinuation of therapy.
disease with orad ciprofloxacin (1000 mg initially, followed by 750 mg po bid) or intravenous
doxycycline (200 mg initially, followed by 100 mg q 12 hrs). Supportive therapy for shock,
fluid volume deficit, and adequacy of airway may all be needed.
D. PROPHYLAXIS
VACCINE: A licensed, alum-pr@ipitated, preparation of purified Bacillu5 anthracis BOTULISM
protective mtigen (PA) has been shown to be effective in preventing or significantly reducing A. CLINICAL SYNDROr4E
the incidence of inhalation mthm. Limited human data suggest that after completion of the
first three doses of the recommended six-do@ primary series (0, 2, 4 weeks, then 6, 12, 18 Botulism is mused by intoxication with the neurotoxin produced by o tri ium
months), protection against both cutaneous and inhalation nthm is afforded. Studies in in m. The toxin is a protein with molecular weight of approximately 150,000, which
rhesus monkeys indicate that good protection is afforded after two doses (10-16 days apart) binds to the presynaptic membrane of neurons at peripheral cholinergic synapses to prevent
for up to 2 years. It is likely that two doses in humans is protective as well, but there is too release of acetylcholine and block neurotmsmission. The blockade is most evident clinically
m conclusions. As with all vaccines, the degree of protection in the cholinergic autonomic nervous system and at the neuromuscular junction.
depends upon the magnitude of the challenge dose; vaccine-induced protection is undoubtedly A biological warfare attack with botutinum toxin delivered by aerosol to the
overwhelmed by extremely high spore challenge. respiratory tract would be expected to cause symptoms similar in most respects to those
In the present setting, three doses of the vaccine (at 0, 2, and 4 weeks) is observed with foodbome botulism.
recommended for prophylaxis against inhalation mthm. Given projected stocks, two doses,
0.5 ml each, administered subcutaneously on days 0 and 14, are recommended initially. A Clinical Features: Symptoms of botulism may begin as early as 3-36 hours following
third dose should be given 2 or more weeks after the second dose as additional vaccine exf>osum, or as late as several days. Initial symptoms include generalized weakness,
becomes available. Con@ndi@tions for use are sensitivity to vaccine components lassitude, and dizziness. Diminished salivation with extreme dryness of the mouth a d throat
R@ctogenicity is may cause complaints of a wre throat. Urinary retention or ileus may also occur. Motor
(formalin, alum, benzethonium chloride) mdlor history of clinical mthm. n
symptoms usually are present early in disease; cranial nerves are affected first with blurred
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Document 52 f:/Week-36/BX003203/DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS/diagnosis and treatment of diseases of importanc:12179609281524
Control Fields 17
File Room = sep96_declassified
File Cabinet = Week-36
Box ID = BX003203
Unit = OTSG
Parent Organization = HSC
Folder Title = DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS
Folder Seq # = 88
Subject = DIAGNOSIS AND TREATMENT OF DISEASES OF IMPORTANC
Document Seq # = 1
Document Date =
Scan Date =
Queued for Declassification = 01-JAN-1980
Short Term Referral = 01-JAN-1980
Long Term Referral = 01-JAN-1980
Permanent Referral = 01-JAN-1980
Non-Health Related Document = 01-JAN-1980
Declassified = 17-DEC-1996