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File: 123096_sep96_decls23_0047.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
phospholipaw C. Other toxins from the organism might be co-wmponized and enhance PLAGUE
effectiveness. For example, the epsilon toxin is neurotoxic in laboratory animals.
A: CLINICAL SYNDROME
Clinical Features: The clinical picture of aefowlized C_ ptrffineens alpha toxin would
be expected to be that of a serious acute pulmonary insult. Absorbed alpha toxin could Plague is a zwnofic disease caused by Yersinia @i , a gram negative, non spore-
produce vascular leak, hemolysis, thrombmytopenia, liver damage, etc. Other toxins forming, bacillus. Under natural conditions, humms become infected through skin
admixed could modify the event. inoculation (flea bite or, less commonly, direct wimal contact), and only rarely via aerosol.
A biological warfare attack with plague bacilli would be delivered via aerosol, or, less likely,
B. DIAGNOSIS via contaminated v@tors (fl@s). 'ne clinical picture seen would depend upon the route of
delivery.
Routine Labomto[y Findings: Clinical laboratory findings might include anemia (due
rimary
septicemic, and pneumonic. 'ne incubation period ranges from 2 to 10 days. In bubonic
Differential Diagnosis: Pulmonary signs might lead to confusion with SEB initially. plague, onset is acute and often fulminmt, with high fever, systemic signs and symptoms,
Liver damage, hemolytic anemia, and tlirombocytopenia are not associated with SEB, and the and exquisitely tender lymph node or nodes. The hallmark of bubonic plague, the bubo,
pulmonary findings sould be reversible in SEB.
represents lymphadenitis involving a node draining the site of inoculation. Most commonly,
the primary site is inguinal, although @illmy or m@ical nodes may be involved. The
SMific !Abomto[y Diagnosis: Acute semm and tissue mmples should be collected involved nodes are swollen and tender, becoming fluctuant and necrotic. Bubonic plague
and rapidly transported to a reference laboratory. Specific immunoassays we available; may be complicated by the development of meningitis or secondary pneumonia. Onset of
however, their utility in diagnosis of human disease is unproven.
pnmary septimmic plague is similar, but without a localizing "bubo". Infmdon by flea bite
in most
and bacteria are readily cultured from clinical mmples. individuals. Primary pneumonic plague is the disease syndrome expected after an aemsol
attack. After a short incubation period of 1-6 days, them is development of cough, chest
C. THERAPY
pain, bloody sputum, progressive respiratory insufficiency, and toxemia. Patients with
plague pneumonia are highly contagious, and should be kept in strict respiratory isolation.
No spmific treatment is available for C, pfrfringens intoxication. Humms with Although some patients with bubonic or septicemic plague may develop secondary pneumonia
enteritis nwroti@s have been treated with antitoxin with some success. as the disease process evolves, large numbers of individuals with plague pneumonia almost
The organism itself is sensitive to penicillin, and, consequently, this is the current certainly would indicate inhalation of organisms delivered via aerosol from a biowufare
dmg of choice. Recent data indicate that clindamycin or rifampin may suppress toxin attack.
production, and provide superior results in nimal models.
B: DIAGNOSIS
D. PROPIIYLAXIS
Routine Laborato[y Findines: Examination of bubo aspirate, sputum, or
There is no available prophylaxis for C. pgrfrinpens intoxication. Toxoids are being cerebrospinal fluid by gram stain will reveal numerous organims typical morphologically of
used to prevent enterifis nwroti=s in humns, and veterinary toxoids we in wide use. Yprsinia @i .
Differential Diaenosis: Bubonic plague should be suspected in large numbers of
individuals with similar findings of fever, malaise, and tender lymphadenopathy. An
epidemic of pneumonic plague in its early stages could be confused with tularemia, anthrax,
or SEB; continued deterioration without stabilization effectively rules out SEB, while gram
stain of the sputum, culture, and presence of the plague Fl antigen is blood specimens
provide more spmific evidence of plague.
84 85
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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