Transcript VRE Vancomycin-resistant enterococci

Super Pathogens
WHAT ARE THEY
AND
HOW TO AVOID THEM
Evan Collette
Ashley Tourigney
Community Based Disease
As members of any emergency response
team it important for us to be aware of new
strains of communicable disease which we
may be exposed to and universally
approved prevention techniques used to
safeguard health care workers.
VRE
Vancomycin-resistant enterococci
Enterococci is a bacteria.
It is present in intestines and
female genital tract normally and
can live without causing harm.
When the bacteria seeds
elsewhere it will cause infections
including urinary tract, blood,
and wound infections.
Vancomycin
Vancomycin in an antibiotic used to treat the
infections caused by enterococci.
In some cases the bacteria has become
resistant to this antibiotic.
They call this resistant bacteria VRE
(vancomycin-resistant enterococci).
How is VRE spread?
VRE is usually passed to others by direct
contact with stool, urine or blood containing
VRE. It can also be spread indirectly via
the hands or on contaminated
environmental surfaces. VRE usually is not
spread through casual contact such as
touching or hugging. VRE is not spread
through the air by coughing or sneezing.
People at increased Risk
Individuals who have been treated in the past
with vancomycin and combinations of other
antibiotics.
People in hospitals, esp. on antibiotics for
long durations.
People with weak immune systems or who
have had surgical procedures.
People with indwelling percutaneous medical
devices and catheters.
Treatment
Most VRE infections can be treated with
antibiotics other than vancomycin. The
treatment of VRE is determined by
laboratory testing to determine which
antibiotics are effective.
People who are colonized (bacteria are
present, but have no symptoms of an
infection) with VRE do not usually need
treatment.
Prevention
Always wash your hands thoroughly after using the
bathroom and before preparing food. Wash with soap
and water (particularly when visibly soiled) or clean
with alcohol-based hand cleaner.
Use a household disinfectant or a mixture of one-fourth
cup bleach and one quart of water to clean those
areas and surfaces that are touched frequently.
Wear gloves if you may come in contact with body fluids
that may contain VRE, such as stool. Always wash
your hands after removing gloves.
Hepatitis
Hepatitis means an inflammation of the liver.
There are 5 viruses that can cause hepatitis.
Some of the viruses can change over time
making it difficult for the body to fight.
Hepatitis
Hepatitis A: is a liver disease caused by the
hepatitis A virus (HAV). Hepatitis A can
affect anyone. In the United States,
hepatitis A can occur in situations ranging
from isolated cases of disease to
widespread epidemics.
Hepatitis
Hepatitis B: is a serious disease caused by a
virus that attacks the liver. The virus, which
is called hepatitis B virus (HBV), can cause
lifelong infection, cirrhosis (scarring) of the
liver, liver cancer, liver failure, and death.
Hepatitis
Hepatitis C: is a liver disease caused by the
hepatitis C virus (HCV), which is found in
the blood of persons who have the disease.
HCV is spread by contact with the blood of
an infected person.
Hepatitis
Hepatitis D: is a liver disease caused by the
hepatitis D virus (HDV), a defective virus
that needs the hepatitis B virus to exist.
Hepatitis D virus (HDV) is found in the
blood of persons infected with the virus.
Hepatitis
Hepatitis E: is a liver disease caused by the
hepatitis E virus (HEV) transmitted in much
the same way as hepatitis A virus. Hepatitis
E, however, does not occur often in the
United States.
Hepatitis
Acute Hepatitis – Clinical Symptoms
Asymptomatic > Symptomatic > Fulminant Liver
Failure > Death
Symptoms (if present) are the same, regardless of
cause (e.g., A, B, C, other viruses, toxins)
Nausea, vomiting
Abdominal pain
Loss of appetite
Fever
Diarrhea
Light (clay) colored stools
Dark urine
Jaundice (yellowing of eyes, skin)
Hepatitis A
Hepatitis A
NUMBER OF YEARS REPORTED INCIDENCE OF
HEPATITIS A EXCEEDED 10 CASES PER 100,000,
BY COUNTY, 1987-1997
Hepatitis A
Transmitted through close personal contact (e.g.,
household contact, sex contact, child day-care
centers), contaminated food, water (e.g.,
infected food handlers), blood exposure (rare)
(e.g., injection drug use, rarely by transfusion)
It occurs most often in children and young adults,
esp. in autumn and winter.
Symptoms include: jaundice, malaise, nausea,
diarrhea, abdominal pain, and lack of appetite
for a period of 2 days-3 weeks.
Preventing Hepatitis A
Vaccine: 97%-100% of children, adolescents, and
adults have protective levels of antibody within 1
month of receiving first dose; essentially 100%
have protective levels after second dose. Serum
titers for up eight years.
Hygiene (e.g., hand washing)
Sanitation (e.g., clean water sources)
Hepatitis A vaccine (pre-exposure)
Immune globulin (pre- and post-exposure)
Hepatitis B
Hepatitis B
Hepatitis B is a serious disease caused by a virus
that attacks the liver. The virus, which is called
hepatitis B virus (HBV), can cause lifelong
infection, cirrhosis (scarring) of the liver, liver
cancer, liver failure, and death.
About 30% of persons have no signs or
symptoms. Signs and symptoms are less
common in children than adults.
It occurs in people of all ages with about the same
incidence throughout the year.
Hepatitis B
Occurs when blood from an infected person enters
the body of a person who is not infected.
HBV is spread through having sex with an infected
person without using a condom, by sharing
needles, needlesticks or sharps exposures on the
job, or from an infected mother to her baby during
birth.
Persons at risk for HBV infection might also be at risk
for infection with hepatitis C virus (HCV) or HIV.
Hepatitis B
The hepatitis B virus takes about 2 months to show up in your blood.
It may stay in your blood for months or years.
Acute Hepatitis B: 9 out of every 10 adults will get rid of the virus
from their bodies after a few months. The symptoms will go away
on their own within a few weeks there is no treatment other than
alleviating the symptoms.
Chronic Hepatitis B: 1 out of every 10 adults will never get rid of
the virus from their bodies. They are called carriers.
After having the virus the person has immunity to it and for others a
vaccine is available.
Hepatitis C
Hepatitis C can lead to cirrhosis or liver cancer, it
is a leading reason for liver transplants.
It is transmitted person to person by blood or body
fluids.
Although the disease usually is mild or seemingly
inapparent, the infection can be severe in
compromised individuals and will become
chronic in about 80% of those infected.
Hepatitis C
There is no cure or vaccine for
Hepatitis C.
No immunity is developed following an
infection.
Some medications are currently used to help
control the disease.
Staphylococcus aureus
“staph”
Staphylococcal Infections -Staph is short for
Staphylococcus, a type of bacteria. There
are over 30 types, but Staphylococcus
aureus causes most staph infections,
including Skin infections, Pneumonia, Food
poisoning, and Toxic shock.
Staphylococcus aureus
“staph”
This bacteria is carried on the skin or in the
nose of healthy people.
Not everyone gets infections from “staph”
bacteria when it is present on their body.
Some people do get skin infections such as
pimples and boils, they are treatable.
In other cases the infection can be serious
causing wound infections, bloodstream
infections, and pneumonia.
Methicillin-resistant Staphylococcus
aureus (MRSA)
MRSA is a type ot “staph” infection that is resistant to
antibiotics called beta-lactams.
β-lactam antibiotics are a broad class of antibiotics that
include penicillin derivatives, cephalosporins,
monobactams (imipenem), carbapenems
(aztreonam), and β-lactamase inhibitors
Of 25-30% of people colonized with staph about 1% is
colonized with MRSA.
Methicillin-resistant Staphylococcus
aureus (MRSA)
Methicillin-resistant Staphylococcus aureus
(MRSA) are identified as nosocomial
pathogens throughout the world.
People who get MRSA are frequently in hospitals
and healthcare facilities, with weakened
immune systems.
Recently, however, cases of MRSA have been
documented in healthy community-dwelling
persons without established risk factors for
MRSA acquisition.
How do you get MRSA?
You can get MRSA by having physical contact
with someone who is infected with it or
carrying it on their body.
Another way is to touch an object that has
MRSA on it, ex: a door knob.
Normal skin of people does not allow the
infection to develop, however an abrasion
or cut on the skin will allow it to.
MRSA
Signs and Symptoms
Infection of the skin starting with small red bumps in
the skin
Pus-filled infections of hair follicles
Collections of pus in under the skin
Infection of eyelid gland
Infections of the skin with openings
Pus filled blisters
MRSA can spread to internal organs as well and can
cause chills, low BP, rash, joint pains, severe
headaches and shortness of breath.
Treatments for MRSA
Most MRSA can be treated by certain
antibiotics like vancomycin and linezolid.
The entire dosage of antibiotic needs to be
taken to “cure” the infection.
Avoid getting MRSA by…
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Cover any skin breaks with antiseptic cream and
a Band-Aid
Use excellent hygiene practices
Wash clothes in contact with MRSA patients or
carriers
Use disposable items when treating MRSA
patients
Use antiseptic solutions and wipes to clean both
hands and surfaces that may contact MRSA
Clostridium difficile
(C.difficle)
This is a bacterium that causes diarrhea and
more serious intestinal conditions.
There is an increased risk when on antibiotics,
because the antibiotic alters the bodies
levels of good bacteria in the intestines.
Clindamycin is the antibiotic most frequently
associated with C. difficile infections
followed by ampicillin and cephalosporins.
Clostridium difficile
The elderly and people in the hospital are at
greater risk, healthy people are not usually
affected.
Once C. difficile has established its self in an
environment it is difficult to remove.
Symptoms of this colitis include abdominal
cramps, diarrhea, fever, electrolyte
imbalance, and potential perforation of the
colon in severe infections.
Modes of Transmission
Contact Transmission
Vector Transmission
Vehicle Transmission
Contact Transmission
Direct contact transmission requires body
contact between individuals. In the health
care worker these can be spread through
unhygienic practice. An example would be
direct fecal-oral transmission transfers fecal
pathogens to mouth via unwashed hands.
Staphylococcal infections, warts and STD’s
are of major concern.
Contact Transmission
Indirect contact transmission occurs through
non-living objects that can harbor and
transmit an infectious agent. Examples
include soiled handkerchiefs, dishes, eating
utensils, doorknobs, bar soap and money.
Tetanus, common cold, enterovirus and
ringworm are commonly transmitted this
way.
Contact Transmission
Droplet transmission occurs when a person
speaks, coughs, or sneezes near others.
The area of greatest exposure is within one
meter of the infected person. Common
cold, influenza, measles, pneumonia, and
whooping cough are commonly spread this
way.
Vehicle Transmission
Waterborne pathogens thrive in water
contaminated by untreated sewage.
Cholera, shigellosis and Campylobacter
infections can be transmitted this way. Of
major concern would be indirect fecal
transmission when pathogens of feces of
one organism affect another organism.
Vehicle Transmission
Airborne microorganisms including dust
particles can be transients from soil, water,
plants or animals. Chickenpox,
tuberculosis, measles and influenza are
commonly transmitted this way. Pathogens
are said to be airborne if they travel more
than one meter this way.
Vehicle Transmission
Foodborne transmission has been a mode of
spreading hepatitis A, staphylococcal food
poisoning, salmonellosis, typhoid fever and
botulinum toxin. They are usually the result
of poorly refrigerated, incompletely cooked
or poorly processed foods. They manifest
themselves through gastrointestinal
symptoms.
Vector Transmission
Mechanical transmission (on insect bodies
such as flies) spreading diseases. These
include E. coli diarrhea, salmonellosis and
trachoma. Pathogens are spread from
insects to food which is then ingested by
humans.
Best Defense
USE GLOVES AND DON’T
TOUCH BODY FLUIDS
UNPROTECTED
Best Defense
WASH
HANDS
OFTEN
Best Defense
Use of masks are recommended when
exposure to infected individuals is identified
but it is important to note that even surgical
masks will not prevent the spread of all
droplets.
Best Defense
Masks are very useful in
impeding the spread of
airborne disease but of even
greater impact is the cleaning
of areas of exposure with wet
mops and damp cloths.
Best Defense
In the event of an emergency,
drinking of bottled water
would be advised.
Best Defense
In an emergency situation when
food goods are being supplied
dried packaged foods are the
best safe source of nutrition.
Best Defense
Keeping these insects and other
potential vectors away from the
food supply.
Bioterrorism
the deliberate release of viruses, bacteria,
or other germs (agents) used to cause
illness or death in people, animals, or
plants
Bioterrorism Agent Categories
Category A
Pose the highest risk to the public and national
security because:
• They can be easily spread or transmitted from
person to person
• They result in high death rates and have the
potential for major public health impact
• They might cause public panic and social
disruption
• They require special action for public health
preparedness
Category B
These agents are the second highest priority
because:
• They are moderately easy to spread
• They result in moderate illness rates and
low death rates
• They require specific enhancements of
CDC's laboratory capacity and enhanced
disease monitoring.
Category C
Include emerging pathogens that could be
engineered for mass spread in the future
because:
• They are easily available
• They are easily produced and spread
• They have potential for high morbidity and
mortality rates and major health impact.
Anthrax Bacillus
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Caused by the spore-forming bacterium, Bacillus
anthracis
Zoonotic disease in herbivores (e.g., sheep,
goats, cattle) follows ingestion of spores in soil
Human infection typically acquired through
contact with anthrax-infected animals or animal
products or atypically through intentional
exposure
Three clinical forms
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Cutaneous Inhalational Gastrointestinal
Anthrax: Current Issues in the U.S.
• Anthrax remains an endemic public health
threat through annual epizootics.
• B. anthracisis one of the most important
pathogens on the list of bioterrorism threats
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Aerosolized stable spore form
Human LD50 8,000 to 40,000 spores, or one deep
breath at site of release
Anthrax: Cutaneous
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Begins as a papule, progresses through a
vesicular stage to a depressed black necrotic
ulcer (eschar)
Edema, redness, and/or necrosis without
ulceration may occur
Form most commonly encountered in naturally
occurring cases
Incubation period: 1–12 days
Case-fatality:
• Without antibiotic treatment—20%
• With antibiotic treatment—1%
Anthrax Cutaneous
Left image: forearm lesion on Day 7—vesiculation and ulceration of initial macular or papular anthrax skin lesion.
Right image: eschar of the neck on Day 15, typical of the last day of lesion.
From Binford CH, Connor DH, eds. pathology of tropical and extraordinary diseases.
Vol 1. Washington DC: AFIP:1976:119. AFIP negative 71-1290-2
NEJM 1999:341:815-826
Anthrax: Inhalational
• A brief prodrome resembling a “virallike”illness, characterized by myalgia,
fatigue, fever, with or without respiratory
symptoms, followed by hypoxia and
dyspnea, often with radiographic evidence
of mediastinal widening.
• Meningitis in 50% of patients
• Rhinorrhea (rare)
Anthrax: Inhalational
• Extremely rare in United States
• (20 reported cases in last century)
• Incubation period: 1–7 days (possibly
ranging up to 42 days)
• Case fatality:
• Without antibiotic treatment—97%
• With antibiotic treatment—75%
Anthrax: Inhalational
Mediastinal widening and
pleural effusion on
Chest X-Ray in
inhalation anthrax
Anthrax: Gastrointestinal
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Abdominal distress, usually accompanied by
bloody vomiting or diarrhea, followed by fever and
signs of septicemia
Gastrointestinal illness sometimes seen as
oropharyngeal ulcerations with cervical
adenopathy and fever
Develops after ingestion of contaminated, poorly
cooked meat.
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Incubation period: 1–7 days
Case-fatality: 25–60% (role of early antibiotic treatment
is undefined)
Anthrax: Treatment
Disinfecting
• Effective sporicidal solutions
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Commercially-available bleach, 0.5% hypochlorite
(1 part household bleach to 9 parts water)
Rinse off concentrated bleach to avoid caustic
effects
Approved sporicidal agents
Incinerate infected material, and suspect material.
Brucellosis
Zoonotic infection transmitted from animals to humans by
ingestion of infected food products, direct contact with
an infected animal, or inhalation of aerosols. This last
method of transmission is remarkably efficient given
the relatively low concentration of organisms (as few
as 10-100 bacteria) needed to establish infection in
humans and has brought renewed attention to this old
disease. Its relatively long and variable incubation
period (1-8 wk), as well as the fact that many
infections are asymptomatic, has made it a less
desirable agent for weaponization.
But…
Because of the predilection to affect joints and the
vague symptoms and chronic nature of the
disease, symptoms can result in relatively longterm disability. The potential for long-lasting
infection that can disable workers in either military
or civilian circles makes Brucella species an
appealing choice for a biological weapon.
Mortality from brucellosis is rare and is usually
secondary to endocarditis (which occurs in
approximately 2% of patients). Nearly all patients
respond to appropriate antibiotic therapy, with
fewer than 10% relapsing.
Treatment
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Given the nonspecific patient complaints, a diagnosis of
brucellosis is unlikely in the ED. With an appropriate
history, an astute clinician may suspect it.
Respiratory isolation/masks usually is not necessary
unless close contact with the respiratory tract for
intubation, suctioning, or other maneuvers that may
expose the caregiver to a large concentration of
aerosolized particles.
The appropriate antibiotic therapy for brucellosis is
combination therapy with doxycycline and rifampin or
streptomycin. There is some evidence of growing
resistance to rifampin in some areas, though ciprofloxacin
and aminoglycosides maintain good coverage.
Botulism
Botulism is a muscle-paralyzing disease caused by a toxin
made by a bacterium called Clostridium botulinum.
www.visualsunlimited.com
Botulism
There are three main kinds of botulism:
Foodborne botulism occurs when a person ingests preformed toxin that leads to illness within a few hours to
days. Foodborne botulism is a public health
emergency because the contaminated food may still
be available to other persons besides the patient.
Infant botulism occurs in a small number of susceptible
infants each year who harbor C. botulinum in their
intestinal tract.
Wound botulism occurs when wounds are infected with C.
botulinum that secretes the toxin.
Botulism
Treatment
An antitoxin, available in the U.S. from the
Centers for Disease Control and Prevention,
stops progression of the disease and can prevent
onset of disease following exposure.
Vaccine
No vaccine is available for the general public. An
investigational vaccine is available for the military
and lab workers
Botulism
Symptoms
• nausea and vomiting (occurs in natural cases
when bacteria are ingested; may not appear if
purified toxin is spread on food)
• difficulty speaking, seeing, and/or swallowing
• drooping eyelids
• muscle weakness starting in the trunk and moving
to the limbs
• muscle paralysis and difficulty breathing
Plague
Plague is an infectious disease
of animals and humans
caused by a bacterium
named Yersinia pestis.
Yersinia pestis is easily
destroyed by sunlight and
drying. Even so, when
released into air, the
bacterium will survive for up
to one hour, depending on
conditions.
Plague
Pneumonic plague can be transmitted from person to
person; bubonic plague cannot. Pneumonic
plague affects the lungs and is transmitted when
a person breathes in Y. pestis particles in the air.
Bubonic plague is transmitted through the bite of
an infected flea or exposure to infected material
through a break in the skin. Symptoms include
swollen, tender lymph glands called buboes.
Buboes are not present in pneumonic plague.
Plague
When bubonic plague is left untreated, plague
bacteria invade the bloodstream. Infection of the
lungs with the plague bacterium causes the
pneumonic form of plague, a severe respiratory
illness. The infected person may experience high
fever, chills, cough, and breathing difficulty and
may expel bloody sputum. If plague patients are
not given specific antibiotic therapy, the disease
can progress rapidly to death. About 14% (1 in 7)
of all plague cases in the United States are fatal.
Plague
The typical sign of the most common form of human
plague is a swollen and very tender lymph gland,
accompanied by pain. The swollen gland is called
a "bubo." Bubonic plague should be suspected
when a person develops a swollen gland, fever,
chills, headache, and extreme exhaustion, and
has a history of possible exposure to infected
rodents, rabbits, or fleas. A person usually
becomes ill with bubonic plague 2 to 6 days after
being infected.
Plague
To prevent a high risk of death, antibiotics should be
given within 24 hours of the first symptoms. Several
types of antibiotics are effective for curing the
disease and for preventing it. Available oral
medications are a tetracycline (such as doxycycline)
or a fluoroquinolone (such as ciprofloxacin). For
injection or intravenous use, streptomycin or
gentamicin antibiotics are used. Early in the
response to a bioterrorism attack, these drugs would
be tested to determine which is most effective
against the particular weapon that was used.
Smallpox
The only known reservoir for the virus is humans; there are no
known animal or insect reservoirs or vectors. The most
frequent mode of transmission is person-to-person spread via
direct droplets onto the nasal, oral, or pharyngeal mucosal
membranes or in the alveoli of the lungs from close, face-toface contact with an infectious individual. Indirect spread
(not requiring face-to-face contact with an infectious
individual) via fine-particle aerosols or fomites has been
reported but is less common.
Smallpox
Symptoms usually begin within 12 to 14 days (range 7 to 17)
following the exposure. The initial symptoms usually
consist of high fever, malaise, fatigue, and severe
headache and backache followed by the appearance of a
maculopapular rash (eruptive stage) that progresses to
papules (1 to 2 days after appearance of rash), vesicles
(~ 4th to 5th day), pustules (by ~ 7th day), and finally scab
lesions (~ 14th day). The rash generally appears first on
the oral mucosa, face, and forearms and then spreads to
the trunk and legs. Lesions are also seen on the palms of
the hands and soles of the feet.
Smallpox
These are smallpox lesions on the skin of the trunk. This photograph
was taken in Bangladesh in 1973
Smallpox
Smallpox vaccine, a live-virus vaccine made from
vaccinia virus, is highly effective at inducing
immunity against smallpox prior to exposure. If
administered within 3 days after exposure to
smallpox virus, it may prevent disease, or
decrease the severity of disease and risk of
death. Smallpox vaccine production ceased in
the early 1980s and current supplies of
smallpox vaccine are limited.
Smallpox
No cure for smallpox exists. Historically, variola
major is fatal in about 30 percent of people
who contract it. Almost no one survives the
hemorrhagic and malignant forms of the
disease. People who recover from smallpox
usually have severe scars, especially on the
face, arms and legs. In many cases, smallpox
may lead to blindness.
Tularemia
Tularemia_Bacteria.
health.utah.gov
Tularemia
Francisella tularensis is very infectious. A small number
(10-50 or so organisms) can cause disease. If F.
tularensis were used as a weapon, the bacteria would
likely be made airborne for exposure by inhalation.
People who inhale an infectious aerosol would
generally experience severe respiratory illness,
including life-threatening pneumonia and systemic
infection, if they are not treated. The bacteria that
cause tularemia occur widely in nature and could be
isolated and grown in quantity in a laboratory,
although manufacturing an effective aerosol weapon
would require considerable sophistication.
Tularemia
People can get tularemia many different ways:
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being bitten by an infected tick, deerfly or other insect
handling infected animal carcasses
eating or drinking contaminated food or water
breathing in the bacteria, F. tularensis
Tularemia is not known to be spread from person to
person. People who have tularemia do not need to be
isolated. People who have been exposed to the
tularemia bacteria should be treated as soon as
possible. The disease can be fatal if it is not treated
with the right antibiotics.
Tularemia
Symptoms usually appear 3 to 5 days after exposure to
the bacteria, but can take as long as 14 days.
Symptoms of tularemia could include:
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sudden fever
chills
headaches
diarrhea
muscle aches
joint pain
dry cough
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progressive weakness
Tularemia
People can also catch pneumonia and develop
chest pain, bloody sputum and can have
trouble breathing and even sometimes stop
breathing.
Other symptoms of tularemia depend on how a
person was exposed to the tularemia bacteria.
These symptoms can include ulcers on the
skin or mouth, swollen and painful lymph
glands, swollen and painful eyes, and a sore
throat.
Viral Hemorrhagic Fevers
Viral hemorrhagic fevers (VHFs) refer to a
group of illnesses that are caused by
several distinct families of viruses. In
general, the term "viral hemorrhagic fever"
is used to describe a severe multisystem
syndrome (multisystem in that multiple
organ systems in the body are affected).
Viral Hemorrhagic Fevers
VHFs are caused by viruses of four distinct families:
Arenaviruses, filoviruses, bunyaviruses, and flaviviruses.
Each of these families share a number of features:
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They are all RNA viruses, and all are covered, or enveloped, in a
fatty (lipid) coating.
Their survival is dependent on an animal or insect host.
The viruses are geographically restricted to the areas where their
host species live.
Humans are not the natural reservoir for any of these viruses.
Human cases or outbreaks of hemorrhagic fevers caused by these
viruses occur sporadically and irregularly.
With a few noteworthy exceptions, there is no cure or established
drug treatment for VHFs.
Viral Hemorrhagic Fevers
Specific signs and symptoms vary by the type of VHF, but
initial signs and symptoms often include marked fever,
fatigue, dizziness, muscle aches, loss of strength, and
exhaustion. Patients with severe cases of VHF often show
signs of bleeding under the skin, in internal organs, or
from body orifices like the mouth, eyes, or ears.
However, although they may bleed from many sites around
the body, patients rarely die because of blood loss.
Severely ill patient cases may also show shock, nervous
system malfunction, coma, delirium, and seizures. Some
types of VHF are associated with renal (kidney) failure.
Viral Hemorrhagic Fevers
Treatment is supportive care.
Best measures are preventive by controlling the
rodent population and clearing areas of rodent
urine and droppings.
Presently there is one hemorrhagic fever virus that
has been identified as a potential bioterrorism
agent. These viruses are of concern because it
takes a very small amount to infect.
Resources
Division of Viral Hepatitis
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, Public
Inquiries: (404) 498-1515 / (800) 311-3435
Emergency Preparedness & Response
Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
CDC Contact Center: 800-CDC-INFO (800-232-4636) • 888-232-6348 (TTY) Director's
Emergency Operations Center (DEOC): 770-488-7100 http://www.bt.cdc.gov/
CBRNE- Brucellosis
Author: Gerald E Maloney Jr, DO, FAAEM, Senior Instructor, Department Emergency Medicine,
Case Western Reserve University School of Medicine; Consulting Staff, Department of
Emergency Medicine and Medical Toxicology, Flight Physician, Metro Life Flight, MetroHealth
Medical Center. Retrieved from eMedicine http://www.emedicine.com/emerg/topic883.htm
March 21, 2008