George A. Sprecace M.D.,
J.D., F.A.C.P. and Allergy Associates of New London,
WHAT YOU SHOULD KNOW!
Smallpox From Chickenpox," as published in Skin & Allergy News, December,
(Requires registration to access site - free)
Therapeutics, and Prophylaxis for Selected Biological Warfare Agents,"
as published in Skin & Allergy News, November, 2001
(Requires registration to access site - free)
What they're saying in the media:
FIRST, A FEW GENERAL RULES:
The most serious and debilitating “disease” that could result from a
terrorist attack involving biologicals or chemicals is PANIC.
This could kill and injure more people than the agents used in the attack,
and could paralyze our health care delivery mechanisms.
Panic must be avoided, by personal and societal preparation, the best of
which methods is information. Thus, this offering.
In this “new world order”, there are no longer victims, by-standers,
hostages or just plain folk. Rather, we are all soldiers - on alert
and ready to act when necessary. Get used to it.
The only guarantees in life are “death and taxes”. No, modern
science will never discover a preventative or cure for death. And
yes, there is an after-life. Prepare for it.
Whether preparing for a terrorist attack or for a final exam, be “process-oriented”,
not “outcome-oriented”. Outcomes have too many variables to hope
to be in control of. But it is our individual part of the process
on which we should make maximum effort. That approach will result
in our being much more effective in all our endeavors...and also in being
at peace with the outcome, whatever that may be.
BIOLOGICAL WARFARE AGENTS: THE “A” LIST
Not contagious; that is, not spread from person to person like a cold
or like tuberculosis. Contact with an original source is required.
Comes in cutaneous, intestinal and inhalational forms. Only the
inhalational form produces the most serious consequences, through the production
of a potent toxin.
The inhalational form, if not diagnosed and treated very early,
will produce hemorrhagic lymphadenitis, mediastinitis, meningitis, and
Two stages: early (hours to days) severe flu-like symptoms, multi-system.
The disease must be suspected, diagnosed and treated in this stage;
it also must be reported to the authorities at this stage; a second stage
of high fever, increasing shortness of breath, sweats, shock and possible
mental obtundation secondary to meningitis. A chest x-ray will likely
show a widened mediastinum due to the large and hemorrhagic lymph nodes.
Death is likely.
Early treatment includes antibiotic prophylaxis if you may have been
exposed to a source of anthrax. Definitive treatment if necessary
should be by intravenous administration of Cipro, Doxycycline, or high-dose
Penicillin. Treatment should be continued for two months, in view
of the possibility of delayed recurrence.
One on-going line of research involves a synthesized variant of the
toxin which may be able to act rapidly as an anti-toxin, and which also
is immuno-genic, meaning that it can also work to immunize against future
Highly contagious viremia, with a 12 - 14 day incubation period.
Sudden high fever, headache, backache, prostration, abdominal pain and
delirium. Then comes the rash: involving the mouth and face and spreading
centrifugally (mainly the extremities), and demonstrating various stages
of eruption at the same time in different locations, from papular (pimple)
to vesicular (water blister) to pustular and encrusted. This differs
from chicken-pox, where the illness is not as severe, where the lesions
mainly involve the torso, and where the lesions tend to be all at the same
stage at any one time.
A hemorrhagic or malignant form develops even more quickly.
Treatment is supportive, with antibiotics used only for secondary infection.
Requires strict quarantine of patient and contacts, vaccination of contacts,
and immediate notification of authorities.
Survival is likely with prompt and comprehensive support.
Operates by means of a potent toxin produced by the organism.
May be contracted food-borne, by wound infection, intestinal source
and by terrorist inhalation source.
Acts by blocking acetyl-choline, the messenger chemical at nerve endings
without which paralysis develops.
An acute and afebrile illness, developing hours to days after the exposure
and lasting weeks or months, if prompt treatment avoids prompt death
Produces a symmetric, descending flaccid paralysis beginning with the
cranial nerves (resulting in double vision, difficulty swallowing and speaking),
and soon producing paralysis of the respiratory muscles.
Differs from Guillain-Barre paralysis, that may occur after a
viral illness or after some vaccinations, which produces an ascending paralysis.
Main treatment is prompt diagnosis, support (including total assisted
ventilation if needed) and equine anti-toxin (which may produce an allergic
Antibiotics are useful only for secondary infection.
Requires prompt notification of authorities.
Treatment involves suspicion, prompt diagnosis, reporting to authorities,
and antibiotic treatment with Streptomycin, Gentamycin, Tetracycline, Doxycycline,
Cipro, or possibly a Sulfa drug.
Highly contagious, from animals (fleas) and humans (droplet spread).
Bubonic, pneumonic and septicemic varieties.
Can produce severe respiratory symptoms (shortness of breath, cough
and coughing up of blood - an important sign - and pneumonia) as well as
fever, gastro-intestinal symptoms, in addition to very painful “bubos”
- tender, swollen lymph nodes typically in the axillae and groin areas.
Chemical Warfare Agents
A RECURRING THEME HERE IS SUSPICION, PROMPT MEDICAL ACTION, AND
PROMPT NOTIFICATION OF AUTHORITIES. THIS IS WHAT IS MEANT BY ”BEING
ALERT”, AND NOT PANICKING. INDEED, OUR TOO FREQUENTLY
LIBERAL MEDIA WOULD DO WELL TO ESPOUSE THIS APPROACH OF INFORMATION
AND PROCESS-ORIENTATION, WHILE BRINGING THEIR OWN “ANXIETY”, “FEAR” AND
“PANIC”, WORDS FREQUENTLY HEARD THESE DAYS FROM SOME OF THEM, IN CHECK.
Pulmonary: (e.g., phosgene) irritates and destroys respiratory
Cyanide: blocks the release of oxygen into tissues; kills quickly.
Vesicants: (e.g., nitrogen mustard) irritates and destroys any
tissue with which it comes in contact.
Nerve gasses: act to produce excess acetylcholine at the nerve
endings, the opposite of the action of botulism toxin, but with similar
results - and very quickly. (Sarin, VX...)
Incapacitating Agents; eg. hallucinogens, riot gases (mace...)