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Group D Bioterrorism

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12 views

Group D Bioterrorism

Uploaded by

6wwvctk8m8
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Clinical Presentation of Inhalational

Anthrax Following Bioterrorism


Exposure

Presented By: Group D


CASE

On October 19, 2001, a 56-year-old male postal worker from the Brentwood
facility in Washington, DC, presented to the emergency department. He had
been well until 3 days prior to admission, when he developed low-grade
fever, chills, cough, dyspnea on exertion, and generalized malaise. The
cough was initially productive of clear sputum until the night of admission,
when it became blood tinged. The dyspnea was progressive and
accompanied on the day of admission by a feeling of midsternal,
nonradiating, pleuritic chest tightness.
On review of systems, the patient noted myalgias, arthralgias, anorexia, and a sore
throat. There was no congestion or other nasal symptoms. The patient had a childhood
history of asthma but had been asymptomatic since adolescence. He denied any
history of smoking tobacco. His primary duties at work involved distribution of express
mail letters from the Brentwood and Baltimore–Washington–International Airport
postal centers to government agencies, including the Senate office building.

The patient's initial vital signs were temperature of 37.5°C, pulse of 110/min,
respirations of 18/min, blood pressure of 157/75 mm Hg, and oxygen saturation of 98%
in room air. The physical examination revealed a thin but otherwise healthy patient in
no apparent distress. The only abnormality on physical examination was a decrease in
breath sounds in the left lower lung base, without dullness, percussion, or egophony.
SUBJECTIVE
Chief Complaint (CC):
Patient presents with a recent onset of respiratory symptoms.

History of Present Illness (HPI):


A 56-year-old male postal worker from the Brentwood facility in Washington, DC, reports
feeling well until 3 days prior to admission, when he developed low-grade fever, chills,
cough, dyspnea on exertion, and generalized malaise. The cough initially produced clear
sputum until the night of admission, when it became blood tinged. He also experienced a
progressive dyspnea and midsternal, nonradiating, pleuritic chest tightness. Additional
symptoms include myalgias, arthralgias, anorexia, and a sore throat, with no congestion
or other nasal symptoms. The patient denies a history of smoking tobacco and notes
childhood asthma, which had been asymptomatic since adolescence.
SUBJECTIVE
History
Medical history: Childhood asthma
Family history: Not documented
Social history: Postal worker; no smoking history

Review of Systems (ROS)


General: Fever, chills
Respiratory: Cough, dyspnea
Musculoskeletal: Myalgias, arthralgias
Gastrointestinal: Anorexia, sore throat
Current Medications, Allergies: Not documented
OBJECTIVE

Vital Signs: Physical Examination:


● Temperature: 37.5°C ● Thin, healthy appearance
● Pulse: 110/min ● Decreased breath sounds in the left
lower lung base
● Respirations: 18/min
● White Blood Cell Count: 7500/μL
● Blood Pressure: 157/75 mm Hg
● Serum Chemistry: Normal (except
● Oxygen Saturation: 98% on room air elevated creatine kinase)
● Arterial Blood Gas: pH 7.45, PaCO2 27
mm Hg, PaO2 80.3 mm Hg, O2
saturation 97%
OBJECTIVE
Radiographic Findings: Laboratory Tests:
● Chest X-ray: Widened mediastinum, ● Blood Culture: Gram-positive rods
bilateral hilar masses, right pleural consistent with B anthracis
effusion, left subpulmonic effusion, right
lower lobe opacity ● Medication/Treatment History:
Ciprofloxacin, rifampin, clindamycin
● Contrast CT: Paratracheal, subcarinal, administered
hilar adenopathy, mediastinal edema,
pleural effusions, air-space disease,
peribronchial tissue thickening
ASSESSMENT
On review of systems, the 57-year-old male patient noted myalgias,
arthralgias, anorexia, and a sore throat. There was no congestion or other
nasal symptoms. He had been well until 3 days prior to admission, when he
developed low-grade fever, chills, cough, dyspnea on exertion, and
generalized malaise. The patient had a childhood history of asthma but had
been asymptomatic since adolescence. He denied any history of smoking
tobacco. Based on the patients finding, the only abnormality on his physical
examination was a decrease of breath sounds in the left lower lung base,
without dullness, percussion, or egophony. Other than that, laboratory
findings revealed a thin but otherwise healthy patient in no apparent
distress.
ASSESSMENT

Blood cultures obtained at the time of admission showed prominent


gram-positive rods on Gram stain at 11 hours, consistent with B
anthracis. The patient was given medications and was admitted to the
hospital for further therapy. On the 20th day of the patient to the
hospital, his condition became stable. Bacillus anthracis was
confirmed as the etiologic organism.
PLAN

Diagnostic tests:
Chest X-ray to evaluate for infiltrates suggestive of pneumonia.
Respiratory viral panel to identify viral pathogens.
Consider PCR testing for COVID-19 given the ongoing pandemic and respiratory
symptoms.
Complete blood count (CBC) with differential to monitor for leukocytosis.
Consider additional tests based on clinical suspicion, such as sputum culture or
Legionella urine antigen testing if indicated.
PLAN
Treatment: Follow-up:
Empiric antibiotic therapy for CAP coverage based Arrange follow-up appointment
on local resistance patterns. Consider azithromycin within 1 week for reassessment of
or doxycycline as first-line agents unless risk factors symptoms and response to
for drug-resistant pathogens are present. treatment.
Symptomatic management with antipyretics,
Educate patient on signs of
analgesics, and supportive care for viral symptoms.
worsening respiratory distress or
Monitor oxygen saturation and respiratory status.
systemic illness requiring immediate
Supplemental oxygen may be necessary if
medical attention.
hypoxemia worsens.
Advise on rest, hydration, and respiratory hygiene Consider occupational health
to prevent transmission of infection. referral for assessment of workplace
exposures and preventive measures.
PLAN
Patient education:
Disposition:
Review importance of completing
Stable for discharge with
antibiotic course as prescribed and
instructions for home care and
seeking medical attention for worsening
follow-up.
symptoms.
Advise on isolation precautions
Provide information on preventive
if COVID-19 is suspected until
measures such as hand hygiene,
test results are available.
respiratory etiquette, and influenza
vaccination.
Discuss strategies to minimize
occupational exposure to respiratory
pathogens in the workplace.
REFERENCES

https://jamanetwork.com/journals/jama/article-abstract/194408

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4921253/

Members:
Donna Pauline Asmod
Katrina Mayabason
Yvonne Louisa Cabangcala
Myglen Rubio
Kyle Nestor Yap

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