生物因子致伤

生物毒剂炭疽杆菌,WHO提供图片InternationalTraumaandDisasterInstitute生物毒剂细菌病毒生物体毒素InternationalTraumaandDisasterInstitute生物恐怖主义使用微生物制剂或生物毒素使人、动物、或植物羅患疾病或导致死亡。InternationalTraumaandDisasterInstitute炭疽热 (细菌)瘟疫 (细菌)兔热病（hareklipdas)(细菌)天花 (病毒)出血热 (病毒)肉毒中毒Botulinum (生化毒素)恐怖主义危害最易超成的疾病:

(ClassA-CDC)InternationalTraumaandDisasterInstitute可疑生物学攻击的迹象在特定地区的非同寻常的疾病模式

悬浮微粒（烟、雾等）形式或经口吸入传播攻击速度快高致病率InternationalTraumaandDisasterInstitute生物毒剂的优势:症状隐密、难以捉摸且可与地方性疾病相似。使用生物试剂很难迅速检定。(缺乏广谱的检定剂,潜伏期长,临床症状出现晚)InternationalTraumaandDisasterInstitute生物毒素的优势:Biologicalagentssparepropertyandphysicalsurroundings.攻击者可使用抗生素或疫苗来自我保护。InternationalTraumaandDisasterInstitute生物武器的优势:

人群间的传播性

炭疽热–无

肉毒杆菌中毒–无野兔病-无瘟疫–有(高)天花–有(高)VHF–有(中等)InternationalTraumaandDisasterInstitute传播途径吸入经口经皮肤和黏膜经皮的(注射)InternationalTraumaandDisasterInstitute传播途径:

吸入浮质点源传播(固定的散播形式)线源传播(移动的散播形式)InternationalTraumaandDisasterInstitute经口传播直接:污染食物或水源间接:悬浮微粒（烟、雾）攻击后的二次污染InternationalTraumaandDisasterInstitute经皮肤感染黏膜磨损*完整的皮肤能有效预防对大多数但不是全部生物毒剂的入侵！InternationalTraumaandDisasterInstituteInfantofMediaWorker,NEJM,11/29/01InternationalTraumaandDisasterInstitute生物攻击的对策InternationalTraumaandDisasterInstitute物理防护是最重要的生物毒剂预防措施!LevelB个人防护措施(PPE)InternationalTraumaandDisasterInstitute预防限制某些生物制剂的作用抗生素疫苗InternationalTraumaandDisasterInstitute疫苗:炭疽热:有瘟疫:无兔热病:(IND)天花:有VHF:无肉毒杆菌中毒:(IND)InternationalTraumaandDisasterInstitute特定细菌毒剂的对策InternationalTraumaandDisasterInstitute炭疽热

(炭疽杆菌)潜伏期:1-6天(平均)皮肤炭疽热表现为典型的黑痂,公共卫生影像图书馆提供,CDCInternationalTraumaandDisasterInstitute携带炭疽热孢子的烟雾攻击可引起吸入性炭疽热(吸入性炭疽热是自然发病的一种罕见形式)InternationalTraumaandDisasterInstitute临床症状:发热/不适感/疲乏/咳嗽渐进性胸痛(2-3天)发病后24-72小时死亡(未经救治)InternationalTraumaandDisasterInstitute临床特征吸入性炭疽热伤员的胸片常显示异常增宽的纵隔,常伴有胸腔积液,但肺部浸润少见。InternationalTraumaandDisasterInstitute纵隔增宽,吸入性炭疽热的特征,患者病死前22小时(公共卫生影像图书馆提供,

CDC).InternationalTraumaandDisasterInstitute炭疽热:预防先锋霉素(口服)强力霉素(口服)持续抗生素应用45到60天可行的情况下在感染后0,2,4周注射疫苗InternationalTraumaandDisasterInstitute瘟疫

(鼠疫耶尔森菌)潜伏期:2-3天InternationalTraumaandDisasterInstitute瘟疫的临床分型:在自然条件下，瘟疫通过跳蚤叮咬而传播3型腹股沟腺炎原发性败血症肺炎

InternationalTraumaandDisasterInstitute临床表现:

(肺炎型瘟疫)高热/寒战/头痛/肌痛血性痰渐进性呼吸衰竭InternationalTraumaandDisasterInstitute瘟疫的预防

强力霉素(口服)目前无可用疫苗InternationalTraumaandDisasterInstitute兔热病一般形式下由于鹿虻、蚊子或扁虱的叮咬而感染三种主要临床类型:溃疡淋巴结型伤寒型肺炎型(最常见于烟雾毒剂生物攻击后)InternationalTraumaandDisasterInstitute兔热病的预防以下途径之一:先锋霉素(口服)强力霉素疫苗(研究性新药)-Pre-ExposureInternationalTraumaandDisasterInstituteResponseto

ViralAgentsInternationalTraumaandDisasterInstituteSmallPox

(Variola)Incubationperiod:7-19daysInternationalTraumaandDisasterInstituteFieldObservation…EarlystagesofSmallpoxcanbemistakenforVaricella(ChickenPox,Monkeypox,orCowpox).InternationalTraumaandDisasterInstituteInternationalTraumaandDisasterInstituteSmallpoxDiagnosis:Fullydevelopedcutaneouseruptionsofsmallpox,mostabundantontheextremitiesandface(centrifugaldistribution)AlllesionssamestageofdevelopmentInternationalTraumaandDisasterInstituteAdvancedsmallpox,courtesyofWHOInternationalTraumaandDisasterInstituteProphylaxis:SmallpoxVaccination/Revaccinationforallexposedindividualswithin3-5daysInternationalTraumaandDisasterInstituteQuarantineDropletandairborneprecautionsIsolationmustbemaintainedforaminimumof17daysfollowingexposureforallcontactsRingvaccinationofclosecontactsInternationalTraumaandDisasterInstituteViralHemorrhagicFevers

(VHF)Adiversegroupofillnessesassociatedwithfeverandableedingdiathesis.InternationalTraumaandDisasterInstituteVHFcausedby4viralfamilies:Filoviridae:e.g.,EbolaandMarburgviruses*Arenaviridae:e.g.,Lassavirus,newworldArenavirusesBunyaviradae:e.g.,Hantaviruses,CCHFFlaviviridae:e.g.,YellowFever*MostimportantVHFfamilywhenconsideringpotentialusebyterroristsInternationalTraumaandDisasterInstituteDiagnosisTravelhistoryHighindexofsuspicionSpecificvirologicdiagnosisInternationalTraumaandDisasterInstituteResponseto

BiologicalToxinsInternationalTraumaandDisasterInstituteBotulinumToxinInternationalTraumaandDisasterInstituteNaturalfood-borneoutbreakstendtooccurinsmallclusters.Highernumbersofcasesshouldraisethepossibilityofabiologicalattack.AerosolizedbotulinumtoxinIntentionalcontaminationofawidelydistributedfoodordrinkitemInternationalTraumaandDisasterInstituteFieldObservation…

BotulinumIntoxicationAfebrileProgressivesymmetrical descendingflaccidparalysisbeginning withbulbar(cranialnerve)palsiesInternationalTraumaandDisasterInstituteClinicalEffects:Symptomsusuallybeginwithcranialnervepalsies:

Ptosis(droopinguppereyelids)Diplopia(doublevision)Dysphagia(difficultyswallowing)Dysphonia(difficultyspeaking)InternationalTraumaandDisasterInstituteProphylaxis:BotulinumToxinVaccine(InvestigationalNewDrug)InternationalTraumaandDisas