1.

Anthrax
Anthrax disease is a severe illness caused by bacteria named Bacillus anthracis. Anthrax
disease can result in pneumonia, blood infection, and death.
Most of the time anthrax bacteria live in an inactive form called spores. Inactive anthrax
spores live naturally in soil and can be carried in the wool or on the skin of animalsusually cows, sheep, or goats. A hard coating helps the spores survive heat, drying, and
radiation for long periods of time.
People can touch, eat, or breathe in anthrax spores. When this happens, the anthrax
spores enter the human body and can turn into active bacteria. This is called exposure to
anthrax. Not everybody who is exposed to anthrax will get sick. But many will, and as
anthrax bacteria multiply inside the body, they can cause very serious illness.
Clinical Manifestations
There are four common routes of anthrax infection, each with different signs and
symptoms. In most cases, symptoms develop within seven days of exposure to the
bacteria. The one exception is inhalation anthrax, which may take weeks after exposure
before symptoms appear.

Cutaneous anthrax
A cutaneous anthrax infection enters your body through a cut or other sore on your skin.
It's by far the most common route the disease takes. It's also the mildest with
appropriate treatment, cutaneous anthrax is seldom fatal. Signs and symptoms of
cutaneous anthrax include:

A raised, itchy bump resembling an insect bite that quickly develops into a
painless sore with a black center
Swelling in the sore and nearby lymph glands

Gastrointestinal anthrax
This form of anthrax infection begins by eating undercooked meat from an infected
animal. Signs and symptoms include:

Nausea
Vomiting
Abdominal pain
Headache
Loss of appetite
Fever
Severe, bloody diarrhea in the later stages of the disease
Sore throat and difficulty swallowing
Swollen neck

Inhalation (pulmonary) anthrax

Inhalation anthrax develops when you breathe in anthrax spores. It's the most deadly way
to contract the disease, and even with treatment it is often fatal. Initial signs and
symptoms of inhalation anthrax include:

Flu-like symptoms, such as sore throat, mild fever, fatigue and muscle aches,
which may last a few hours or days
Mild chest discomfort
Shortness of breath
Nausea
Coughing up blood
Painful swallowing

As the disease progresses, you may experience:

High fever
Trouble breathing
Shock
Meningitis a potentially life-threatening inflammation of the brain and spinal
cord

Injection anthrax
This is the most recently identified route of anthrax infection. It's contracted through
injecting illegal drugs and has been reported only in Europe so far. Initial signs and
symptoms of injection anthrax include:

Redness at the area of injection (without an area that changes to black)

Significant swelling

As the disease progresses, you may experience:

Shock
Multiple organ failure
Meningitis

Medical Management
Doctors have several options for treating patients with anthrax, including antibiotics and
antitoxin. Patients with serious cases of anthrax will need to be hospitalized. They may
require aggressive treatment, such as continuous fluid drainage and help breathing
through mechanical ventilation.

Antibiotics
All types of anthrax infection can be treated with antibiotics, including intravenous
antibiotics (medicine given through the vein). If someone has symptoms of anthrax,
its important to get medical care as quickly as possible to have the best chances of a
full recovery. Doctors will select antibiotics that are best for treating anthrax and that
are best for the patient based on their medical history.

Antitoxin
When anthrax spores get inside the body, they can be activated. When they become
active, anthrax bacteria can multiply, spread out in the body, and produce toxinsor
poisons. Anthrax toxins in the body cause severe illness.
After anthrax toxins have been released in the body, one possible treatment is
antitoxin. Antitoxins target anthrax toxins in the body. Doctors must use antitoxin
together with other treatment options.
Currently, there are a few types of antitoxins that can be used for treating anthrax.
Nursing Interventions
1. Monitor vital signs and hemodynamic parameters closely for circulatory collapse.
2. Monitor temperature for response to antibiotic therapy.

3. Auscultate chest for crackles, indicating need for better secretion mobilization.
4. Monitor oxygen saturation and arterial blood gases periodically to determine
oxygenation status and acid-base balance.
5. Monitor level of consciousness and for meningeal signs such as nuchial rigidity.
6. Provide supplemental oxygen or mechanical ventilation, as needed.
7. Position for maximum chest expansion and reposition frequently to mobilize
secretions.
8. Suction frequently and provide chest physiotherapy to clear airways, prevent
atelectasis, and maximize oxygen therapy.
9. Administer I.V. fluids to encourage oral fluid intake to replace the fluid lost through
hyperthermia and tachypnea.
10. For G.I. anthrax, maintain G.I decompression, monitor emesis and liquid stool
output, and medicate for abdominal pain, as needed.
11. Advice the patient and family that anthrax is not transmitted person to person; one
must come in contact with the spores to contact infection.

2. Hemmorhagic fever viruses

Viral hemorrhagic fevers (VHFs) are a group of illnesses caused by four families of
viruses. These include the Ebola and Marburg, Lassa fever, and yellow fever viruses.
VHFs have common features: they affect many organs, they damage the blood vessels,
and they affect the body's ability to regulate itself. Some VHFs cause mild disease, but
some, like Ebola or Marburg, cause severe disease and death.
Clinical Manifestations
Signs and symptoms typically begin abruptly within five to 10 days of infection with
Ebola or Marburg virus. Early signs and symptoms include:

Fever
Severe headache
Joint and muscle aches
Chills
Weakness

Over time, symptoms become increasingly severe and may include:

Nausea and vomiting

Diarrhea (may be bloody)
Red eyes
Raised rash
Chest pain and cough
Stomach pain
Severe weight loss
Bleeding, usually from the eyes, and bruising (people near death may bleed from
other orifices, such as ears, nose and rectum)
Internal bleeding

Medical Management
Medications
While no specific treatment exists for most viral hemorrhagic fevers, the antiviral drug
ribavirin (Rebetol,Virazole, others) may help shorten the course of some infections and
prevent complications in some cases.

 Therapy
Supportive care is essential. To prevent dehydration, you may need fluids to help
maintain your balance of electrolytes minerals that are critical to nerve and muscle
function.

Surgical and other procedures

Some people may benefit from kidney dialysis, an artificial way of removing wastes
from your blood when your kidneys fail.

How are patients with viral hemorrhagic fever treated?

Patients receive supportive therapy, but generally speaking, there is no other treatment or
established cure for VHFs. Ribavirin, an anti-viral drug, has been effective in treating
some individuals with Lassa fever or HFRS. Treatment with convalescent-phase plasma
has been used with success in some patients with Argentine hemorrhagic fever.

3. Botulism
Botulism is a rare but serious condition caused by toxins from bacteria called
Clostridium botulinum.
Three common forms of botulism are:

Foodborne botulism. The harmful bacteria thrive and produce the toxin in
environments with little oxygen, such as in canned food.
Wound botulism. If these bacteria get into a cut, they can cause a dangerous
infection that produces the toxin.
Infant botulism. This most common form of botulism begins after Clostridium
botulinum bacterial spores grow in a baby's intestinal tract. It typically occurs
between the ages of 2 months and 8 months.

All types of botulism can be fatal and are considered medical emergencies.
Clinical Manifestations
Foodborne botulism
Signs and symptoms of foodborne botulism typically begin between 12 and 36 hours
after the toxin gets into your body. But, the start of symptoms can range from a few hours
to several days, depending on the amount of toxin ingested. Signs and symptoms of
foodborne botulism include:

Difficulty swallowing or speaking

Dry mouth
Facial weakness on both sides of the face
Blurred or double vision
Drooping eyelids
Trouble breathing
Nausea, vomiting and abdominal cramps
Paralysis

Wound botulism

Most people who develop wound botulism inject drugs several times a day, so it's
difficult to know for sure how long it takes for signs and symptoms to develop after the
toxin enters the body. Wound botulism signs and symptoms include:

Difficulty swallowing or speaking

Facial weakness on both sides of the face
Blurred or double vision
Drooping eyelids
Trouble breathing
Paralysis

Infant botulism
If infant botulism is related to food, such as honey, problems generally begin within 18 to
36 hours after the toxin enters the baby's body. Signs and symptoms include:

Constipation (often the first sign)

Floppy movements due to muscle weakness and trouble controlling the head
Weak cry
Irritability
Drooling
Drooping eyelids
Tiredness
Difficulty sucking or feeding
Paralysis

Certain signs and symptoms usually don't occur with botulism. For example, botulism
doesn't generally increase blood pressure or heart rate, or cause fever or confusion.
However, sometimes, wound botulism may cause fever.
Medical Management
For cases of foodborne botulism, doctors sometimes clear out the digestive system by
inducing vomiting and giving medications to induce bowel movements. If you have
botulism in a wound, a doctor may need to remove infected tissue surgically.

Antitoxin
If you're diagnosed early with foodborne or wound botulism, injected antitoxin reduces
the risk of complications. The antitoxin attaches itself to toxin that's still circulating in
your bloodstream and keeps it from harming your nerves.
The antitoxin cannot, however, reverse the damage that's been done. Fortunately, nerves
do regenerate. Many people recover fully, but it may take months and extended
rehabilitation therapy.
A different type of antitoxin, known as botulism immune globulin, is used to treat
infants.

Antibiotics
Antibiotics are recommended for the treatment of wound botulism. However, these
medications are not advised for other types of botulism because they can hasten the
release of the toxins.

Breathing assistance
If you're having trouble breathing, you will probably need a mechanical ventilator for up
to several weeks as the effects of the toxin gradually lessen. The ventilator forces air into
your lungs through a tube inserted in your airway through your nose or mouth.

 Rehabilitation
As you recover, you may also need therapy to improve your speech, swallowing and
other functions affected by the disease.

Nursing Interventions
1. If you suspect the patient ate contaminated food, obtain a careful history of his food
intake for the past several days.
2. If the patient ate the food within several hours, induce vomiting, begin gastric
lavage, and give a high enema to purge any unabsorbed toxins from the bowel.
3. If clinical signs of botulism appear, have the patient admitted to the intensive care
unit.
4.

Before giving anti-toxin, obtain an accurate patient history of allergies.

5. If the patient has difficulty in swallowing, initiate nasogastric tube feedings or TPN
as ordered.
6.

Suction the patient as needed.

7.

Administer I.V. fluids as ordered.

8.

Turn the patient often and encourage deep breathing exercises.

9.

Position the patient in proper alignment and assist with range-of-motion exercises.

10. Observe the patient carefully for abnormal neurologic signs.

11. Monitor intake and output.
12. If the patient has difficulty speaking, try to anticipate his needs. Assure him that this
symptom will pass and establish an alternative method of communication.

4. Smallpox
Smallpox is a contagious, disfiguring and often deadly disease that has affected humans
for thousands of years. Naturally occurring smallpox was eradicated worldwide by 1980
the result of an unprecedented global immunization campaign.
Samples of smallpox virus have been kept for research purposes. This has led to concerns
that smallpox could someday be used as a biological warfare agent.
No cure or treatment for smallpox exists. A vaccine can prevent smallpox, but the risk of
the vaccine's side effects is too high to justify routine vaccination for people at low risk
of exposure to the smallpox virus.
Clinical Manifestations

The first symptoms of smallpox usually appear 12 to 14 days after you're infected.
During the incubation period of seven to 17 days, you look and feel healthy and can't
infect others.
Following the incubation period, a sudden onset of flu-like signs and symptoms occurs.
These include:

Fever
Overall discomfort
Headache
Severe fatigue
Severe back pain
Vomiting, possibly

A few days later, flat, red spots appear first on your face, hands and forearms, and later
on your trunk. Within a day or two, many of these lesions turn into small blisters filled
with clear fluid, which then turns into pus. Scabs begin to form eight to nine days later
and eventually fall off, leaving deep, pitted scars.
Lesions also develop in the mucous membranes of your nose and mouth and quickly turn
into sores that break open.
Medical Management
No cure for smallpox exists. In the event of an infection, treatment would focus on
relieving symptoms and keeping the person from becoming dehydrated. Antibiotics
might be prescribed if the person also develops a bacterial infection in the lungs or on the
skin.
Nursing Interventions
1) Antitoxin should be given.
2) Penicillin is effective against tetanus micro-organism.
3) Wound should be cleaned thoroughly.
4) Antibiotics should be given to prevent infection of wound.
5) Sterilization of all contaminated hospital supplies.
6) Place the child in dark quiet room.
7) Avoid any stimulation which may cause spasm.
8) A combination of muscle relaxant, sedative and tranquilizer to control tetanospasm.
9) Tracheostomy may be necessary if laryngospasm occur.
10-I.V fluid ,oxygen ,respirator for respiratory failure. Suction ,indwelling
catheter may be necessary.

5. Brucellosis
Brucellosis is a bacterial infection that spreads from animals to people most often via
unpasteurized milk, cheese and other dairy products. More rarely, the bacteria that cause
brucellosis can spread through the air or through direct contact with infected animals.
Brucellosis symptoms may include fever, joint pain and fatigue. The infection can
usually be treated successfully with antibiotics. Treatment takes several weeks to months,
however, and relapses are common.
While brucellosis is uncommon in the United States, the disease affects hundreds of
thousands of people and animals worldwide. Avoiding unpasteurized dairy products and
taking precautions when working with animals or in a laboratory can help prevent
brucellosis.
Clinical Manifestations

Symptoms of brucellosis may show up anytime from a few days to a few months after
you're infected. Signs and symptoms are similar to those of the flu and include:

Fever
Chills
Sweats
Weakness
Fatigue
Joint, muscle and back pain
Headache

Brucellosis symptoms may disappear for weeks or months and then return. In some
people, brucellosis becomes chronic, with symptoms persisting for years, even after
treatment. Long-term signs and symptoms include fatigue, fevers, arthritis and
spondylitis an inflammatory arthritis that affects the spine and adjacent joints.
Medical Management
Treatment for brucellosis aims to relieve symptoms, prevent a relapse of the disease and
avoid complications. You'll need to take antibiotics for at least six weeks, and your
symptoms may not go away completely for several months. The disease can also return
and may become chronic.

6. Q Fever
Q fever is an infection caused by the bacterium Coxiella burnetii. Q fever is usually a
mild disease with flu-like symptoms. Many people have no symptoms at all. In a small
percentage of people, the infection can resurface years later. This more deadly form of Q
fever can damage your heart, liver, brain and lungs.
Q fever is transmitted to humans by animals, most commonly sheep, goats and cattle.
When you inhale barnyard dust particles contaminated by infected animals, you may
become infected. High-risk occupations include farming, veterinary medicine and animal
research.
Mild cases of Q fever clear up quickly with antibiotic treatment. But if Q fever recurs,
you may need to take antibiotics for at least 18 months.
Clinical Manifestations
Many people infected with Q fever never show symptoms. If you do have symptoms,
you'll probably notice them between three and 30 days after exposure to the bacteria.
Signs and symptoms may include:

High fever, up to 105 F (41 C)

Severe headache
Fatigue
Cough
Nausea
Diarrhea
Sensitivity to light

Medical Management

Q fever is treated with the antibiotic doxycycline. How long you take the medicine
depends on whether or not you have acute or chronic Q fever. For acute infections,
antibiotic treatment lasts two to three weeks.
People who have chronic Q fever usually must take a combination of antibiotics for at
least 18 months. Even after successful chronic Q fever treatment, you'll need to go back
for follow-up tests for years in case the infection returns.
Mild or nonsymptomatic cases of acute Q fever often get better on their own with no
treatment. However, if you have symptoms of Q fever, antibiotic treatment is
recommended.
If you have Q fever endocarditis, you may need surgery to replace damaged heart valves.

7. Tularemia
Tularemia is a rare infectious disease that typically attacks the skin, eyes, lymph nodes
and lungs. Tularemia also called rabbit fever or deer fly fever is caused by the
bacterium Francisella tularensis.
The disease mainly affects mammals, especially rodents, rabbits and hares, although it
can also infect birds, sheep, and domestic animals, such as dogs, cats and hamsters.
Tularemia spreads to humans through several routes, including insect bites and direct
exposure to an infected animal. Highly contagious and potentially fatal, tularemia usually
can be treated effectively with specific antibiotics if diagnosed early.
Clinical Manifestations
Most people exposed to tularemia who become sick generally do so within three to five
days, although it can take as long as 14 days. Several types of tularemia exist, and which
type you get depends on how and where the bacteria enter the body. Each type of
tularemia has its own set of symptoms.

Ulceroglandular tularemia
This is the most common form of the disease. Signs and symptoms include:

A skin ulcer that forms at the site of infection usually an insect or animal bite
Swollen and painful lymph glands
Fever
Chills
Headache
Exhaustion

Glandular tularemia
People with glandular tularemia have the same signs and symptoms of ulceroglandular
tularemia, but without skin ulcers.

Oculoglandular tularemia
This form affects the eyes and may cause:

Eye pain
Eye redness
Eye swelling and discharge
An ulcer on the inside of the eyelid
Sensitivity to light

 Oropharyngeal tularemia
Usually caused by eating poorly cooked wild animal meat or drinking contaminated
water, this form affects the mouth, throat and digestive tract. Signs and symptoms
include:

Fever
Throat pain
Mouth ulcers
Vomiting
Diarrhea
Inflamed tonsils
Swollen lymph nodes in the neck

Pneumonic tularemia
This type of tularemia causes signs and symptoms typical of pneumonia:

Dry cough
Chest pain
Difficulty breathing

Other forms of tularemia also can spread to the lungs.

Typhoidal tularemia
This rare and serious form of the disease usually causes:

High fever
Extreme exhaustion
Vomiting and diarrhea
Enlarged spleen (splenomegaly)
Enlarged liver (hepatomegaly)
Pneumonia

Medical Management
Tularemia can be effectively treated with antibiotics such as streptomycin or gentamicin,
which are given by injection directly into a muscle or vein. Depending on the type of
tularemia being treated, doctors may prescribe oral antibiotics such as doxycycline
(Oracea, Vibramycin, others) instead.
You'll also receive therapy for any complications such as meningitis or pneumonia. In
general, you should be immune to tularemia after recovering from the disease, but some
people may experience a recurrence or reinfection.