Biological Warfare Defence Medical Guidelines

File: doc61_06.txt
Page: 06
Total Pages: 8
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   P~GE C)5 RHIP~~~\\\\
   ~n~~~~sYR~TIoNsffi  PponUCTioN OF ~~~CCINE H~S BEEN INCRE~SE~ ~Nn
   V\ILL BE SUFFICIENT FOR THE ENTIRE FORCE BY t~1~Y ~~~1
         B.  O~   BOTULISM
   BOTULISM IS ~ LIFE THRE~TENING,    P~R~LYTIC ILLNESS PRODUCEfl BY
   NEUROTOXIN EL~BOR~TE~ BY CLOSTRInIUM BOTULINUM        THE N~TUR~L
   DISE~SE IS PRIM~RILY FROM FOOn POISONING ~LTHOUGH \AOUNn BOTULISM
   ~ND INF~NT BOTULISM no OCCUR.     THE TOXIN RELE~SED BY THE
   B~CTERI~ DURING GRO\4TH H~S EIGHT IMMUNOLOGIC~LLY DISTINCT TOXIN
   TYPES ~ND ~ GIVEN B~CTERI~L STR~IN PROnUCES ONLY ~ SINGLE TOXIN
   T'?PE.   THE ~OXINS INTERFERE NITH NEUROTR~NSMISc.ION ~T PERIPHER~L
   CHOLINERGIC SYll~PSES BY BINDING TIGHTLY TO THE PRESYN~PTIC
   MEMBR~N~ ~ND PREVENTING THE RELE~SE OF THE NEUROTR~NSMITTER
   ~CETYLCHOLINE.     THE SYMPTOMS ~RE THEREFORE THOSE OF ~TROPINE
   PbISONING H~ND EX~CTLY THE OPPOSITE OF CHEMIC~L NERVE H~'GENT
   POISONING.    PH~R~LYS IS IS ~ SYMMETR I C~L DESCENDING  FL~CC In
   P~R~LYSIS ~ND OCCURS QUICF::LY ~FTER INH~L~TION (3 - 48 HOURS
   POST-EXPOSURE).
         THE INTERRUPTION OF CHOLINERGIC ~UTONOMIC TR~NSMISSION RESULTS
  - IN- DIMINISHED S~LIV~TION ~ND EXTREME DRYNESS OF THE MOUTH,
   TONGUE, ~ND PH~RYNX, NHICH IS UNRELIEVED BY DRINrING FLUInS. THE

)


   P~GE 06 RHIP~~~\\\\ -
   DRYNESS M~Y BE QUITE P~INFUL ~ND C~USE THE P~TIENT TO COMPL~IN
   OF    SORE *THRO~T~~. ILEUS, CONSTIP~TION1 ~ND URIN~RY RETENTION
   C~N RESULT.    ~ CONSTELL~TION OF SIGNS SUGGEST THE DI~GNOSIS:     t)
   UNEX PL~ I NED POSTU~~L HYPOTENTI ON; 2) nI L~TED  UNRE~CT I VE PUPILS;
   3) DRY MUCOUS MEMBR~NES; 4) nESCENnING P~R~LYSIS NITH
   PROGRESSIVE RESPIR~TORY NE4~NESS; ~ND 5) THE ~BSENCE OF FEVER.


   * -   TRE~TMENT OF PRECIPITOUS RESPIR~TORY F~ILURE NITH E~RLY
   ELECTIVE TR~CHEOSTOMY ~ND THE USE OF VENTIL~TORY ~SSIST~NCE C~N
   BE LIFE-S~VING.     IF ILEUS IS PROFOUND, N~SOG~STRIC SUCTION ~ND
   P~RENTER~L NUTRITION M~Y BE NECESS~RY.      URIN~RY RETENTION NILL
   REQUIRE INDNELLING BL~DDER C~THETERI~~TION.       FEVER SIGNIFIES ~
   COMPLIC~TING NOSOCOMI~L B~CTERI~L INFECTION.       ~NTITOXIN THER~PY
   IS RECOMMENDED ~LTHOUGH ~NTITOXIN IS IN SHORT SUPPLY ~ND SHOULD
   BE ~DMINISTERED ~S SOON ~S POSSIBLE ~FTER SPECIMENS FOR
   L~BOR~TORY STUDY ~RE OBT~INED.     ~NTITOXIN M~Y BE BENEFICI~L EVEN
  - Ifl DEL4YED.  THE HEPT~V~LENT ~NTITOXIN IS OF EQUINE ORIGIN ~ND
   UP TO 2C) PERCENT OF THE P~TIENTS H~VE UNTON~RD RE~CTIONS.
   BT    -  -


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