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File: 123096_sep96_decls23_0046.txt
Subject: DIAGNOSIS AND TREATMENT OF DISEASES OF IMPORTANCE
Unit: OTSG
Parent Organization: HSC
Box ID: BX003203
Folder Title: DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS
Document Number: 1
Folder Seq #: 88
would involve much smaller numbers of individuals, and would more likely be accompanied
Given current and projected vaccine stocks, three or more vaccine doses (0, 2, and 12 by pulmonmy infiltrates.
weeks, then I year if possible, by @e subcutaneous inj@tion) are recommended only to The dyspnm of botulism is associated with obvious signs of muscular paralysis; its
selected individuals or groups judged at high risk for exposure to botulinum toxin aerosols. cholinergic blocking effects result in a dry respiratory trm, and patients are afebfile.
Given projected antitoxin stocks and absence of ph@acokinctic data for human and Inhalation of nerve agent may lead to weakness, dyspnm, and copious secretions. The early
despeciated equine products, there is no indication at present for use of antitoxin as a clinical manifestations of inhalation authors, tularemia, or plague may be similar to those of
generally available prophylactic mortality. SEB. However, rapid progression of respiratory signs and symptoms to a stable state
distinguished SEB intoxication. Mustard exposure would have ranked vesication of the skin
in addition to the pulmonary injury (Smtion IV).
Laboratory Diagnosis: Toxin is cleared from the serum rapidly and is
difficult to detect by the time of symptom onset. Nevertheless, specific laboratory tests are
STAPIIYLOCOCCAL ENTEROTOXIN B available to detect SEB (@ Section 111), and @mm should be collected as early as possible
after exposure. In situations where many individuals me symptomatic, sem should be
A. CLINICAL SYNDRONIE obtained from those not yet showing evidence of clinical disease. Most patients develop a
significant antibody response, but this may require 2-4 weeks.
Staphylmmcal enterotoxin B (SEB) is one of several exotoxins produced by C. THERAPY
Staphylococcus aureus, causing food poisoning when ingested.
A biological warfare attack with aerosol delivery of SEB to the respiratory tmct
produces a distinct syndrome causing significant morbidity and potential mortality. Treatment is limited to supportive care.
Clinical Features: The disease begins 1-6 hours after exposure with the sudden onset D. PROPHYLAXIS
tion
dyspn@ and retrostemal chest pain may also be present. Fever, which may reach 103- 106'
F, has ]@ted 2-5 days, but cough may persist 1-4 weeks. In many patients, nausea, which has protected monkeys, but no vaccine is presently available for human use.
may be s(Evere, vomiting, and diarrhea will also occur. Physical findings are often
unremarkable. Conjunctival injection may be present, and in the most severe cases, signs of
pulmonary edema would be expected. The chest X ray is generally normal, but in severe
cases, there will be increased interstitial markings, atel@tasis, and possibly overt pulmonary
edema. In moderately severe laboratory exposures, lost duty time has been < 2 weeks, but, CLOSTRIDILJM PERFRINGENS
based upon mimal data, it is anticipated that severe exposures will result in fatalities.
B. DIAGNOSIS A. CLINICAL SYNDROME
1. Routine Laboratory Findings: Laboratory findings are noncontributory except for Clostridium 1&rfrinpens is a common anaerobic bacterium associated with three
a neutrophilic leukmytosis and elevated erythrocyte sedimentation rate. distinct disease syndromes: (a) go gangrene or clostridial myon@rosis, lb) enteritis
n@roti@s (pig-bel), (el clostfidial food poisoning. Each of these syndromes has very
g inocula of C pgrfringes to specific sites to induce
involvement are not seen, and gastrointestinal symptoms are prominent. disease, and it is difficult to envision a general scenario in which the spores or vegetative
The nonspecific findings of fever, nonproductive cough, myalgia, and headache organisms could be used as a biowarfue agent. There are, however, at least 12 protein
occurring in large numbers of patients in " epidemic setting would suggest any of several toxins elaborated, and one or more of these could be produced, concentrated, and used as a
infectious respiratory pathogens, particularly influenn, adenovims, or mycoplasm in a weapon. Waterbome disease is conceivable, but unlikely. 'ne best available speculation
a. (1. Dased on virtually no exploratory data with which to sharpen our conclusions) is that the
single biological warfare attack with SEB, cases would likely have their onset within a single alpha toxin would be lethal by aerosol. This is a well-chmcterized, highly toxic
day, while these other, naturally occurring, outbreaks would present over a more prolonged
interval. Naturally occurring outbreaks of Q fever and tularemia might cause confusion, but
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Document 52 f:/Week-36/BX003203/DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS/diagnosis and treatment of diseases of importanc:12179609281524
Control Fields 17
File Room = sep96_declassified
File Cabinet = Week-36
Box ID = BX003203
Unit = OTSG
Parent Organization = HSC
Folder Title = DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS
Folder Seq # = 88
Subject = DIAGNOSIS AND TREATMENT OF DISEASES OF IMPORTANC
Document Seq # = 1
Document Date =
Scan Date =
Queued for Declassification = 01-JAN-1980
Short Term Referral = 01-JAN-1980
Long Term Referral = 01-JAN-1980
Permanent Referral = 01-JAN-1980
Non-Health Related Document = 01-JAN-1980
Declassified = 17-DEC-1996