253.2 📚 國考版

253.2.0.1 必背 — CDC Categories

  • Category A (highest): anthrax, smallpox, plague, botulism, tularemia, VHF
  • Category B: brucellosis, glanders, melioidosis, Q fever, ricin, etc.
  • Category C: emerging — nipah, hantavirus, MDR-TB

253.2.0.2 必背 — Anthrax

  • Bacillus anthracis; spores; multiple toxins
  • Cutaneous (95% natural): painless black eschar
  • Inhalational (bioterror main): biphasic + widened mediastinum on CXR/CT + mediastinitis + meningitis (45%+ mortality with Tx)
  • Treatment: ciprofloxacin or doxycycline + 1-2 more × 60 days; antitoxin (raxibacumab, obiltoxaximab)
  • Vaccine: BioThrax (military + post-exposure)
  • 2001 letter attacks highlighted

253.2.0.3 必背 — Smallpox

  • Eradicated 1980 (last natural case Somalia 1977)
  • Stockpiles CDC + Russia
  • Synchronous lesion progression + centrifugal
  • Vaccines: ACAM2000 (live) + JYNNEOS (MVA-BN safer immunocompromise)
  • Tecovirimat (TPOXX) for treatment

253.2.0.4 必背 — Plague

  • Yersinia pestis; bipolar “safety pin”
  • 3 forms: bubonic (LAP), septicemic (sepsis), pneumonic (bioterror; person-to-person)
  • Pneumonic mortality 95%+ untreated
  • Treatment: streptomycin or gentamicin IM/IV; doxy / cipro alternative; 10 days
  • PEP: doxy or cipro × 7-10 d for contacts
  • Isolation pneumonic plague

253.2.0.5 必背 — Botulism

  • Clostridium botulinum toxin
  • Most potent biological toxin known
  • Descending flaccid paralysis + 4 D’s
  • BAT (Botulinum Antitoxin) ASAP + supportive ventilation
  • BabyBIG infants

253.2.0.6 必背 — Tularemia

  • Francisella tularensis; highly infectious
  • Pneumonic form for bioterror
  • Streptomycin or gentamicin IM/IV × 10 d
  • PEP: doxy or cipro × 14 d

253.2.0.7 必背 — VHF Bioterror

  • Ebola + Marburg + Lassa + Junín
  • Severe + multi-organ + hemorrhage
  • Supportive primarily
  • Ribavirin (Lassa); mAbs (Ebola)
  • Vaccines (Ervebo for Ebola)

253.2.0.8 必背 — Bioterror Recognition

  • Unusual disease in unusual location
  • Cluster of similar cases short timeframe
  • Common exposure
  • Multiple casualties without natural cause
  • Unusual route (inhalational, pneumonic)

253.2.0.9 必背 — Response

  • Recognition → notification (public health + CDC) → isolation → PPE → BSL-3+ specimens → empirical Tx → vaccination/PEP → decontamination → mass casualty + forensic