Chapter 30: Agents of Bioterror and Forensic Microbiology. Answers Explained

MULTIPLE CHOICE 1. What is bioterrorism? a. The use of bacteria, viruses, fungi, or toxins to injure people, animals, or crops to cause civil unrest b. The use of synthetic biological substances to kill innocent pe ...

MULTIPLE CHOICE 1. What is bioterrorism? a. The use of bacteria, viruses, fungi, or toxins to injure people, animals, or crops to cause civil unrest b. The use of synthetic biological substances to kill innocent people c. The use of biological substances to kill, maim, or injure as many people as possible d. The use of biohazardous substances to cause chaos A Bioterrorism is the use of bacteria, viruses, fungi, or toxins to injure people, animals, or crops to cause civil or economic unrest. REF: 728 OBJ: Level 1: Recall 2. Who will be most likely to suspect a covert bioterrorism attack? a. Firefighters and the police b. Microbiologists and physicians c. The public health department d. Centers for Disease Control and Prevention (CDC) and Homeland Security B A covert event poses more of a challenge to public health interests. Clinical microbiologists and physicians will most likely be the first to suspect the attack. REF: 728 OBJ: Level 2: Interpretation 3. What document prohibits the use of biological agents during war? a. Geneva Protocol b. Treaty of Versailles c. Antiproliferation Pact d. Law of Armed Conflict A Despite a Geneva Protocol prohibiting the use of biological agents during war signed by many nations, a number of countries began biological warfare research programs in the 1920s. REF: 728 OBJ: Level 1: Recall 4. What classification system was developed in 1999 by academic infectious disease experts, government officials, military intelligence experts, and law enforcement officials? a. Biosafety levels b. High, moderate, and low categories c. A, B, C categories d. Normal, increased, and high categories C In 1999, academic infectious disease experts, national public health experts, Department of Health and Human Services agency representatives, civilian and military intelligence experts, and law enforcement officials met to comment on the threat potential of infectious agents to civilian populations. As a result, agents were placed into one of three categories—A, B, or C—for initial public health preparedness efforts. REF: 729 OBJ: Level 1: Recall 5. What category of bioterrorism agents would have the greatest impact? a. Category A b. Category B c. Category C d. Category D A Category A agents (or Biothreat Level A) would have the greatest impact, whereas categories B and C would have less impact. Although Bacillus anthracis is considered a biosafety level 2 (BSL-2) in clinical laboratories, it is a category A agent in regard to a bioterror threat. REF: 730 OBJ: Level 1: Recall 6. How can biological weapons enter the host? a. Through the respiratory tract b. Through the gastrointestinal (GI) tract c. Through the mucous membranes d. All of the above D Biological weapons can enter the host via the respiratory tract, GI tract, and through the skin and mucous membranes. Dispensing bioterror agents in food or water may not be efficient because of the dilution of the agents. REF: 731 OBJ: Level 2: Interpretation 7. One of the first recorded terror attacks occurred in 1984 in a restaurant in The Dalles, Oregon. What organism was used in this attack? a. Salmonella b. Escherichia coli c. Clostridium d. Staphylococcus A In 1984, the followers of Bhagwan Shree Rajneesh used Salmonella as a weapon to help influence election results in The Dalles, Oregon. By spraying liquid-based Salmonella culture into salad bars in restaurants, these followers caused 750 people to develop culture-positive salmonellosis. REF: 728 OBJ: Level 1: Recall 8. What federal regulation establishes the rules of possession, use, and transfer of select agents and toxins? a. Public Health Security and Bioterrorism Preparedness and Response Act of 2002 b. 42 CFR 73 c. Animal Health and Inspection Act d. Infectious Agent Act B In the 1990s, an individual was arrested in Ohio and in Nevada while carrying Yersinia pestis and anthrax spores in his car. Ironically, ordering and possessing these potential weapons did not necessarily constitute a crime. These cases identified gaps in the law and helped define the need for stricter laws, such as the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 and the recently enacted 42 CFR 73, Possession, Use and Transfer of Select Agents and Toxins; Final Rule (March 2005). REF: 728 OBJ: Level 1: Recall 9. All the following organizations established the Laboratory Response Network except: a. United States Army Medical Research Institute for Infectious Diseases (USAMRIID). b. Centers for Disease Control and Prevention (CDC). c. Central Intelligence Agency (CIA). d. Federal Bureau of Investigation (FBI). C In an effort to increase responsiveness and to create a nationwide ability to rapidly detect the covert or overt deployment of biological weapons in the United States and its territories, the CDC, the Association of Public Health Laboratories (APHL), the FBI, and USAMRIID established the Laboratory Response Network (LRN) in 1999; later that year, most states and territories were implementing training for the detection of biological attacks using standardized LRN protocols. REF: 731 OBJ: Level 1: Recall 10. Which of these are designated as sentinel hospitals in the Laboratory Response Network (LRN)? a. Centers for Disease Control and Prevention (CDC) b. Reference laboratories c. State public health laboratories d. Community hospitals with microbiology laboratories D As defined by the LRN, community hospitals with microbiology capabilities are designated as sentinel (formerly level A) LRN laboratories. Sentinel laboratories must have a biosafety level 2 (BSL-2) facility and the laboratory protocols published on the CDC and American Society for Microbiology (ASM) Web sites to rule out the presence of biological agents. REF: 731 OBJ: Level 1: Recall 11. What is the role of the sentinel laboratory? a. To rule out or refer suspicious isolates b. To identify suspicious isolates c. To act as a reference laboratory for physician office laboratories d. None of the above A The role of a sentinel laboratory is to rule out or refer suspicious isolates, not to identify. Because sentinel laboratories will refer isolates to a regional reference laboratory, clinical laboratory scientists must be aware of the strict requirements for shipping and transporting infectious agents. REF: 731 OBJ: Level 1: Recall 12. What type of anthrax is most deadly and most likely to be seen in a bioterrorism attack? a. Gastrointestinal b. Inhalation c. Cutaneous d. Spinal B Inhalation anthrax occurs when a patient inhales Bacillus anthracis; it usually takes at least 8000 spores to initiate this form of the disease. Inhalation anthrax is the form of anthrax most likely to be seen in a bioterrorism event. Data from the accidental spore release in Sverdlosk, Russia, in 1976 suggested a mortality rate of almost 100%. However, the mortality rate of patients with inhalation anthrax in the United States in 2001 was only 45% (5 out of 11). REF: 733 OBJ: Level 1: Recall 13. What is the specimen of choice for cutaneous anthrax? a. Blood b. Spinal fluid c. Vesicular fluid from lesions d. Sputum C The specimen of choice for cutaneous anthrax is vesicular fluid from fresh vesicles. Also, swabs can be used to collect material from under the edge of the crust of the eschar. REF: 734 OBJ: Level 1: Recall 14. What is the specimen of choice for gastrointestinal and inhalation anthrax? a. Sputum b. Vesicular fluid from lesions c. Spinal fluid d. Blood D The specimen of choice for patients with gastrointestinal anthrax is blood, particularly a few days after exposure. The specimen of choice for patients with inhalation anthrax is also blood. REF: 734 OBJ: Level 1: Recall 15. A microbiologist is looking at a sheep blood agar (SBA) plate from a patient who might have been exposed to a biological agent. The colonies that are growing on the plate are nonhemolytic, large, have a ground-glass appearance, and look like a Medusa’s head. On Gram stain, the colonies are large gram-positive rods that seem to have central spores. What is the most probable organism? a. Bacillus anthracis b. Brucella mallei c. Burkholderia cepacia d. Yersinia pestis A In aerobic culture, B. anthracis will yield large (2- to 5-mm), nonhemolytic colonies on 5% SBA. Colony growth can be rapid, as little as 8 hours. Mature colonies have a ground-glass appearance; cells are characteristically large gram-positive bacilli, possibly showing endospore formation. The spores are central or subterminal and do not cause the bacterial cell to swell. The colony margins often have feathery projections coming from the margin, referred to as “Medusa-head” colonies. REF: 734 OBJ: Level 3: Synthesis 16. Organisms that have the following characteristics—aerobic growth, nonhemolytic colonies 2 to 5 m in diameter, catalase positive, nonmotile, large gram-positive bacilli recovered from lesions, blood, cerebrospinal fluid (CSF) or lymph nodes—can be presumptively identified as: a. Brucella mallei. b. Bacillus anthracis. c. Yersinia pestis. d. Burkholderia cepacia. B According to Centers for Disease Control and Prevention (CDC) protocols, a presumptive identification of B. anthracis can be made if an isolate has the following characteristics: aerobic growth, nonhemolytic colonies 2 to 5 mm in diameter, catalase positive, nonmotile, large gram-positive bacilli recovered from lesions, blood, CSF, or lymph nodes. REF: 734 OBJ: Level 2: Interpretation 17. What organism caused the disease known as the Black Death? a. Brucella mallei b. Bacillus anthracis c. Yersinia pestis d. Burkholderia cepacia C Throughout history, plague pandemics have demonstrated the efficacy of this organism as a weapon against humankind. The infection, commonly referred to as the Black Death, was decimating the Muslims, and in an effort to spread the disease to the Genoese in Kaffa, Tartar soldiers who had died of the Black Death were catapulted into the walled city. REF: 735 OBJ: Level 1: Recall 18. Yersinia pestis causes all the following except _____ plague. a. bubonic b. septicemic c. pneumonic d. meningococcal D Y. pestis causes bubonic plague, septicemic plague, and pneumonic plague. The infections can occur as a result of being bitten by an infested flea, handling contaminated materials, or inhaling aerosolized plague bacteria. REF: 736 OBJ: Level 1: Recall 19. What type of plague is the most common and results from the bite of a flea? a. Bubonic plague b. Septicemic plague c. Pneumonic plague d. Osmotic plague A Bubonic plague, the most common form of disease, results from the bite of a flea. It is characterized by fever, chills, headache, and malaise. The plague bacteria are transported to the local lymph nodes, most commonly the femoral, inguinal, or cervical nodes. As the bacteria multiply, the lymph node becomes inflamed and painful, forming the characteristic bubo with evident erythema. REF: 736 OBJ: Level 1: Recall 20. A microbiologist is looking at a set of plates from a seriously ill patient. The sheep blood agar (SBA) plate shows small, nonhemolytic colonies that have a fried egg appearance. On MacConkey, these organisms grow as a small, nonlactose fermenter. On Gram stain, this organism is a bipolar staining, plump gram-negative rod. What is the most probable organism? a. Brucella mallei b. Bacillus anthracis c. Yersinia pestis d. Burkholderia cepacia C Laboratory Response Network (LRN) protocols define a suspicious Yersinia pestis isolate as a bipolar staining gram-negative node that forms very small colonies after 24 hours of incubation at 37° C, although colonies grown at room temperature may be larger. Colonies of Y. pestis on SBA may grow slowly, and cultures may have to be held for up to 48 hours for good colony growth. Colonies are nonhemolytic and can have a fried egg appearance. On media selective for gram-negative bacilli, such as MacConkey agar, the organism will grow as small, nonlactose fermenting colonies. REF: 737 OBJ: Level 3: Synthesis 21. What disease is associated with rabbits? a. Francisella tularensis b. Bacillus anthracis c. Yersinia pestis d. Burkholderia cepacia A The most common mammal associated with tularemia in the United States is the rabbit. F. tularensis was first isolated and described in 1911, when it was found to be the cause of an outbreak in ground squirrels in Tulare County, California. REF: 737 OBJ: Level 1: Recall 22. What is the most common presentation for tularemia? a. Pneumonic tularemia b. Ulceroglandular tularemia c. Bubonic tularemia d. Septicemic tularemia B Depending on the source and route of infection, tularemia can have a number of clinical presentations. The most common presentation is ulceroglandular tularemia, which results from the inoculation of the organism into the dermis of the patient. REF: 738 OBJ: Level 1: Recall 23. When should a microbiologist consider Francisella tularensis? a. Tiny, gram-negative coccobacilli that do not grow well on chocolate or MacConkey’s and are biochemically inert b. Tiny, gram-negative coccus that grows well on blood agar c. Tiny, pleomorphic, poor-staining, gram-negative coccobacilli that do not grow well, if at all on blood agar d. None of the above C The microbiologist should consider F. tularensis when she or he finds a pleomorphic, poorly staining, gram-negative coccobacilli from a blood culture that does not grow well, if at all, on blood agar. REF: 739 OBJ: Level 2: Interpretation 24. All of the following are synonyms for brucellosis except _____ fever. a. Malta b. undulant c. Gibraltar d. relapsing D Synonyms for brucellosis include Malta fever, undulant fever, Mediterranean fever, Gibraltar fever, goat fever, Bang’s disease, and Cyprus fever. REF: 740 OBJ: Level 1: Recall 25. A microbiologist is looking at the blood culture plates taken from a woman who had ingested fresh, unpasteurized milk. The growth on the blood agar and chocolate agar showed small, circular, smooth, convex, nonpigmented, and nonhemolytic colonies. Gram stain revealed tiny gram-negative rods. The organism was catalase, oxidase, nitrate reduction, and urease positive, but showed a lack of motility. What is the most probable organism? a. Francisella tularensis b. Brucella abortus c. Yersinia pestis d. Burkholderia cepacia B Brucella colonies are small, circular, smooth, and convex, nonpigmented and nonhemolytic. On Gram stain, brucellae reveal tiny gram-negative coccobacilli. Results for a presumptive identification of Brucella spp. include the characteristics mentioned earlier for an organism that was isolated from an appropriate specimen, along with catalase, oxidase, nitrate reduction, urease positivity, and lack of motility. REF: 740 OBJ: Level 3: Synthesis 26. What organism causes glanders? a. Francisella tularensis b. Brucella abortus c. Yersinia pestis d. Burkholderia mallei D The genus Burkholderia contains two species considered potential agents of bioterrorism: B. mallei and B. pseudomallei. The disease caused by B. mallei is called glanders, and the disease caused by B. pseudomallei is called melioidosis. REF: 740 OBJ: Level 1: Recall 27. A microbiologist observes culture plates that have larger nonpigmented gray colonies at 24 hours that are indole-negative, nonmotile, catalase-positive, and resistant to polymyxin B disks. The Gram stain shows this is a gram-negative coccobacilli. What is the most probable organism? a. Francisella tularensis b. Brucella mallei c. Yersinia pestis d. Burkholderia cepacia B Gram-negative coccobacilli or small gram-negative bacilli with poor growth at 24 hours, forming larger nonpigmented gray colonies at 48 hours that are indole-negative, nonmotile, catalase-positive, and resistant to polymyxin B disks or colistin disks are presumptively identified as B. mallei and must be submitted to the state public health laboratory or a Laboratory Response Network (LRN) reference laboratory. REF: 742 OBJ: Level 3: Synthesis 28. What organism causes Q fever? a. Coxiella burnetii b. Brucella abortus c. Yersinia pestis d. Burkholderia cepacia A C. burnetii is the causative agent for the oddly named Q fever. The name of the disease was derived after an outbreak among slaughterhouse workers in Australia in 1935. The disease was called Query fever because no cause was found. REF: 742 OBJ: Level 1: Recall 29. What is characteristic of smallpox? a. The pustules penetrate deeply into the tissue b. Infections also occur on the palms and the soles of the feet c. The synchronous progression of the lesions d. All of the above D One of the most characteristic signs of smallpox, differentiating it from other viral fever/rashes, is the synchronous progression of the lesions—all lesions have nearly the same appearance. Also, lesions are more heavily concentrated on the extremities, as the virus prefers cooler body temperatures found in these locations. Another significant feature of smallpox infection is that the palms and soles are not spared, as they are with varicella. Vesicles continue to progress into pustules. The pustules are unique, in that they penetrate deeply into the tissue of the patient and are extremely turgid. REF: 743 OBJ: Level 2: Interpretation 30. How is smallpox diagnosed? a. Through a Centers for Disease Control and Prevention (CDC) algorithm b. By clinical signs c. Through cell culture d. All of the above D Detection and identification of smallpox virus is based on patient signs and symptoms as defined by the CDC’s Acute, Generalized Vesicular or Pustular Rash Protocol. REF: 745 OBJ: Level 1: Recall 31. Viral hemorrhagic fevers include all the following except: a. Ebola. b. Crimean-Congo. c. Lassa fever. d. black fever. D The hemorrhagic fever viruses include, but are not limited to, Ebola and Marburg viruses; Lassa fever virus; Crimean-Congo hemorrhagic fever virus; Rift Valley fever virus; several hantaviruses; and Dengue, yellow fever, and Omsk hemorrhagic fever viruses. REF: 745 OBJ: Level 1: Recall 32. Botulism toxin is a(n) _____ primarily produced by Clostridium botulinum. a. neurotoxin b. mucosal toxin c. enterotoxin d. endotoxin A Botulinum toxin is a neurotoxin primarily produced by C. botulinum, although other clostridia, including C. butyricum and C. baratii, can also produce this toxin. Seven different serotypes of the toxin, designated A through G, have been identified. The serotypes implicated in disease are A, B, and E. REF: 746 OBJ: Level 1: Recall 33. What is ricin? a. A potent biological toxin that disrupts native DNA strands b. A potent biological toxin that stops cell wall synthesis c. A potential biological toxin that inhibits protein synthesis d. All of the above C Ricin, from castor beans, is a potent biological toxin that inhibits protein synthesis. Clinical manifestations depend on the route of exposure. Ingestion of ricin typically leads to profuse vomiting and diarrhea followed by multisystem organ failure and possible death within 36 to 72 hours of exposure. Inhalation of ricin usually leads to respiratory distress, fever, and cough followed by the development of pulmonary edema, hypotension, respiratory failure, and possible death within 36 to 72 hours. REF: 747 OBJ: Level 1: Recall