BIOTERRORISM
DISEASES / AGENTS:
A Visual Guide for US Air Force
Public Health Officers
Compiled by:
Michael J. Cuomo, Captain, USAF, BSC
Columbus Air Force Base, MS (AETC)
Contents:
• Anthrax (Bacillus anthracis)
• Botulism (Clostridium botulinum)
• Brucellosis (Brucella Species)
• Cholera (Vibrio cholerae)
• Cryptosporidiosis (Cryptosporidium Species)
• Eastern Equine Encephalitis
• Ebola Hemorrhagic Fever (Ebola Virus)
• Escherichia coli O157:H7 Infection (E. coli O157:H7)
• Epsilon toxin poisoning (Clostridium perfringens)
• Glanders (Burkholderia mallei)
• Hantavirus Pulmonary Syndrome - HPS (Hantavirus)
• Lassa Hemorrhagic Fever (Lassa Virus)
• Marburg Hemorrhagic Fever (Marburg Virus)
• Melioidosis (Burkholderia pseudomallei)
• Plague (Yersenia pestis)
• Psittacosis (Chlamydia psittaci)
• Q fever (Coxiella burnetii)
• Ricin Poisoning (Ricin toxin)
• Salmonellosis (Salmonella Species)
• Shigellosis (Shigella Species)
• Smallpox (Variola Major)
• Tularemia (Francisella tularensis)
• Typhus Fever (Rickettsia prowazekii)
• Venezuelan Equine Encephalitis
• Western Equine Encephalitis
Anthrax (Bacillus anthracis)
Description: This illustration depicts Bacillus anthracis taken from the peritoneum
using a Hiss capsule stain.
Anthrax is diagnosed by isolating B. anthracis from the blood, skin lesions,
or respiratory secretions, or by measuring specific antibodies in the blood of
persons suspected of having been infected.
Content Provider: CDC
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Botulism (Clostridium botulinum)
Description: A photomicrograph of Clostridium botulinum bacteria.
This is a photomicrograph of Clostridium botulinum stained with Gentian
violet. The bacterium C. botulinum produces a nerve toxin, which causes the
rare, but serious paralytic illness Botulism.
Content Provider: CDC
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credited and notified in any public or private usage of this image.
Brucellosis (Brucella Species)
Description: A photomicrograph of the bacterium Brucella melitensis, initially named
Micrococcus melitensis.
This is a photomicrograph of Brucella melitensis, the cause of Brucellosis.
Symptoms are similar to flu and may also include severe infections of the
central nervous systems, and the lining of the heart, or endocardium.
Content Providers(s): CDC
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Cholera (Vibrio cholerae)
Description: This Gram-stain depicts flagellated Vibrio comma bacteria, a strain of V.
cholerae; the cause of Asiatic cholera.
A person may get cholera by drinking water or eating food contaminated with
the cholera bacterium, therefore, inadequate sewerage treatment can facilitate
the spread of the disease during epidemics.
Content Providers: CDC
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Cryptosporidiosis
(Cryptosporidium Species)
Description: This micrograph of a direct fecal smear is stained to detect
Cryptosporidium sp., an intracellular protozoan parasite.
Using a modified cold Kinyoun acid-fast staining technique, and under an oil
immersion lens the Cryptosporidium sp. oocysts, which are acid-fast stain
red, and the yeast cells, which are not acid-fast stain green.
Content Provider: CDC
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credited and notified in any public or private usage of this image.
Eastern Equine Encephalitis
Description: This colorized transmission electron micrograph (TEM) depicts a
salivary gland that had been extracted from a mosquito, which was
infected by the Eastern equine encephalitis (EEE) virus, which has been
colorized red; magnified 83,900x.
The Eastern equine encephalitis (EEE) virus is a member of the family
Togaviridae, and genus Alphavirus. EEE is a mosquito-borne viral disease.
As the name suggests, it occurs in the eastern half of the US. Due to the high
case fatality rate, it is regarded as one of the more serious mosquito-borne
diseases in the United States. This virus is transmitted to humans through the
bite of an infected mosquito. The main transmission cycle is between birds
and mosquitoes. Several species of mosquitoes can become infected with the
EEE virus. The most important mosquito in maintaining the enzootic (animal-
based, in this case bird-mosquito-bird) transmission cycle is Culiseta
melanura. Horses can become infected with, and die from EEE virus
infection.
Content Providers: CDC/ Fred Murphy; Sylvia Whitfield
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Ebola Hemorrhagic Fever
(Ebola Virus)
Description: Ebola virus antigen in skin
Immunohistochemical demonstration of Ebola virus antigen in skin.
Histopathology.
Content Providers(s): CDC/Dr. Sherif R. Zaki
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Escherichia coli O157:H7 Infection
Description: After 24 hours, this inoculated MacConkey agar culture plate cultivated
colonial growth of Gram-negative Escherichia coli bacteria.
Normally, E. coli serves a useful function in the body by suppressing the
growth of harmful bacterial species, and by synthesizing appreciable amounts
of vitamins. A minority of E. coli strains are capable of causing human illness
by several different mechanisms. E. coli serotype O157:H7 is a rare variety of
E. coli that produces large quantities of one or more related, potent toxins that
cause severe damage to the lining of the intestine. These toxins [verotoxin
(VT), shiga-like toxin] are closely related, or identical to the toxin produced
by Shigella dysenteriae.
Content Provider: CDC
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Epsilon toxin poisoning
(Clostridium perfringens)
Description: This photomicrograph reveals Clostridium perfringens grown in
Schaedler’s broth using Gram-stain.
Clostridium perfringens is a spore-forming, heat-resistant bacterium that can
cause food-borne disease. The spores persist in the environment, and often
contaminate raw food materials. These bacteria are found in mammalian
feces, and soil.
Content Providers: CDC/Don Stalons
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credited and notified in any public or private usage of this image.
Glanders (Burkholderia mallei)
Description: Burkholderia pseudomallei grown on sheep blood agar for 72 hours.
Burkholderia pseudomallei is a Gram-negative aerobic bacteria, and is the
causative agent of melioidosis. The organism's colonial morphology changes
somewhat as the incubation is extended.
Content Providers: CDC/Courtesy of Larry Stauffer, Oregon State Public Health Laboratory
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Hantavirus Pulmonary
Syndrome - HPS (Hantavirus)
Description: This micrograph depicts an atypical enlarged lymphocyte found in the
blood smear from a HPS patient.
Hematologic findings are important in HPS. The large atypical lymphocyte
shown here is an example of one of the laboratory findings, which when
combined with a bandemia. and dropping platelet count is characteristic of
HPS.
Content Provider: CDC
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Lassa Hemorrhagic Fever
(Lassa Virus)
Description: This transmission electron micrograph (TEM) depicted numbers of Lassa
virus virions adjacent to some cell debris. The virus, a member of the
virus family Arenaviridae, is a single-stranded RNA virus, and is zoonotic,
or animal-borne that can be transmitted to humans.
There are a number of ways in which the virus may be transmitted, or spread,
to humans. The Mastomys rodents shed the virus in urine and droppings.
Therefore, the virus can be transmitted through direct contact with these
materials, through touching objects or eating food contaminated with these
materials, or through cuts or sores. Because Mastomys rodents often live in and
around homes and scavenge on human food remains or poorly stored food,
transmission of this sort is common. Contact with the virus also may occur
when a person inhales tiny particles in the air contaminated with rodent
excretions. This is called aerosol or airborne transmission. Finally, because
Mastomys rodents are sometimes consumed as a food source, infection may
occur via direct contact when they are caught and prepared for food.
Content Providers: CDC/ C. S. Goldsmith, P. Rollin, M. Bowen
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Marburg Hemorrhagic Fever
(Marburg Virus)
Description: This transmission electron micrograph (TEM), photographed at the
Centers for Disease Control in Atlanta, Georgia, confirmed the suspicion
that the 1975 Rhodesian (now Zimbabwean) hemorrhagic fever patient
had indeed acquired the Marburg virus while traveling through that
country.
Note that in this particular section, the cylindrical Marburg virions were
sectioned in various planes, which is why some are seen as longitudinal
sections, i.e., lengthwise, while others are seen cut in a transaxial plane, i.e.,
cross-sectioned, and look circular.
Content Providers: CDC/ Dr. J. Lyle Conrad
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Melioidosis
(Burkholderia pseudomallei)
Description: Burkholderia pseudomallei grown on sheep blood agar for 48 hours.
Burkholderia pseudomallei is a Gram-negative aerobic bacteria, and is the
causative agent of melioidosis. The organism's colonial morphology changes
somewhat as the incubation is extended.
Content Providers: CDC/Courtesy of Larry Stauffer, Oregon State Public Health Laboratory
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Plague (Yersinia pestis)
Description: This photomicrograph depicts the histopathologic changes in lung tissue
in a case of fatal human plague pneumonia; Mag. 160X.
Note the moderate suppurative pneumonia including the presence of many
polymorphonuclear leukocytes (PMN), capillary engorgement, and
intraalveolar debris, all indicative of an acute infection. H&E stain was used
to process this slide.
Content Providers: CDC/Dr. Marshal Fox
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Psittacosis
(Chlamydia psittaci)
Description: This DFA-stained micrograph showed the presence of Chlamydia psittaci
bacteria in mouse brain tissue; Mag. 400X.
Direct Fluorescent Antibody (DFA) employs a fluorescently labeled, antigen
specific antibody, which attaches itself to the cell membrane bound antigen on
the Chlamydia psittaci bacteria, and fluoresces under ultraviolet light
microscopy.
Content Providers: CDC/ Dr. Vester Lewis
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Q fever (Coxiella burnetii)
Description: Coxiella burnetii is a species of intracellular, pathogenic bacteria, and is the
causative agent of Q fever. The genus Coxiella is morphologically similar to
the rickettsia, but with a variety of genetic and physiological differences. C.
burnetii are small Gram negative bacteria with two growth phases, as well as a
spore form which lies idle in soil. It can survive standard disinfectants, and is
resistant to many other environmental changes.
Content Providers: Rocky Mountain Laboratories, NIAID, NIH
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credited and notified in any public or private usage of this image.
Ricin Poisoning
(Ricin toxin)
Description: Ricin is a potent toxin that has potential to be used as an agent of biological
warfare and as a weapon of mass destruction (WMD). Ricin is widely available,
easily produced, and derived from the beans of the castor plant (Ricinus
communis). Ricin can be extracted from castor beans and is known to have an
average lethal dose in humans of 0.2 milligrams (1/5,000th of a gram), though
some sources give higher figures. The 2007 Guinness World Records Book
considers ricin the world's most potent plant toxin.
Content Providers(s): USDA
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Salmonellosis
(Salmonella Species)
Description: This photograph depicts the colonial growth pattern displayed by
Salmonella typhimurium bacteria cultured on a Hektoen enteric (HE) agar
medium; S. typhimurium colonies grown on HE agar are blue-green in
color, for this organism is a lactose non-fermenter, but it does produce
hydrogen sulfide, (H2S), therefore there can be black-colored deposits
present.
HE agar is the medium designed for the isolation and recovery of fecal
bacteria belonging to the family, Enterbacteriaceae.S. typhimurium causes
25% of the 1.4 million Salmonellosis infections a year in the United States.
Most persons infected with Salmonella sp. develop diarrhea, fever, and
abdominal cramps 12 - 72 hours after infection. The illness usually lasts 4 - 7
days, and most people recover without treatment. However, in some cases, the
diarrhea may be so severe that the patient needs to be hospitalized.
Content Providers(s): CDC
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Shigellosis
(Shigella Species)
Description: This photograph depicts the colonial morphology displayed by Gram-
negative Shigella boydii bacteria on a blood agar plate (BAP).
Four species from the genus Shigella, S. boydii, S. dysenteriae, S. flexneri, and
S. sonnei, are the etiologic agents of the bacterial infection, shigellosis. Most
who are infected with Shigella spp. develop diarrhea, which is often bloody,
fever, and stomach cramps starting a day or two after they are exposed to the
bacterium. Shigellosis usually resolves in 5 to 7 days.
Content Providers(s): CDC
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Smallpox
(Variola Major)
Description: Close-up of smallpox pustules found on the thigh of a patient during the
sixth day of the rash.
The smallpox lesions, or pustules, will eventually form scabs that will fall off
leaving marks on the skin. The patient is contagious to others until all of the
scabs have fallen off.
Content Providers: CDC/Dr. Paul B. Dean
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Tularemia
(Francisella tularensis)
Description: Francisella tularensis, Colonization on Cysteine Heart Agar after 72
hours.
F. tularensis, Colony Characteristics when grown on Cysteine Heart Agar,
colonies 2-4 mm, smooth, entire, greenish-white, butyrous with opalescent
sheen at 48-72hrs.
Content Providers: CDC/ Courtesy of Larry Stauffer, Oregon State Public Health Laboratory
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Typhus Fever
(Rickettsia prowazekii)
Description: This Gram-negative, intracellular bacteria is quite small and, in addition, it is
responsible for causing the disease typhus, which is called classic, European,
or epidemic typhus. This bacteria that attacks only humans is spread by the
body louse, or occasionally the head louse, and it is usually worst in areas of
crowding, poverty, or bad sanitation. The bacteria, which has a short
generation time of about ten hours, is first picked up by the louse from a
human blood that it consumed. The bacteria enter the digestive system of the
louse, and they begin to replicate, which allows the louse to spread the disease
to other humans. The bacteria enters the body through the feces or the vomit
of the louse, or if a crushed louse is able to get into the skin. Eventually the
bacteria in the digestive system of the louse becomes so numerous, that in
about ten days the louse itself dies.
Content Providers: CDC
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Venezuelan Equine Encephalitis
Description: This photomicrograph of mouse brain tissue after dying of Venezuelan
Encephalitis reveals neural necrosis and edema.
First recognized in the 1930s, Venezuelan Encephalitis has been responsible
for numerous outbreaks of febrile illnesses and encephalitis involving
thousands of humans and hundreds of thousands of equines, primarily in
tropical America.
Content Providers: CDC/Dr. F. A. Murphy
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Western Equine Encephalitis
Description: The virus that causes western equine encephalitis has a complex life cycle
involving birds and a specific type of mosquito, Culex tarsalis, that is common
in farming areas and around irrigated fields. Humans, horses, and other
mammals are not an important part of the life cycle of the virus. In rare cases,
however, people who live in or visit an area where the virus lives can be
infected by the bite of an infected mosquito. Horses are common in these
regions and can also be infected. After infection, the virus invades the central
nervous system, including the spinal cord and brain.
Infection can cause a range of illnesses, from no symptoms to fatal disease.
People with mild illness often have only a headache and sometimes fever.
People with more severe disease can have sudden high fever, headache,
drowsiness, irritability, nausea, and vomiting, followed by confusion,
weakness, and coma. Young infants often suffer seizures.
Content Providers: CDC/Dr. F. A. Murphy
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Culex tarsalis
Description: This photograph depicted a close-up view of a Culex tarsalis mosquito as it
was about to begin feeding, after having landed on the skin of what will
become its human host. Note the light-colored band wrapped around its
dark-scaled proboscis (A), and the multiple similarly light-colored bands
wrapped around its distal appendages, i.e., the tibia and femur, of its
forelegs and middle pair of legs (B), identifying this as C. tarsalis.
Other identifying characteristics include the presence of two silver dots on its
dorsal scutum, however, in this particular image, only one of the two bilateral
silver scutal marks is visible (C), and a blunted distal abdominal tip, which is
not visible in this view. The epidemiologic importance of C. tarsalis lies in its
ability to spread Western Equine Encephalitis (WEE), St. Louis Encephalitis
(SLE), and California Encephalitis, and is currently the main vector of West
Nile virus in the Western United States.
Content Provider: CDC
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