FACULTY OF HEALTH SCIENCE
MEDICAL LABORATORY TECHNOLOGY
CLINICAL MICROBIOLOGY II
MLT 455
ASSIGNMENT:
BIOTERRORISM
PREPARED BY:
MOHAMMAD SAIFUL ANUAR BIN GHAZALI 2018401854
MOHAMAD ANWAR SYAFIQ BIN ISMAIL 2018680424
NUR HAZIRAH BINTI KAMAL BAHRIN 2018299558
NURFARAHANI AZRIAWIL BINTI TAWIL 2018645482
MIN TASNIM BINTI MUHAMMAD 2018680394
NURASSYIKIN BINTI BRAHIM 2018680426
NUR SYAHIRAH BINTI MUHAMMAD SUFFI 2017697012
SITI NORSYAFIQAH BINTI IBRAHIM 2017697058
PREPARED FOR:
DR. ROSLINAH MOHD HUSSAIN
BIOTERRORISM – INTRODUCTION
Bioterrorism refers to the usage of microorganisms (such as bacteria, viruses, and fungi) or toxins by states or nonstate actors (terrorist or extremists’ groups) to produce biological weapons which can cause disease or death among humans, animals and plantsCITATION Mah17 l 18441 (Mahendra et al., 2017). The biological agents that are most likely to be used as biological weapons can be classified into three categories; A, B and C categories. These agents are sorted according to their epidemicity (their ability to be disseminated or transmitted), and also based on their rate of morbidity and mortality. Organisms under category A; such as Yersinia pestis, possess the highest risk because they are easily disseminated or transmitted from one person to another person. These organisms also result in high mortality rates and are capable of causing major public health impact. Category B biological agents; such as Salmonella species, are prioritized as the second highest biological agents because they are moderately easy to be disseminated. In addition, their morbidity and mortality rates are moderate and low respectively. Organisms that are classified under category C; such as Nipah virus are prioritized as the third highest biological agents. This include the emerging pathogens that have the potential to be engineered for mass dissemination in the near future due to its availability. Organisms under this category could be produce and disseminate easily and they probably has high morbidity and mortality rates, and might be linked to major health impact CITATION CDC17 l 18441 (CDC, 2017).

Mohammad Saiful Anuar Bin Ghazali / 2018401854 / HS2413D
CATEGORY A – ANTHRAX ; PLAGUE
Bacillus anthracis is the bacteria that cause anthrax, a disease in which can be transmitted from animal to human and one of the agents that are used for bioterrorism. Bacillus anthracis is a large, Gram-positive and facultative anaerobic bacterium. It is also an endospore-forming rod that is only formed under aerobic conditions and rapidly forms endospore when exposed to air. There are three different clinical forms of human anthrax cases which are cutaneous, respiratory and intestinal anthrax. Cutaneous anthrax has the lowest mortality rate compared to the other form which are 10 to 20% when untreated. 25 to 50% of fatality rate occurs in cases for intestinal anthrax and cases that involve respiratory anthrax are almost always fatal despite any kind of treatments given to victims. Acting as the deadliest form of anthrax, respiratory anthrax is often chosen as a weapon of bioterrorism. Once inhaled, the bacterial spores germinate in alveoli of the lungs. This is where the macrophage acts by phagocytising the spore. However, the deadly spore has the ability to survive phagocytosis and eventually kill the macrophage. The bacteria will then disseminate in bloodstream and leads to septicemia. Death occurs two to three days later due to septic shock. It is reasonable to be used by bioterrorist as their spores can be easily obtained in nature, produced widely in lab and the viability of endospores can last long for over 60 years. They only require 1 to 5 days of incubation period and their microscopic spores can be inserted into all types of media such as powders, sprays, food as well as water.

Nurfarahani Azriawil Binti Tawil / 2018645482 / HS2413A
Plague, also known as Black Death, a disease cause by the bacteria Yersinia pestis. This mortal disease had spread across the Europe in 1347 until 1352 and killed 20 to 30 million people before antibiotics were discovered. The bacteria, was carried by the rodents, normally black rats which can be transmitted to humans via fleas. There are three types of plague, bubonic plague, septicemic plague and pneumonic plague. Bubonic plague is the most common form of plague and infects lymphatic system causes inflammation and swollen of lymph nodes. Septicemic plague is an infection of the bloodstream, usually transmitted by the infected flea or direct contact with an infected person. Pneumonic plague, the most lethal form of plague disease and can be spread from person to person. Usually, when a person was infected with plague disease, they will becomes ill with bubonic plague within 2 to 6 days. If it was left untreated during this condition, bubonic plague will enter their bloodstream where the bacteria will multiply and develop septicemic plague. When both bubonic and septicemic plague spread into lungs, the infected person will get pneumonic plague, which causes pneumonia. The latest outbreak of plague occurred in Indian City of Surat, Gujarat in 1994. Reported death cases were 58 out of 2500 cases that had been reported. Plague can be treated with the help of antibiotics. When one was diagnosed with pneumonic plague, it was very necessary for them to receive antibiotic treatment as soon as possible within 24 hours of symptoms, to prevent high risk of death. Unfortunately, plague vaccine is not available in the near future.

Nur Hazirah Binti Kamal Bahrin / 2018299558 / HS2413D
CATEGORY B – BRUCELLOSIS
Brucellosis or also known as Malta fever is an infection caused by the bacteria from Brucellaceae family. The genus is further divided into 6 species containing B.suis, B.canis, B.neotomae, B.ovis, B.obortus and B.melitensis with more different species being discovered. Brucellosis was categorized under group B bioterrorism agent as it can be disseminated moderately and has low motility rate. The symptoms include fever, perspiration, malaise, and weight loss. However, a chronic infection may cause complications to other organs such as heart and liver. From the 21st century, Brucella is selected as a potential biological weapon due to several aspects. Firstly, it is selected because of the accessibility of virulent strain. With the presence of lipopolysaccharide cell wall as their virulent factor, it is found out that strains with smoother cell wall is said to be more virulent and resistant against destruction by immune cells. Next, Brucella can survive well in a certain condition providing them storage stability. Besides, the ability to cause a chronic disease with a low infection dose and the simplicity of spreading the organism through aerosol are the main reasons why it is used as a biological weapon. For example, B.suis was firstly weaponized by the USA at Pine Bluff Arsenal as it resist drying and well-survived in aerosols. Bombs with the organisms were tested with animals in field trials from 1944 to 1945. However, Brucella and other biological weapons were destroyed when the programme was discontinued by President Richard Nixon. Brucella sp. are preferred as bioterrorism agent as they are highly contagious via aerosol route with a dose estimated of 10-100 microorganisms. It was estimated that the release of 50 kg B.suis via a plane along 2 km line on a city could affect 125,000 out of 500,000 people with 500 deaths approximately.
Nur Syahirah Binti Muhammad Suffi / 2017697012 / HS2413A
Brucellosis is a zoonotic disease where it is transmitted from animal to human instead of between human. The mode of transmission include the consumption of infected animals or their products, by direct contact with the infected animals or their secretions and through airborne. Brucella species are heat sensitive organisms therefore pasteurization process is the most effective method to kill the pathogenic bacteria in the animal products such as milk to make sure they are safe to be consumed. For bioterrorism purpose, the spreading of Brucella through air or aerosol is the most effective method to cause an outbreak. It is also the most common occupational-acquired disease especially in the laboratory as the laboratory personnel might accidentally sniff the culture or aerosol might form while handling it. Brucellosis is diagnosed by isolating Brucella species from biological specimens collected from infected host and serological testing. Currently, there is no vaccination against Brucellosis available for human. However, there are vaccines developed for the livestock. For example, weakened strain of B.abortus is used to develop the vaccine for cattle against the disease. The antibiotic therapy is the only treatment available for human against Brucellosis. The combination of antibiotics and the duration of the therapy are the important factors to ensure an optimum treatment against the agent. In conclusion, Brucella species is utilized as one of bioterrorism agent for its small infectious doses, rapid transmission through aerosols and other different routes and persistence capability in the environment. Some opinions believe that there will be new outbreaks of brucellosis in the future as a new Brucella species with new genetic properties had been discovered. So, it is hoped that new measurements and disease controls can be developed to fight against the outbreak of this disease.
Siti Norsyafiqah Binti Ibrahim / 2017697058 / HS2413B
CATEGORY C – NIPAH VIRUS
Nipah virus (NiV) emerged as anew virus exactly 20 years ago, causing serious morbidity and mortality in both animals and humans and eradicated the pig-farming industry in Malaysia (Ang et al., 2018). In early march 1999, a virus from cerebrospinal fluid of an encephalitis patient has been isolated by virologists from University of Malaya. Nipah virus (NiV), by the name itself was suggested because the specimen from a fatal human case was first isolated from Kampung Sungai Nipah, a village in Negeri Sembilan, Malaysia (Ang et al., 2018). In 2001, Meherpur district, Bangladesh for the first time reported for an outbreak of Nipah encephalitis and since then sporadic cases and outbreaks were reported from diverse districts of Bangladesh. There were two outbreak cases of Nipah encephalitis in the eastern State of West Bengal during the year 2001 and 2007 occurred in India (Yadav et al., 2018). NiV accomplish some criteria to be considered as a potential agent for bioterrorism due to its high virulence, significant morbidity and mortality, human-to-human and animal-to-human transmission, fear, and panic among people and massive economic losses. It is thus listed as category C bioterrorism whereby category C agent is an emerging pathogen that could be engineered for mass dissemination due to their availability, ease of production and dissemination and ability to cause a substantial health impact (Williams and Sizemore, 2018), and require biosafety level (BSL) 4 facilities to handle the specimen (Ang et al., 2018).
Min Tasnim Binti Muhammad / 2018680394 / HS2413C
The mode of transmission of Nipah virus in Malaysia commonly through direct contact with infected animals such as pigs and fruit bats. Besides, direct contact with infected person also can be the transmission route (CDC, March 20, 2014). There are several signs and symptoms of Nipah virus which basically range from asymptomatic infection to fatal encephalitis and acute respiratory infection. Commonly infected people having symptoms like fever, headache, myalgia (muscle pain), vomiting and sore throat. Person with encephalitis may experience symptoms like dizziness, drowsiness, neurological sign and altered consciousness. Acute respiratory infection patient may also experience severe respiratory problems and atypical pneumonia (WHO, May 30, 2018). Currently, there is no available drugs and vaccines specifically for Nipah virus infection but intensive care are recommended for patients with severe respiratory and neurologic complications. In case of outbreaks, any animal premises should be isolated immediately. Destroy all infected animal by burial or incineration of carcasses. Setting up an animal health or wildlife surveillance system to detect Nipah virus by using a one health approach can provide early warning for the human public health authorities and veterinary. Only during acute and convalescent phase of the Nipah virus infection can be diagnosed. Real time polymerase chain reaction also known as RT-PCR detection via enzyme-linked immunosorbent assay from antibody or any bodily fluids can be used to detect Nipah virus infection. Other than that, cell culture such as virus isolation can also be used to detect Nipah virus infection (WHO, May 30, 2018).

Nurassyikin Binti Brahim / 2018680426 / HS2413C
CONCLUSION
As a conclusion, the history showed us that human being used the biological weapons in the warfare where their goal is to defeat the enemies without considering the harmful and toxicity that produced from the bioterrorism they created. These indicates that human are already exposes in developing the advance technology to handle with the several types of bioterrorism agents although there were extremely difficult and very high cost to deal with public health disasters around the world. Of course, the health care awareness must be the first responder to face this bioterrorist attacks which they have more knowledge and capabilities to rule out the agents that cause the bioterrorism with the precautionary measures (Salerno R et. al 2002). On the other hand, sufficient supply of medicines, laboratory components, vaccines are essentially to provide also articulating the standard operation procedures at all stages must be carry on to reduce the morbidity and mortality of bioterrorist attacks (Lt Col S Das et al. 2010).
Mohamad Anwar Syafiq Bin Ismail / 2018680424 / HS241 3D
REFERENCES
CDC. (2017, August 17). Centers for Disease Control and Prevention. Retrieved from Bioterrorism Agents/Diseases: https://emergency.cdc.gov/agent/agentlist-category.asp
Mahendra et al. (2017). An Overview on Biological Weapons and Bioterrorism. American Journal of Biomedical Research, 24.

Centers for Disease Control and Prevention, 2015, History of The Plague.

Centers for Disease Control and Prevention. 2018. Bioterrorism agents. Centers for Disease Control and Prevention, Atlanta, GA. https://fas.org/biosecurity/resource/documents/CDC_Bioterrorism_Agents.pdfYadav, P., Sudeep, A., Gokhale, M., Pawar, S., Shete, A., Patil, D., Kumar, V., Lakra, R., Sarkale, P., Nichol, S., … Mourya, D. (2018). Circulation of Nipah virus in Pteropus giganteus bats in northeast region of India, 2015. The Indian journal of medical research, 147(3), 318-320. doi:   HYPERLINK “https://dx.doi.org/10.4103%2Fijmr.IJMR_1488_16” “pmc_ext” 10.4103/ijmr.IJMR_1488_16
Williams M, Sizemore DC. Biologic, Chemical, and Radiation Terrorism Review. Updated 2018 Apr 4. In: StatPearls Internet. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493217/
Pappas, Georgios ; Panagopoulou, Paraskevi ; Christou, L ; Akritidis, N. (2006). Brucella as a biological weapon. Cellular and molecular life sciences : CMLS. 63. 2229-36. 10.1007/s00018-006-6311-4.

Doganay, M. (2013). Brucella as a Potential Agent of Bioterrorism. Retrieved Nov 05th, 2018 from https://www.ncbi.nlm.nih.gov/pubmed/22934672Salerno R, Hickok L(2002). Strengthening bioterrorism prevention: Global biological materials management. Biosecurity and Bioterrorism: Biodefense Strategy, Practice and Science, 5: 107-116.

Lt Col S Das* , Brig VK Kataria (Retd)+(2010) ,Contemporary Issue, Bioterrorism: A Public Health Perspective, MJAFI,No.3, Volume 66.

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