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File: 970207_aadcn_009.txtand possible, albeit somewhat more difficult, to induce tetracycline resistance. Therefore, if there is information indicating a biological weapon attack, prophylaxis with ciprofloxacin (500 mg po bid), or doxycycline (100 mg po bid) should begin. If unvaccinated, a single 0.5 ml dose of vaccine should also be given subcutaneously. Should the attack be confirmed as anthrax, antibiotics should be continued for at least 4 weeks in all exposed. In addition, two 0.5 ml doses of vaccine should be given 2 weeks apart in unvaccinated; those previously vaccinated with fewer than three doses should receive a single 0.5 ml booster, while vaccination probably is not necessary for those who have received the entire three-dose primary series. Upon discontinuation of antibiotics, patients should be closely observed; if clinical signs of anthrax occur, patients should be treated as indicated above. If vaccine is not available, antibiotics should be continued beyond 4 weeks until the patient can be closely observed upon discontinuation of therapy. :- BOTULISM CLINICAL SYNDROME Botulism is caused by intoxication with the neurotoxin produced by Clostridium botulinum. The toxin is a protein with molecular weight of approximately 150,000, which binds to the presynaptic membrane of neurons at peripheral cholinergic synapses to prevent release of acetylcholine and block neurotransmission. The blockage is most evident clinically in the cholinergic autonomic nervous system and at the neuromuscular junction. A biological warfare attack with botulinum toxin delivered by aerosol to the respiratory tract would be expected to cause symptoms similar in most respects to those observed with foodborne botulism. Clinical Features: Symptoms of botulism may begin as early as 3-36 hours following exposure, or as late as several days. Initial symptoms include generalized weakness, lassitude, and dizziness. Diminished salivation with extreme dryness of the mouth and throat may cause complaints of a sore throat. 7
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