This case presents a medical scenario involving a 55-year-old woman in critical condition after a suspected bioterrorism attack involving pneumonic plague. The patient arrives at the emergency department intubated and in septic shock, with a history of severe respiratory distress, high fever, and coughing up blood. EMS reports possible exposure to a plague bioterrorism attack in a subway, raising concerns about the patient’s condition and potential public health risks. The case focuses on recognizing bioterrorism-related illnesses, using appropriate personal protective equipment (PPE), and isolating the patient. Key management steps include advanced airway management, fluid resuscitation, vasopressor support, and initiating appropriate antibiotics for pneumonic plague. The scenario also highlights the need for coordination with infection control, notification of public health authorities, and postexposure prophylaxis for healthcare providers exposed to the patient’s secretions. This exercise emphasizes quick, coordinated care in the face of a potential biological disaster involving a highly contagious pathogen.

The scenario begins with the evaluation of multiple patients, including a 6-year-old boy, a 21-year-old marathon runner, and a 70-year-old man, all presenting with symptoms of nausea, vomiting, and diarrhea. As the senior medical officer, the physician must recognize the viral gastroenteritis outbreak and take steps to manage the rapidly spreading illness with limited resources, all while on a ship far from shore. Key teaching points include the differential diagnosis of gastrointestinal symptoms across various age groups, the management of dehydration and electrolyte imbalance, and the implementation of infection control measures. The scenario emphasizes the need for coordinated public health action in a confined, resource-limited setting, while also navigating the captain’s decision not to turn the ship around, as no patients are critically ill.

This case presents a scenario involving a 45-year-old postal worker with inhalational anthrax following a suspected bioterrorism attack. The patient arrives at the emergency department in critical condition, presenting with shortness of breath, altered mental status, and a widened mediastinum on chest X-ray. His wife reports flulike symptoms over the past few days, and both she and the patient work in a mailroom at a government office. The scenario focuses on recognizing and managing inhalational anthrax, a rare but life-threatening condition. Key teaching points include securing the airway, fluid resuscitation for septic shock, and appropriate antibiotic therapy. Additionally, it emphasizes the importance of notifying public health and law enforcement authorities to manage the potential bioterrorism threat. The case highlights the critical need for timely intervention, proper use of personal protective equipment, and coordination with infection control and public health authorities during a bioterrorism event.

This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to viral gastroenteritis (rotaviruses, noroviruses, caliciviruses, adenoviruses, sapoviruses, astroviruses). It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to Prion disease (CJD, vCJD). It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to rotaviruses. It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to human coronaviruses (SARS-CoV, MERS-CoV and SARS-CoV-2. It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to Toxoplasma gondii. It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to HIV. It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to rabies virus. It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to HSV. It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to human CMV. It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to influenza viruses. It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to parainfluenzaviruses. It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to HAV. It provides information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to VZV. It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to RSV. It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to chlamydia (C.trachomatis, C.pneumoniae, C. psittaci, C. abortus, LGV). It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.