Infectious Diseases in Critical Care Medicine

Table 6

Assessing the Patient for Category A Agents

Pathogen(incubation period)

Systemic symptoms

Central nervoussystem

Cardiorespiratory

Gastrointestinal

Skin and mucousmembranes

Miscellaneous

Class A pathogens

Anthrax (B. anthracis)

Inhalation anthrax

(1–6 days mostcommon; up to6 wk reported).In monkeyexperiments,spores germinatedas late as58–98 daysafter exposure.

Malaise, fever, fatigue,

myalgia, substernaldiscomfort,headache,abdominal pain, andvomiting in the firstphase beforetransientimprovement.

Hemorrhagic meningitis

may develop in up to50% of patients.

Nonproductive cough,

followed by stridorand respiratoryfailure. Chest X raymay reveal awidenedmediastinum insecond phase ofdisease.

Biphasic disease is well

described. Improvementmay be seen 1–3 daysafter initial symptomsfollowed by rapidrespiratory failure andshock. No person-to-person spread. Up to 86%mortality reported afteraccidental release inSverdlovsk, USSR.

Cutaneous anthrax

(1–12 days: mostcommonly theincubation from acut, abrasion, orinsect bite is2–3 days butvaries from 12 hrto 19 days.)

Usually none.

Dissemination hasbeen reported.

Pruritis followed by

a painless papularlesion that evolvesto vesicles(24–36 hr) andinto an eschar(1–3 days) withsurrounding edema.10% have multiplelesions.

Can be spread person-to-

person by contact withskin lesions. Lesions arefound most commonly onthe head and neck andupper extremity.Untreated, there is up to20% mortality. Withtreatment, 80–90% oflesions resolve withoutscaring.

Oropharyngeal

anthrax

. (1–2 days)

after consuming(usually)contaminated meat.

Many patients

develop respiratorydistress and sepsis.

Local edema and

lesions appear onthe base of thetongue, tonsils,posterior pharynx,or hard palate.

(Continued )

Bioterrorism Infections in Critical Care 443