Infectious Diseases in Critical Care Medicine

Table 6

Assessing the Patient for Category A Agents (

Continued

)

Pathogen(incubation period)

Systemic symptoms

Central nervoussystem

Cardiorespiratory

Gastrointestinal

Skin and mucousmembranes

Miscellaneous

Gastrointestinal

anthrax

(1–7 days

although commonly3–7 days)

Nausea, vomiting,

anorexia, fever,abdominal pain,hematemesis,bloody diarrhea.

An eschar forms on the wall

of the intestine, usuallythe terminal ileum orcaecum. Untreated, deathin 2–5 days, (25–60%mortality). Rare patientssuccumb within hours.

Anthrax meningitis

5% of anthrax cases

involve meningitisor hemorrhagicmeningoencephalitis.CT and MRI revealfocal intracerebralhemorrhage withleptomeningealenhancement.

25% of cases

develop frominhalationanthrax.

The majority of

anthrax meningitiscases developedfrom cutaneousdisease.

No primary focus

can be foundin 10% of cases.

An anthrax bioterrorist attack may result in all five forms of anthrax in a single patient or any permutation or combination of disease presenting in patients appearing

simultaneously or sequentially to a single institution or area institutions!

Botulism

(C. botulinum toxin

)

C. botulinum

,

C.

barattii

,C.

butyricum

,

C.

argentinense

toxins

A–G. (12–80 hr byinhalation;immediate to 12–72hr—range 2–8 daysby ingestion). Mostnaturally occurringhuman disease iscaused by types A,B, and E (Eassociated with fish;type C and D oftencause disease inmammals andbirds).

Patients are afebrile

and fatigue iscommon (77%).Typically causescranial nerveparalysis [facialparalysis (63%);gaze paralysis(65%); tongueweakness (58%);decreased gag(65%)] withoutaffection sensation.

Double vision (91%);

blurred vision (65%);pupils fixed anddilated pupils (40%);nystagmus (22%);ptosis (73%); slurredspeech, dizziness(51%); weakness(69–73%); unsteadygait, descendingweakness, flaccidparalysis with fullconsciousness(90%) untilrespiratory failure;paresthesias (14%);ataxia (17%).

Dyspnea (60%);

sensation of asore throat (54%).

Dysphagia (96%);

constipation (73%);nausea (64%);vomiting 59%;abdominal cramps(42%); diarrhea(19%).

Increased mucous

production in mouthand throat and/ordry mouth (93%)and throat.

444 Cleri et al.