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

Tularemia (F. tularensis)

incubation: average 3–6 days (range hours to 2–3 wk) for all forms of disease.

Ulceroglandular or

glandular tularemiafrom direct contactwith infectedanimals (hands) orvector-bornedisease (legs).

Sudden onset of fever,

chills, myalgias,headache, drycough. Pathologicchanges in the lunginclude necrotizingbronchopneumoniaand caseousnecrosis.

30% develop

pneumonia.

In the ulceroglandular

form, patientspresent with fever,chills, and skinlesionsaccompanied byregionaladenopathy.

Portal of entry through skin

where a papule developsto a slow-healing ulcerwith a crust. Severalenlarged axillary oringuinal nodes develop.

Oropharyngeal

tularemia

from

ingestion ofcontaminated foodor water.

Ulcerative pharyngitis

or tonsillitis, mostoften unilateral withlymphadenopathy.

From contaminated food or

water supply.

Oculoglandular

tularemia

A form of

ulceroglandular diseasewith primary lesion inconjunctiva.

Typhoidal tularemia

.

May be contractedthrough inhalationor ingestion ofcontaminated food.Untreated mortality:30%.

Prolonged high-grade

fever with relativebradycardia.Pulmonaryinfiltrates common.

Gastrointestinal

symptoms arecommon.

Papular lesions and

erythema nodosummay be seen in allforms.

No focal disease. Life-

threatening sepsis maydevelop. Knowncomplications: meningitis,endocarditis,rhabdomyolysis.

Respiratory or

pneumonictularemiacontracted throughinhalation orhematogenousspread.

Severe respiratory

insufficiency ornecrotizingpneumonia.F. tularensissubspeciesholarctica

may

cause discreteinfiltrates (24).

X ray may show necrotizing

pneumonia, infiltratessimilar to plaguepneumonia, hilaradenopathy, and pleuraleffusion.

448 Cleri et al.