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

Junin virus: Argentine

hemorrhagic fever(7–14 days)

Presents with fever,

thrombocytopenia,and neurologicsymptoms.

Neurologic symptoms

are common andbegin with the onseton hemorrhage onthe 4th day of illness.Patients are irritable,lethargic, and havemuscular hypotonia,hyporeflexia,areflexia,proprioceptivedisturbances,tremors of the tongueand hands, changesin levels ofconsciousness, andinability to walk.

3–4 days after a nonspecific

illness, patients develophypotension andpetechiae in the softpalate, axilla, and gingiva.Untreated: 15–30%mortality.

Bunyaviridae

Rift valley fever

(2–6

days)

Sudden onset of fever,

headache, joint andmuscle pains,conjunctivitis, andphotophobia.

5–10% develop retinal

disease 1–3 wk afteronset of fever(macular exudates,retinal hemorrhages,and vasculitis). 1–5%develop neurologiccomplications.

Commonly causes abortions

in livestock. Patientsexperience a partialrecovery and thensymptoms return for aprotracted course. 1%mortality

Crimean-Congo

hemorrhagic fever(1–3 days after tickbite and 5–6 daysafter transfusion)

Sudden onset of fever,

chills dizziness,neck pain, andmyalgia.

Neuropsychiatric

symptoms.

Cardiovascular

symptoms.

Lymphadenopathy

and hepatomegaly.Nausea, vomiting,and diarrhea,diffusegastrointestinalbleeding.

Nosocomial transmission

documented.Hemorrhage and flushingis seen. DIC, renal,hepatic, and respiratoryfailure may insue with a30% mortality.

450 Cleri et al.