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

Hantavirus genus

Hemorrhagic fever

with renal syndrome(2–3 wk; range 2days–2 mo)

Febrile phase.

Conjunctival and

pharyngeal injectionfrom vasculardilatation.

Flu-like illness with low back

pain from retroperitonealedema, flushing.

Hypotensive phase.

Mild hypotension to

shock andhemorrhage lasting1–2 days.

Massive

gastrointestinalbleeding in somepatients.

Petechiae may

develop.

Oliguric phase.

Change in mental

status.

Pulmonary edema.

Hypertension and renal

failure. Untreated: 50%mortality.

Diuretic phase.

May last several months

Convalescent phase.

Hanta virus pulmonary

syndrome: SinNombre virus(1–2 wk; range1–4 wk)

Prodromal phase

3–5 days (range1–10 days). Abruptonset of fever,myalgia, malaise,chills, anorexia, andheadache.

Shortness of breath

and pulmonaryedema, productiveand nonproductivecough, tachypnea,fever, hypotension,and hypoxia.

As patient worsens,

there is nausea,vomiting, abdominalpain, and diarrhea.

Chest X ray may be initially

normal but progresses topulmonary edema andacute respiratory distresssyndrome. Most deaths in48 hr. 33% recover(those that survive thefirst 2–3 days).

Andes virus

(A south

Americanhantavirus)

Evidence of person-to-

person spread. This isanother virus as abioterrorists weapon.

Filoviridae

Ebola virus: Ebola

hemorrhagic fever(4–10 days; range2–21 days)

Abrupt onset of fever,

severe headaches,myalgia, abdominalpain, diarrhea, andpharyngitis.

Hemiplegia, psychosis,

coma, and seizuresare common.

Hemaemesis, bloody

diarrhea, andgeneralizedmucosal bleeding.

Herpes-like lesions on

the mouth andpharynx. Severeconjucntivalinjection andgingival bleeding.There is aprominentmaculopapular rashthat evolves intopetechiae,ecchymosis, andbleeding fromvenepuncture sitesand mucosa.

Shock, metabolic acidosis,

diffuse coagulopathy.

Patients die by day 10

(60–90% mortality.

(Continued )

Bioterrorism Infections in Critical Care 451