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

Marburg virus:

Marburghemorrhagic fever(3–10 days)

Sudden onset of fever,

chills, headache,myalgia.

Delirium develops late

in the disease withshock, massivebleeding, and multi-organ failure. Uveitisreported.

Rash is followed by

nausea, vomiting,chest andabdominal pain.Jaundice, weightloss, pancreatitis,liver failure.

Some patients

develop amaculopapular rashbeginning on the 5thday of illness.

After 6–8 days,

patients progress tosevere hemorrhagicfever.

Mortality recorded at

25–90% (more often25–30%)

Flaviviridae

Dengue and dengue

hemorrhagic fever(2–7 days)

Nonspecific febrile

illness, Denguefever

Sudden onset of (break

bone fever) severemuscle pains,headache,prostration. Retro-orbital pain. Anorexicand restless4–6 days.

Facial flushing,

conjucntivalinjection. 50% ofpatients have anearly transienterythematous rash.

Fever, arthralgia, and rash.

Positive tourniquet test,epistaxis, petechiae, orpurpura.

As fever rapidly

resolves, amorbilliform orscarlatini-form rashappears onextremities withpetechiae on thelegs andgeneralizedlymphadenopathy.

There is a 2nd febrile phase

lasting 2–3 days with rashdesquamation.

Convalescence is long and

patients remaindebilitated anddepressed.

Dengue hemorrhagic

fever

Begins day 2–5 after

dengue fever.Restlessness,diaphroesis.

Shock, hypotension,

hemorrhagicmanifestations,respiratory failure(alveolarhemorrhage andfluid accumulation,renal failure).

Petechiae, purpura,

spontaneousbleeding from gumsand gastro-intestinal tract,tender hepato-megaly.

10% mortality may be

reduced to

<

1% mortality

with fluid resuscitation.

Encephalopathy may

complicate clinicalcondition

Yellow fever virus

and yellow fever(3–6 days)

Most infections mild

and patientsrecover in 48 hr.

Minority have severe

headache.

Relative bradycardia

for degree of fever.

Minority have low back pain

and proteinuria withheadache.

452 Cleri et al.