Infectious Diseases in Critical Care Medicine

Table 7

Assessing the Patient for Selected Category B and C Agents (

Continued

)

Pathogen (incubationperiod)

Systemic symptoms

Central nervoussystem

Cardiorespiratory

Gastrointestinal

Skin, joints, andmucous membranes Miscellaneous

Psittacosis

(C. psittaci

)

(1–2 wk)

Asymptomatic disease

to severepneumonia.

Pneumonia during

recovery,thrombophlebitisand pulmonaryembolism reported.

May be accompanied

by splenomegaly.Early, mildtransaminaseelevations.

Mortality: 15–20%

untreated;

<

1% treated

patients.

Q fever

(C. burnetii

)

(10–21 days)

Usually asymptomatic

or self-limited mildflu-like illness.

May present as

meningoencephalitis.

May present as

pneumonia (mostcommon).Varyingradiologicappearances.

May present as

granulomatoushepatitis especiallyin younger patients.

Malaise and fever may last

for months. Somepatients develop chronicfatigue-like syndrome.

Has rarely presented

as severemultiorgan failure,or fever and severecholera-likediarrhea.

Endocarditis can

complicate disease.Rare fatal casesfrom myocarditis.

May be accompanied

by splenomegaly.Early, mildtransaminaseelevations.

Has mimicked

peritonitis.

Ricin toxin

from

R.

communis

(castor

beans) (sublethalexposures—onset4–8 hr)

Human sublethal

exposure: fever,chest tightness,cough, shortness ofbreath, nausea, andjoint pain.

Sublethal doses in

animals resulted inataxia and weightloss in addition toinflammatoryinfiltrates in thelungs.

Causes immediate

acute lung injuryand adultrespiratory distresssyndrome. Rapidlyfatal necrotizingairway disease inanimals.

Oral intake causes

bloody diarrhea.

Lethal doses resulted in

deposition of fibrin andglomerular leukocytosis.

Staphylococcal

enterotoxin B(3–12 hr)

Sudden onset of fever,

chills, headache,and myalgia. Feverfor 2–5 days.

Nonproductive cough

(may persist up to4 wk). Occasionalretrosternal chestpain and shortnessof breath.

Nausea, vomiting,

diarrhea. Ifswallowed,gastrointestinalsymptoms moresevere.

Can result in toxic shock and

death with intenseexposure or ingestion.

456 Cleri et al.