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

Multidrug-resistant M. tuberculosis

. Usually pulmonary, can be disseminated.

SARS virus

(SARS-

associatedcoronavirus)(2–14 days)

Nonrespiratory

prodrome 2–7 days:fever, headache,malaise, myalgia,diarrhea.

Respiratory phase

begins 2–7 daysafter prodrome:nonproductivecough, shortness ofbreath. Physicalfindings minimal.Chest X ray:ground-glassopacities, focalconsolidationsespecially inperiphery andsubpleural regionsof lower lobes. By2nd wk, shiftingX-ray picture andprogression to bothlungs.

Human-to-human

transmission throughdroplets, direct andindirect contact withpatients or fomitescontaminated byrespiratory secretions,feces, urine, and tears;airborne transmission hasoccurred. Fatality rate9.6%.

West Nile virus

(a

Flaviviridae) (5–14days)

Mild flu-like prodrome. Hyponatremia, tremor,

acute asymmetricflaccid paralysis orsingle-limbweakness,myoclonus,dyskinesias,Parkinsonism, withencephalitis havepoor prognosis. Nosensorydisturbances.

Encephalopathic patients

(without metabolicabnormalities) havegeneralized slow-waveabnormalities and insome cases triphasicwaves.

Significant risk for

older adults andcompromisedpatients.

458 Cleri et al.