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

Pandemic and avian

influenza

(H5N1

influenza) (2–5 daysafter exposure topoultry; 2–8 daysrange; median:3.5 days)

Rapidly progresses to

adult respiratorydistress syndrome,multiorgan failure,and death in6–10 days.

Acute respiratory

symptoms: fever>

38

8 C, cough,

shortness of breath,sore throat (lesscommon).

Diarrhea, vomiting,

abdominal, andpleuritic painprogresses rapidlyto respiratory failurewithin 1st wk.

Majority of cases have

abnormal chest X rays:bronchopneumonia orlobar pneumonia. Someautopsies revealedhemorrhagic pneumoniasimilar to 1918 pandemicinfluenza.

Most infectious before

illness and in 1st2 days of illness.

Fatality rate 62.7%.

Monkeypox virus

(Orthopoxvirus

of

the Poxviridaefamily) (9–21 days)

2–3 day febrile

prodrome(sometime withlymphadenopathy,chills, back pain,and headache)typical precedingrash.

Encephalitis.

Sore throat, cough,

rhinitis, cough,pneumonia, orrespiratory compli-cations 12%. Upperrespiratory tractlymphadenitis withdysphagia andairway obstruction.

Gastrointestinal

complaints (nausea,vomiting, abdominalpain, diarrhea)

<

25 lesions—7.5%:not incapacitated;25–90 lesions:incapacitated;>

100 lesions:

required intensivenursing.

Bacterial skin infection most

common complication.

Rash: papular or

vesicular pustularrash. Fever maydevelop withoutrash and vice versa.

Incubation period and

symptoms differ for thosewith noninvasive versuscomplex exposures (seeRef. 30).

Genetically engineered biological weapons.

Expect the unexpected!

Abbreviations

: EEE, eastern equine encephalitis; WEE, western equine encephalitis.

Source

: From Refs. 7, 8, and 31–42.

Bioterrorism Infections in Critical Care 459