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

Plague

(Y. pestis

)

Hematogenous

Plague Pneumonia(24–60 hr)

Less than 50% of

naturally occurringdisease haslymphadenopathy.

Patients present with

fever, cough, chestpain, dyspnea, andhemoptysis.

70% have GI

symptoms withsecondary plaguepneumonia.

Inhalation plague

pneumonia(incubationdepends oninoculum:24–60 hr).Expectationafter an aerosolbiologic attack:1–6 days.

Contagious and

rapidly fatal. Maypresent simply asfever with coughand dyspnea.

Sore throat may be an

initial presentingsymptom. X rayreveals a patchybronchopneumonia.Sputum is thin,watery, and bloodtinged.

Nausea, vomiting,

abdominal pain, anddiarrhea may beseen.

Bubonic plague

(24–60 hr)

75% of naturally

occurring cases.Sudden onset offever, rigors,malaise, headache,and weakness withsimultaneous (ornext day) painlesslocalizedlymphadenopathy

Insomnia, delirium,

stupor, weakness,staggering gait,vertigo, slurredspeech, memoryloss.

Tachycardia,

tachypnea,hypotension.

Hepatomegaly

present, elevatedliver enzymes andhypoglycemia maysuggest Reye’ssyndrome.

25% develop pustules,

vesicles, eschars,or papules nearbubo or flea bite.Cellulitis,abscesses,ulcerations, andecthymagangrenosum arerare. Untreated,some develop ageneralized papularrash of the hands,feet, and pectoralareas, which, if thepatient survive,evolve from papulesto vesicles topustules resemblingsmallpox.

(Continued )

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