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

Epsilon toxin

of

C. perfringens(incubation inhumans unknown)

Microvascular

endothelial injuryand diffusevasogenic cerebraledema.

In animals, in

gastrointestinaltract, causeswasting, diarrhea,and enterocolitis.

Food safety threats

(e.g.,

Salmonella sp.

,

E. Coli

O157:H7,

Shigella, Vibrio

spp.,

L. monocytogenes, C. jejuni, Y. enterocolitica

): These organisms may present with

gastrointestinal and/or systemic disease.

L. monocytogenes

has a propensity to cause meningitis in the compromised host and rhomboencephalitis in the normal host.

E. coli

O157:H7 hemolytic uremic syndrome.

S. typhi

causes typhoid fever, which may be protracted, and patients may present with relative bradycardia and occasionally rose spots

on the trunk.

Shigella

species causes bloody diarrhea.

Disease presentation of Melioidosis (

Bk. pseudomallei

) and human

Bk. mallei

closely overlap.

Melioidosis

(Bk.

pseudomallei

)

(1–21 days;1–5 days for sepsis;hours for inhalation;incubation periodmay be extendedover months toyears). Weaponizeddisease may appearin 1–4 days.

Most disease

subclinical althoughfulminant rapidlyfatal disease inimmunecompromisedpatients. Maypresent as sepsis.

Sepsis patients may

present withconfusion,headache,photophobia,myalgias, flushing,cyanosis, jaundice.

Pulmonary lesions on

chest X ray mostcommon site oflocalized disease.Cyanosis withsevere disease.

Jaundice, hepato-

megaly,splenomegaly.

Diarrhea

Tends to form abscesses.

Cutaneous andsubcutaneous pustules.Erythroderma,lymphadenopathy.

Chronic infection may

manifest as multipleabscesses of theskin, soft tissue andviscera.

Chronic localized

abscesses in liver,lung, brain, lymph-adenitis, osteo-myelitis, septicarthritis and spleen.

Recrudescence of infection

occurs especially in timesof stress. Parotidabscesses in children.

Glanders

(Bk. mallei

)

(1–21 days;1–5 days forsepsis; hours forinhalation).Weaponizeddisease may appearin 1–4 days.

Presents abruptly with

swollen nodes,weight loss, andsubcutaneousabscesses. Chronicinfection maymanifest as multipleabscesses of theskin, soft tissue,and viscera.

Mucocutaneous

exposure may resultin headache, fever,myalgia, localizednodular or erosiveinfection.Photophobia, severeheadache,lacrimation, ocularexudates andulceration, erosion ofthe nasal septum.

Acute necrotizing

pneumonia or acuterespiratory distresssyndrome. Maypresent as chroniccavitary diseaseconfused withtuberculosis.

Ulcerating nodules in

gastrointestinaltract.

Mortality 19–50% even with

treatment. Mortality>

90% in 24–48 hr without

treatment in septicemicform.

(Continued )

Bioterrorism Infections in Critical Care 455