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

Typhus fever

(R. prowazekii

)

(8–16 days forlouse-bornedisease)

Prodrome 2 days.

Onset aburpt withfever, chills,myalgias.

Headache progresses

to delirium withouttreatment.

Rales. Chest X ray:

interstitial infiltrates.Cough becomessevere withouttreatment.

Gangrene a rare

complication seenin untreatedpatients.

80% develop rash

(erythematous2–6 mm macules)in 4 days sparingthe face, palms, andsoles; conjunctivalinjection. Rashbecomeshemorrhagicwithout treatment.

Brill–Zinsser disease

(recrudescent typhus).

Viral encephalitis

[alphaviruses(e.g., Venezuelanequine encephalitis1–6 days)], EEE(5–7 days), WEE(5–10 days)

Most disease self-

limited, flu-likeillness.

Venezuelan: 1% of

adults and 4% ofchildren developencephalitis with20% mortality. EEE>

50% mortality with

clinical disease.WEE 3–4% mortality.

Viruses

(noroviruses, hepatitis A virus): common cause of gastroenteritis (norovirus) and hepatitis A.

Water safety threats

[e.g.,

V. cholerae

,

C. parvum

(1–14 day incubation)]

Protozoa

[C. cayatanensis, G. lamblia

(12–20 day incubation)

, E. histolytica

(3 wk incubation)

, Toxoplasma

spp.,

Microsporidia

). Usually cause gastroenteritis.

Category C pathogens

Emerging infectious diseases

such as Nipah virus and hantavirus; yellow fever virus, Tick-borne encephalitis complex (Flaviviridae). Other viruses within the same group are

louping ill virus, Langat virus, and Powassan virus. See Table 6 for hantavirus and yellow fever virus.

Tick-borne hemorrhagic fever viruses

[Crimean-Congo hemorrhagic fever (

Nairovirus

-a Bunyaviridae)], Omsk hemorrhagic fever, Kyasanur forest disease and Alkhurma viruses.

See Table 6.

(Continued )

Bioterrorism Infections in Critical Care 457