Infectious Diseases in Critical Care Medicine

Table 10

Treatment for Adults (

Continued

)

Pathogen

Initial treatment prior to availability of susceptibility

Q fever (

C. burnetii

)

Susceptible to tetracyclines, macrolides, rifampin, and quinolones. Long-term cotrimoxazole treatment should be used to treat

pregnant women with Q fever (320 mg of trimethoprim and 1600 mg of sulfamethoxazole for at least 5 wk of pregnancy. Afterdelivery, patients with “chronic” serologic profiles were treated with a combination of doxycycline; resistant to

b-lactams and

aminoglycosides.

Clarithromycin and moxifloxacin are adequate alternatives to doxycycline monotherapy. Monotherapy associated with relapses.

The addition of rifampin problematic in patients taking anticoagulation. Fluorquinolone-doxycycline or doxycycline-hydroxychloroquine are two combination therapies that may be superior to monotherapy.

Meningitis: fluoroquinolone.Endocarditis: doxycycline plus hydroxycholoquine or monotherapy.

Ricin toxin from

R. communis

(castor

beans)

Supportive care. In case of ingestion, if no contraindication, clear gastrointestinal tract (gastric lavage and charcoal instillation).

Postexposure passive antibody therapy and vaccine in animal experimentation.

Staphylococcal enterotoxin B

Supportive care. In case of ingestion, activated charcoal should be used to bind remaining toxin in gastrointestinal tract.

Underdevelopment: single immunoglobulin-like domain of the T-cell receptor (variable region, Vbeta) protein-binding agent.

Typhus fever (

R. prowazekii

)

Doxycycline 200 mg/day for 5–10 days as soon as this diagnosis is suspected.

Viral encephalitis [alphaviruses (e.g.,

Venezuelan equine encephalitis,eastern equine encephalitis, westernequine encephalitis)]

Supportive therapy. Chloroquine has been shown to inhibit another alphavirus, chikungunya virus. Vaccines have not been

approved yet, and monoclonal antibodies have undergone animal studies.

Viruses (noroviruses, hepatitis A virus)

Supportive therapy. Vaccination for hepatitis A.

Water safety threats (e.g.,

V. cholerae

,

C. parvum

)

Specific antimicrobial therapy and supportive care.

Protozoa (

C. cayatanensis, G. lamblia,

E. histolytica, Toxoplasma

spp.,

Microsporidia

)

Category C pathogens

Emerging infectious diseases such as

Nipah virus and hantavirus; yellowfever virus, tick-borne encephalitiscomplex (Flaviviridae). Other viruseswithin the same group are louping illvirus, Langat virus, and Powassanvirus.

(Continued )

Bioterrorism Infections in Critical Care 471