Acute Care 22: Symptom Recognition /Therapy Recommendations*—
Category A Bioagents
Obtain up-to-date recommendations in consultation with CDC and/or state/local health departments and/or infectious disease experts. Anthrax and smallpox are of particular concern because they are hardy organisms easily grown in large quantities.
| Agent | Symptom Complex | Incubation | Therapy | Immunization | Prophylaxis |
| Smallpox | Prodrome
of fever, headache, nausea/vomiting, malaise; 2-3 days later: macular>deep pustular synchronous face/upper extremity rash. High to moderate lethality. |
7-17 days | Cidofovir undergoing trial | Limited amounts of live virus vaccine at CDC. Smallpox vaccine, 1 dose by scarification | Live vaccine (or vaccina immune globulin) if within 3 days of exposure; > 3 days exposure warrants both. |
| Inhalational anthrax (See other sources for skin and GI forms). |
Influenza-like
illness but with
no sore throat or rhinorhea plus
shortness of breath. Very high lethality |
Usually
1-6 days but can be up to 8 weeks |
STAT IV multidrugs: Cipro or doxycycline plus one of: rifampin, vancomycin, penicillin, ampicillin, imipenem, clindamycin, clarithromycin, chloramphenicol | Bioport
military vaccine: multiple doses and annual boosters |
Confirmed
exposure: 60 days of either Cipro 500 mg every 12 hours or doxycycline 100 mg every 12 hours |
| Plague | Fever, dyspnea, hemoptysis, followed by fulminant pneumonia and respiratory failure. High lethality without treatment | 2-3 days | IV
drugs: streptomycin or gentamycin or doxycycline, or chloramphenicol |
Greer activated vaccine: multiple doses and boosters | Doxycycline
100 mg twice daily or Cipro 500 mg twice daily or tetracycline 500 mg four times daily: 7 days or duration of exposure |
| Botulism | Bulbar
palsies followed by descending symmetrical flaccid paralysis. High lethality without respiratory support (long term) |
1-5 days | DOD
heptavalent antitoxin. CDC trivalent antitoxin. Antibiotics not effective |
DOD
(IND) pentavalent toxoid |
NA |
| Tularemia | Flu-like
illness followed by pulmonary infection and/or sepsis. Mod lethality
without treatment |
1-21 days | 10-14
day course of IM streptomycin or IV/IM gentamycin or IV Cipro |
IND-live
attenuated vaccine>incomplete protection |
Doxycycline
100 mg twice daily or Cipro 500 mg twice daily x 2 weeks |
| Viral
hemorrhagic fevers |
High fever, HA, pains, followed by GI/mucous membrane bleeding. High lethality | 4-21 days | Ribavirin
IV may help some arenaviruses; passive antibody for AHF, BHF, Lassa, and CCHF |
Several
IND vaccines |
Post
exposure oral ribavirin may be effective. |
| AHF-Argentine hemorrhagic fever; BHF-Bolivian hemorrhage fever; CCHF-Crimean Congo hemorrhagic fever; DOD-Department of Defense; GI-gastrointestinal; HA-headache; IND-Investational New Drug; *Sources: CDC (2002)/National Center for Infectious Diseases (NCID). See Vol III EMP16. | |||||