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| Disease |
Incubation |
Symptoms |
Signs |
Diagnostic tests |
Transmission and Precautions |
Treatment (Adult dosage) |
Prophylaxis |
|
Inhaled Anthrax |
2-6 days Range: 2 days to 8 weeks |
Flu-like symptoms Respiratory distress |
Widened mediastinum on chest X-ray (from adenopathy) Atypical pneumonia Flu-like illness followed by abrupt onset of respiratory failure |
Gram stain (“boxcar” shape) Gram positive bacilli in blood culture ELISA for toxin antibodies to help confirm |
Aerosol inhalation No person-to-person transmission Standard precautions |
Mechanical ventilation Antibiotic therapy Ciprofloxacin 400 mg iv q 8-12 hr Doxycycline 200 mg iv initial, then 100 mg iv q 8-12 hr Penicillin 2 mil units iv q 2 hr -- possibly add gentamicin |
Ciprofloxacin 500 mg po bid or doxycycline 100 mg po bid for ~ 8 weeks (shorter with anthrax vaccine) FDA-approved vaccine: administer after exposure if available |
|
Botulism |
12-72 hours Range: 2 hrs – 8 days |
Difficulty swallowing or speaking (symmetrical cranial neuropathies) Symmetric descending weakness Respiratory dysfunction No sensory dysfunction No fever |
Dilated or un-reactive pupils Drooping eyelids (ptosis) Double vision (diplopia) Slurred speech (dysarthria) Descending flaccid paralysis Intact mental state |
Mouse bioassay in public health laboratories (5 – 7 days to conduct) ELISA for toxin |
Aerosol inhalation Food ingestion No person-to-person transmission Standard precautions |
Mechanical ventilation Parenteral nutrition Trivalent botulinum antitoxin available from State Health Departments and CDC |
Experimental vaccine has been used in laboratory workers |
|
Plague |
1-3 days by inhalation |
Sudden onset of fever, chills, headache, myalgia Pneumonic: cough, chest pain, hemoptysis Bubonic : painful lymph nodes |
Pneumonic: Hemoptysis; radiographic pneumonia -- patchy, cavities, confluent consolidation Bubonic: typically painful, enlarged lymph nodes in groin, axilla, and neck |
Gram negative coccobacilli and bacilli in sputum, blood, CSF, or bubo aspirates (bipolar, closed “safety pin” shape on Wright, Wayson's stains) ELISA, DFA, PCR |
Person-to-person transmission in pneumonic forms Droplet precautions until patient treated for at least three days |
Streptomycin 30 mg/kg/day in two divided doses x 10 days Gentamicin 1-1.75 mg/kg iv/im q 8 hr Tetracycline 2-4 g per day |
Asymptomatic contacts; or potentially exposed Doxycycline 100 mg po q 12 hr x 7 days Ciprofloxacin 500 mg po Tetracycline 250 mg po q 6 hr x 7 days Vaccine production discontinued |
|
Tularemia “pneumonic” |
2-5 days Range: 1-21 days |
Fever, cough, chest tightness, pleuritic pain Hemoptysis rare |
Community-acquired, atypical pneumonia Radiographic: bilateral patchy pneumonia with hilar adenopathy (pleural effusions like TB) Diffuse, varied skin rash May be rapidly fatal |
Gram negative bacilli in blood culture on BYCE (Legionella) cysteine- or S-H-enhanced media Serologic testing to confirm: ELISA, microhemagglutination DFA for sputum or local discharge |
Inhalation of agents No person-to-person transmission but laboratory personnel at risk Standard precautions |
Streptomycin 30 mg/kg/day IM divided bid for 10-14 days Gentamicin 3-5 mg/kg/day iv in equal divided shoulders x 10-14 days Ciprofloxacin possibly effective 400 mg iv q 12 hr (change to po after clinical improvement) x 10-14 days |
Ciprofloxacin 500 mg po q 12 hr x 2 wks Doxycycline 100 mg po q 12 hr x 2 wks Tetracycline 250 mg po q 6 hr Experimental live vaccine |
|
Smallpox |
12-14 days Range:7-17 days |
High fever and myalgia; itching; abdominal pain; delirium Rash on face, extremities, hands, feet; confused with chickenpox which has less uniform rash |
Maculopapular then vesicular rash -- first on extremities (face, arms, palms, soles, oral mucosa) Rash is synchronous on various segments of the body |
Electron microscopy of pustule content PCR Public health lab for confirmation |
Person-to-person transmission Airborne precautions Negative pressure Clothing and surface decontamination |
Supportive care Vaccinate care givers |
Vaccination (vaccine available from CDC) |