Bioterrorism

Chapter 37 Bioterrorism








4 What pathogens would present with respiratory failure?




image Anthrax: Pneumonic anthrax is caused by the inhalation of the spore form of Bacillus anthracis. It begins as a nonspecific influenza-like illness with fever, cough, malaise, headache, and vomiting. Rapid progression occurs to hemorrhagic mediastinitis, hilar lymph node enlargement, respiratory failure, hemodynamic collapse, and death. Although chest radiographs classically show only a widened mediastinum without pulmonary infiltrates, several of the victims from the anthrax letter attacks in the fall of 2001 did have pulmonary infiltrates and pleural effusions. Bacteremia and meningitis can occur.


image Plague: Pneumonic plague, caused by Yersinia pestis, can develop secondarily from bubonic plague via hematogenous dissemination from involved lymph nodes or primarily from inhalation of the plague bacillus. Patients are seen with the sudden onset of headache, fever, shortness of breath, cough, and hemoptysis. Chest radiographs most often reveal bilateral bronchopneumonia. There may be leukocytosis, disseminated intravascular coagulation (DIC), and elevated liver function test results. Rapid progression to respiratory failure and shock ensues.


image Tularemia: If Francisella tularensis is inhaled, a syndrome similar to community-acquired pneumonia develops with fever, myalgias, headache, pleuritic chest pain, and a dry cough. Concomitant pharyngitis may be present. Some patients demonstrate a pulse-temperature deficit, where an increase in temperature is not accompanied by a relative increase in heart rate. Chest radiographs may have a variety of findings including unilateral or bilateral pneumonia, hilar lymphadenopathy, pleural effusions, and, less often, parenchymal cavitation.




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Jul 7, 2016 | Posted by in CRITICAL CARE | Comments Off on Bioterrorism

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