Pediatric emergency medicine trisk 4543 4543
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because persons are progressively exposed to increased numbers of infectious
patients, fomites, or vectors that spread the organism.
A history of geographic connection among patients, or some observation of an
unusual source of exposure such as a powder in an envelope, might also trigger
suspicion. By exotic diseases, it is suggested that many infections caused by
biologic weapons, particularly with advanced disease, are relatively unusual and
unique. Diseases that are rare, not endemic in the area of exposure, or that are
normally spread by vectors that are not indigenous to the relevant geographic area
would also be suspected, especially if numerous cases developed simultaneously.
FIGURE 132.1 Approach to the early recognition and diagnosis of an attack with an unknown
biologic agent. VEE, Venezuelan equine encephalitis; JE, Japanese encephalitis; Rx, treatment;
CXR, chest x-ray; VHF, viral hemorrhagic fever. (Reprinted from Henretig FM, Cieslak TJ,
Kortepeter MG, et al. Medical management of the suspected victim of bioterrorism: an
algorithmic approach to the undifferentiated patient. Emerg Med Clin N Amer 2002;20:351–
364. Copyright © 2002 Elsevier Science (USA). With permission.)
Additional clues to a biologic agent attack might include especially high
infection or intoxication rates among exposed persons, high numbers of patients
with atypical pneumonia, unusually high morbidity or mortality, simultaneous
epidemics caused by different pathogens, attack rates lower in persons sheltered
