Pediatric emergency medicine trisk 4545 4545
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In the absence of a known release, the discovery of a patient with characteristic
findings of a disease caused by a Category A agent should prompt further
investigation, as well as the institution of appropriate infection control measures.
Perhaps an ED triage nurse discovers that within a short period of time two
separate infants arrive with complaints of floppiness and weakness, raising the
concern for infant botulism. Perhaps a pediatric resident becomes concerned
about a viral hemorrhagic fever after encountering a highly febrile and illappearing child with a purpuric rash who recently traveled to Africa. Although
not all of the Category A biologic agents are spread from person to person ( Table
132.3A ), in these cases it would be prudent to assume this mode of spread. The
staff member, after washing his hands, should put on a gown, gloves, and eye
protection. An N-95 respirator should be added if there is concern for smallpox or
viral hemorrhagic fever. The child should be covered with a sheet, provided a
mask, and escorted directly to a negative-pressure room for further evaluation and
treatment.
CLINICAL ASSESSMENT AND MANAGEMENT
Specific Agents
Anthrax
CLINICAL PEARLS AND PITFALLS
Inhalational anthrax should be suspected when there is fever with a
widened mediastinum on chest x-ray in the absence of trauma.
Inhalational anthrax is not contagious and therefore poses no risk to
healthcare workers.
Background. Anthrax is caused by infection with Bacillus anthracis, a grampositive spore-forming rod capable of surviving long periods in its spore form
without nutrients or moisture. Natural disease caused by B. anthracis manifests in
cutaneous, gastrointestinal (GI), and inhalational forms. Anthrax spores can be
formulated in a manner to enhance aerosolization. The resulting small particles
may drift long distances with air currents, produce lethal infection when inhaled,
and resist environmental degradation, making them a formidable terrorist
weapon.
The anthrax attacks of 2001 resulted in 22 confirmed cases (11 inhalational, 11
cutaneous), with five deaths, resulting from presumed or known exposure to
