Pediatric emergency medicine trisk 4548 4548
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Confirmation may be obtained by blood culture. State health laboratories,
USAMRIID, and the CDC can also confirm a diagnosis of anthrax by polymerase
chain reaction (PCR) and immunohistochemical assay.
Management. As anthrax has little potential for person to person transmission,
standard precautions are adequate for healthcare workers caring for anthrax
victims. Given the usual 1- to 5-day incubation period, decontamination of
victims presenting days after exposure is unwarranted. Aerosolization of
organisms from skin or clothing likewise poses little threat under typical
circumstances, but bathing and laundry with soap and water would seem prudent
soon after direct physical contact with a suspect substance.
Although naturally occurring strains of B. anthracis are usually quite sensitive
to penicillin G, penicillin-resistant strains of B. anthracis are known; thus, many
experts consider ciprofloxacin, levofloxacin, or doxycycline as essential
components of first-line treatment for victims of intentional anthrax. Infectious
Disease and Emergency Preparedness experts can provide advice regarding
postexposure prophylaxis. See Table 132.3B for detailed treatment
recommendations for children. Newer treatments include the recently licensed
monoclonal antibodies raxibacumab and obiltoxaximab, as well as investigational
anthrax immune globulin preparations.
Plague
Background. Plague, caused by infection with the gram-negative bipolar-staining
rod Yersinia pestis, is usually transmitted in nature via the bite of fleas. Endemic
disease is still seen in areas of the southwestern United States, South and
Southeast Asia, as well as in South America and Africa. Plague has long appeared
attractive as an agent of bioterrorism. Testimony to its extreme lethality and
infectivity can be obtained by considering that the “Black Death” eliminated onethird of the population of Europe during the Middle Ages.
Pathophysiology. Y. pestis is a facultative intracellular pathogen that is able to
survive temporarily within macrophages, thus aiding its dissemination to distant
sites following inoculation or inhalation. It is lymphotropic, and significantly
tender regional lymphadenopathy (e.g., in the distribution of a flea bite) is a
prominent feature of bubonic plague. Pneumonic plague (along with smallpox) is
one of the few bioterrorist threats readily transmissible from person to person via
the respiratory route, and coughing patients are often highly contagious.
