Pediatric emergency medicine trisk 4554 4554
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administration of antitoxin is unlikely to reverse disease (the antitoxin is most
effective when given during the clinically asymptomatic, or latent, period), it may
be useful in preventing progression when administered to exposed persons. In
addition, a licensed human botulinum immunoglobulin is available to treat infant
botulism. While the product (BabyBIG) contains antibody against botulinum
toxin types A to E, it has only been studied, and is thus only licensed, to treat type
A and B intoxication. Botulism is not contagious, and standard precautions are
adequate for patient care.
Tularemia
Tularemia is a highly infectious plague-like disease caused by the gram-negative
coccobacillus Francisella tularensis. Several clinical forms of naturally occurring
tularemia are known, but pneumonic tularemia would presumably be the most
likely clinical presentation in the event of an intentional aerosol release of F.
tularensis. The onset of symptoms may be abrupt and include fever,
nonproductive cough, substernal tightness, pleuritic chest pain, occasional
hemoptysis, chills, headache, malaise, anorexia, and fatigue. Chest radiographs
may show infiltrates, hilar adenopathy, pleural effusion, or miliary infiltrates
(may mimic tuberculosis).
Tularemia is not contagious, and standard precautions are adequate in patient
care. However, because of the very low infectious dose by aerosol, processing
tularemia bacterial cultures is an extreme health risk to laboratory staff, who
therefore must be notified of a suspected case, and special precautions are
warranted. See Table 132.3B for detailed treatment recommendations for
children.
VIRAL HEMORRHAGIC FEVERS
The viral hemorrhagic fevers are a heterogeneous group of illnesses caused by
infection with lipid-enveloped RNA viruses belonging to the families
Arenaviridae, Bunyaviridae, Filoviridae, and Flaviviridae. These viruses may
cause deadly, fulminant illnesses with fever, hypotension, and bleeding diatheses.
A high mortality rate, with a capacity for human-to-human transmission by direct
contact with body fluids makes the filoviruses (e.g., Ebola and Marburg viruses)
and arenaviruses (e.g., Lassa fever virus) particularly concerning. Bunyaviridae
such as Crimean-Congo Hemorrhagic Fever virus can also be transmitted to
healthcare providers. Supportive care remains the cornerstone of therapy for most
of the viral hemorrhagic fevers. Intravenous ribavirin appears somewhat
efficacious in treating disease due to the Arenaviridae.
