Pediatric emergency medicine trisk 4532 4532
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Signs and Symptoms
Coma: Chapter 17
Respiratory Distress: Chapter 71
Seizures: Chapter 72
Medical, Surgical, and Trauma Emergencies
Environmental Emergencies, Radiological Emergencies, Bites and
Stings: Chapter 90
Infectious Disease Emergencies: Chapter 94
Pulmonary Emergencies: Chapter 99
Toxicologic Emergencies: Chapter 102
BIOLOGIC AGENTS
CLINICAL PEARLS AND PITFALLS
Biologic attacks should be suspected when there are an unusually high
number of cases, a common exposure history, and exotic disease
presentations.
Ciprofloxacin, levofloxacin, and doxycycline are currently considered
drugs of choice in the treatment and prophylaxis of anthrax, plague,
and tularemia, even in children ( Tables 132.1 and 132.2 ).
Current Evidence
A working group convened by the Centers for Disease Control and Prevention
(CDC) identified anthrax, smallpox, plague, botulism, tularemia, and the viral
hemorrhagic fevers as the biologic exposures that would constitute the gravest
threats to public health and security; the causative microorganisms and toxins are
termed Category A agents. We thus limit our focus here to these six agents (
Tables 132.3A and 132.3B ). In addition, we add a brief discussion of the
phytotoxin (plant toxin) ricin because of its ready availability and ease of
production. Treatment protocols for these uncommon conditions are likely to
evolve continuously, particularly if future incidents occur, as was the case when
the mail-borne anthrax outbreak unfolded.
Of note, the fluoroquinolones and/or tetracyclines are currently considered
drugs of choice in the treatment and prophylaxis of anthrax, plague, and
tularemia. Although these have often been avoided by pediatricians in the past,
