Table 4.1. Early Clinical Signs and Symptoms After Exposure to Selected Bioterrorist Agents

Clinical Signs and Symptomsa

Agent or Disease

Respiratory

Influenza-like illness ± atypical pneumonia

Tularemia.
Brucellosis.
Q fever.
Venezuelan equine encephalomyelitis.
Eastern equine encephalomyelitis.
Western equine encephalomyelitis.

Influenza-like illness with cough and respiratory distress

Inhalational anthrax.
Pneumonic plague.
Inhalational tularemia.
Ricin.
Aerosol exposure to Staphylococcal enterotoxin B.
Hantavirus.

Exudative pharyngitis and cervical lymphadenopathy

Oropharyngeal tularemia

Neurologic

Flaccid paralysis

Botulism

Encephalitis

Venezuelan equine encephalomyelitis.
Eastern equine encephalomyelitis.
Western equine encephalomyelitis.

Meningitis

Inhalational anthrax.
Septicemic and pneumonic plague.
Venezuelan equine encephalomyelitis.
Eastern equine encephalomyelitis.
Western equine encephalomyelitis.

Gastrointestinal

Diarrhea

Salmonella species.
Shigella dysenteriae.
Escherichia coli O157:H7.
Vibrio cholerae.
Cryptosporidium parvum.

Vomiting, abdominal pain, bloody diarrhea, hematemesis

Gastrointestinal (GI) anthrax

Dermatologic

Vesicular rashb associated with fever, headache, malaise

Smallpox

Painless ulceration progressing to black eschar

Cutaneous anthrax

Ulcer plus painful regional lymphadenopathy and influenza-like illness

Ulceroglandular tularemia

Petechiaeb with fever, myalgia, prostration

Viral hemorrhagic fever

Cardiovascular

Shock after respiratory distress

Inhalational anthrax.
Ricin.
Viral hemorrhagic fever.

Hematologic

Thrombocytopenia

Brucellosis.
Viral hemorrhagic fever.
Hantavirus.

Neutropenia

Viral hemorrhagic fever.
Venezuelan equine encephalomyelitis.
Eastern equine encephalomyelitis.
Western equine encephalomyelitis.

Hemorrhage

Viral hemorrhagic fever

Disseminated vascular coagulation

Viral hemorrhagic fever

Renal

Hemolytic-uremic syndrome, thrombotic thrombocytopenic purpura

Escherichia coli O157:H7 and other shiga toxin-producing E. coli.
Shigella dysenteriae.

Oliguria, renal failure

Viral hemorrhagic fever.
Hantavirus.

Other

Painful lymphadenopathy

Bubonic plague

Purulent conjunctivitis with preauricular or cervical lymphadenopathy

Oculoglandular tularemia
     

a Based on route of exposure; likely to make someone seek medical attention; other manifestations (e.g., fever, headache, vomiting, diarrhea) possible and common early on in many illnesses.
b Rashes of diseases that cause petechiae or vesicular skin lesions may start as macular or papular lesions.

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