Pediatric Terrorism and Disaster Preparedness: Table 4.1

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

Clinical Signs and Symptoms^a	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 rash^b 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
Petechiae^b 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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