Table 4.3. Diagnostic Procedures, Isolation Precautions, Treatment, and Postexposure Prophylaxis for Selected Bioterrorist Agents in Children

Agent

Incubation Period

Diagnostic Specimens and Procedures

Isolation Precautions

Treatment

Postexposure Prophylaxisa

Comments

Alphaviruses (VEE, EEE, and WEE)

2-10 days

Cerebrospinal fluid (CSF) for viral isolation, antibody detection in CSF and acute and convalescent serum

Standard; respiratory precautions for WEE virus

Supportive

Protection from mosquito vectors

 

Anthrax

1-60 days

Gram stain of buffy coat, CSF, pleural fluid, swab of skin lesion; culture of blood, CSF, pleural fluid, skin biopsy

Standard; contact for skin lesions

Ciprofloxacinb or doxycyclinec; combine with one or two additional antimicrobial agents for inhalational, gastrointestinal (GI), or oropharyngeal diseased

Ciprofloxacinb, doxycyclinec, or amoxicilline; anthrax vaccine

Additional antimicrobial agents to be used for inhalational, GI, or oropharyngeal disease include rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, and clarithromycin

Botulism

Foodborne: 2 hr-8 days

Inhalational: 24-72 hr

Toxin detection from serum, feces, enema fluid, gastric fluid, vomitus, or suspected food samples; culture of feces or gastric sections; nerve conduction testing

Standard

Supportive care; mechanical ventilation and parenteral nutrition may be required; equine botulism antitoxin given as soon as possible (CDC)f

 

Type-specific antitoxin should be administered when possible; antitoxin prevents additional nerve damage but does not reverse existing paralysis

Brucellosis

5-60 days

Culture of blood or bone marrow; acute and convalescent serum for antibody testing

Standard; contact for draining skin lesions

Doxycyclinec and rifampin; if younger than 8 yr old, use TMP-SMX

Doxycyclinec and rifampin

TMP-SMX may substitute for rifampin with doxycycline

Plague

2-4 days

Culture or fluorescent antibody staining of blood, sputum, lymph node aspirate

Droplet

Streptomycin sulfate or gentamicin sulfate; doxycyclinec or tetracyclinec

Doxycyclinec; tetracyclinec

TMP-SMX is an alternative; chloramphenicol for meningitis

Q fever

10-40 days

Acute and convalescent serum samples

Standard

Doxycyclinec or tetracyclinec

Doxycyclinec or tetracyclinec

Chloramphenicol is an alternative for treatment or prophylaxis

Smallpox

7-19 days

Culture of pharyngeal swab of skin lesions

Airborne, contact

Supportive care

Vaccine if administered within 4 days

 

Staphylococcal enterotoxin B

3-12 hr

Serum, urine, and respiratory secretions for toxin; acute and convalescent serum for antibodies

Standard

Supportive care

None available

 

Ricin

4-8 hr

Serum and/or respiratory secretions for enzyme immunoassay

Standard

Supportive care; gastric lavage and cathartics if toxin is ingested

Protective mask

 

Viral hemorrhagic fevers

6-17 days

Culture and/or antigen detection of blood and other body tissuesg; serum for acute and convalescent antibody detection

Standard, droplet, and contact precautionsh

Ribavarin IV for Lassa fever; plasma from convalescent patients for Argentinean hemorrhagic fever; supportive care

   

Notes: EEE = Eastern equine encephalitis; VEE = Venezuelan equine encephalitis; WEE = Western equine encephalitis.

a Prophylaxis should be administered only after consultation with public health officials and only in situations in which exposure is highly likely. The duration of prophylaxis has not been determined for most agents.
b If susceptibility is unknown or indicates resistance to other agents. Ciprofloxacin is not licensed by the Food and Drug Administration (FDA) for use in people younger than 18 yr but is indicated for potentially serious or life-threatening infections.
c Tetracyclines, including doxycycline, are not approved by the FDA for this indication and are usually contraindicated for children younger than 8 yr, but treatment is warranted for selected serious infections.
d Treatment should be administered parenterally initially but may be changed to oral therapy for cutaneous infection without dissemination.
e Amoxicillin may be used as prophylaxis only if the organism is known to be susceptible.
f Botulism antitoxin must be obtained from the Centers for Disease Control and Prevention (CDC) Drug Service, 404-639-3670 (weekdays, 8 am to 4:30 pm) or 404-639-2888 (weekends, nights, holidays).
g Isolation should be attempted only under Biosafety Level-4 conditions.
h Because of the risk of nosocomial transmission, the State health department and the CDC should be contacted for specific advice about management and diagnosis of suspected cases.

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