TAILIEUCHUNG - Chapter 115. Approach to the Acutely Ill Infected Febrile Patient (Part 8)

Inhalational Anthrax (See also Chap. 214) Inhalational anthrax, the most severe form of disease caused by Bacillus anthracis, had not been reported in the United States for more than 25 years until the recent use of this organism as an agent of bioterrorism (Chap. 214). Patients presented with malaise, fever, cough, nausea, drenching sweats, shortness of breath, and headache. Rhinorrhea was unusual. All patients had abnormal chest roentgenograms at presentation. Pulmonary infiltrates, mediastinal widening, and pleural effusions were the most common findings. Hemorrhagic meningitis was seen in 38% of these patients. Survival was more likely when antibiotics were given. | Chapter 115. Approach to the Acutely Ill Infected Febrile Patient Part 8 Inhalational Anthrax See also Chap. 214 Inhalational anthrax the most severe form of disease caused by Bacillus anthracis had not been reported in the United States for more than 25 years until the recent use of this organism as an agent of bioterrorism Chap. 214 . Patients presented with malaise fever cough nausea drenching sweats shortness of breath and headache. Rhinorrhea was unusual. All patients had abnormal chest roentgenograms at presentation. Pulmonary infiltrates mediastinal widening and pleural effusions were the most common findings. Hemorrhagic meningitis was seen in 38 of these patients. Survival was more likely when antibiotics were given during the prodromal period and if multidrug regimens were used. In the absence of urgent intervention with antimicrobial agents and supportive care inhalational anthrax progresses rapidly to hypotension cyanosis and death. Avian Influenza H5N1 Infection See also Chap. 180 Human cases of avian influenza were first reported in Hong Kong. Recent cases have occurred primarily in Southeast Asia particularly Vietnam. However evidence of a rapidly expanding geographic distribution of the virus throughout the world is of grave concern. Avian influenza should be considered in patients with severe respiratory tract illness particularly if they have been exposed to poultry. To date human-to-human transmission is rare. Patients present with high fever an influenza-like illness and lower respiratory tract symptoms. Watery diarrhea may develop and may precede respiratory symptoms. Dyspnea develops a median of 5 days after the onset of symptoms and can progress to respiratory distress syndrome multiorgan failure and death within 910 days after the onset of illness. Early antiviral treatment with neuraminidase inhibitors should be initiated along with aggressive supportive measures. Hantavirus Pulmonary Syndrome See also Chap. 189 Hantavirus pulmonary .

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