AGENT

DETECTION

TREATMENT

I: 1–6 d.  FLS.  Possible widened mediastinum.  Gram stain (gram-positive rod) of blood and blood culture (late).

TBI: treatment may be delayed 24 h. until cultures from incident site available.

PEP (only if instructed by govt. officials): ciprofloxacin or doxycycline po x 8 wks.

Severe cases: ciprofloxacin, doxycycline, or penicillin IV.

I: 4 h–5 d.  Severe gastroenteritis with "rice water" diarrhea.

Oral rehydration with WHO solution or IV hydration.

Tetracycline, doxycycline (dosage as below or 300 mg one time)  po for 3 d.  Ciprofloxacin or norfloxacin po for 3 d. if resistant strains.

I: 2-3 d.  FLS.

CXR: patchy infiltrates or consolidation.

Gram stain of lymph node aspirate, sputum, or CSF (gram negative, non-spore forming rods).

Isolation.

PEP: doxycycline or ciprofloxacin for 7 days

Symptomatic: gentamicin or doxycycline IV for 10–14 days.

Meningitis: chloramphenicol.

I: 2-10 d.  FLS.

Gentamicin for 10–14 d.

I: 10-40 d.  FLS.

Most cases self-limited.

Tetracycline or doxycycline po for 5–7 d.

I: 7-17 (avg. 12) d.  FLS.  Later erythematous rash that progresses to pustular vesicles.

Electron or light microscopy of pustular scrapings.  PCR. 

Isolation.

PEP: vaccinia vaccine scarification and vaccinia immune globulin IM.

I: 1-6 d. FLS.

Immunoassay.

Supportive.

I: 4-21 d.  FLS.  Easy bleeding and petechiae.

Enzyme immunoassay.

Isolation.  Supportive care.

Some respond to ribavirin.

I: 1-5 d.  Descending bulbar, muscular and respiratory weakness.

Supportive.

PEP: toxoid.

Symptomatic: anti-toxin.

I: 3-12 h.  FLS.

Supportive.

I: 18-24 h.  FLS, pulmonary edema, and severe respiratory distress.

Supportive.

I: 2-4 h.  Skin, respiratory and GI symptoms.

Supportive.

Abbreviations: CSF: cerebro-spinal fluid.  CXR: chest x-ray.  d: days.  h: hours.  FLS: flu-like symptoms.  GI: gastro-intestinal.  I: incubation period.

PCR: polymerase chain reaction.  PEP: post-exposure prophylaxis.  TBI: threatened biologic incident.  WHO: World Health Organization.

Dosages: Chloramphenicol: 50-75 mg/kg/d, divided q 6 hrs.  Ciprofloxacin: po: 500 mg q 12 h.; IV: 400 mg q 8-12 h.  Doxycycline: po: 100 mg q 12 hrs; IV: 200 mg initially then 100 mg q 12 h.  Erythromycin: po: 500 mg q 6 h.  Gentamicin: 3-5 mg/kg/d.  Norfloxacin: po: 400 mg.  Penicillin: IV: 2 million units q 2 h.  Tetracycline: po: 500 mg q 6 h.  Streptomycin: IM: 15 mg/kg, BID.  Vaccinia immune globulin: IM: 0.06 mL/kg. 

WHO solution: 3.5 g NaCl, 2.5 g NaHCO₃, 1.5 g KCl and 20 g of glucose per liter of water.