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TABLE 3
Biological Weapons: Recommended Diagnostic Procedures, Isolation, and
Treatment in Children16,43
|
| Agent |
Incubation
Period |
Diagnostic Sample(s) |
Isolation
Precautions* |
Treatment Options |
Prophylaxis |
Comments
|
|
| Anthrax |
1-60
d |
Blood culture, blood smear;
skin lesions or tissue, culture or fluorescent antibody (FA)
staining |
Standard, contact for skin lesions |
Ciprofloxacin§
or doxycycline or (penicillin G and streptomycin)¶, vaccine,
if available (see text) |
Ciprofloxacin§ or
doxycycline |
Alternate agents: gentamicin, erythromycin,
chloramphenicol |
| Brucellosis |
5-60 d |
Blood or bone marrow,
culture, acute/convalescent sera |
Standard, contact if lesions are
draining |
Doxycycline and rifampin; if <8 y,
trimethoprim-sulfamethoxazole |
Doxycycline and
rifampin |
Trimethoprim-sulfamethoxazole may substitute for rifampin
with doxycycline |
| Plague |
2-3 d |
Blood, sputum, lymph node
aspiration, culture or FA staining |
Droplet |
Streptomycin or
gentamicin, doxycycline or chloramphenicol |
Doxycycline,
tetracycline |
Trimethoprim-sulfamethoxazole is alternative;
chloramphenicol for meningitis |
| Q fever |
10-40
d |
Acute/convalescent sera |
Standard |
Doxycycline or
tetracycline |
Doxycycline, tetracycline |
| Tularemia |
2-10
d |
Sputum or tissue, culture#, FA available, acute/convalescent
sera |
Standard |
Streptomycin or gentamicin |
Doxycycline,
tetracycline |
| Smallpox |
7-17 d |
Pharyngeal swab or lesions,
culture |
Airborne, contact |
Cidofovir** |
NA (vaccine effective
but not available) |
| Botulism |
1-5 d |
Serum for toxin if <3 d;
stool or gastric secretions, culture for organism and look for toxin;
nerve conduction |
Standard |
Antitoxin (CDC) |
If ingested,
induced vomiting, gastric lavage, purgation and high enemas may
benefit |
Aminoglycosides potentiate paralysis; antitoxin after
exposure for asymptomatic not usually given
|
Staphylococcal
enterotoxin B |
1-6 h |
Nasal swab, culture
serum and urine for organism and look for
toxin |
Standard |
Supportive care |
NA
|
| Ricin |
|
|
|
|
NA |
|
|
*
For decontamination guidelines, see text.
|
|
See the Report of the Committee on Infectious Diseases (Red
Book) 24th ed, 1997 (or the most current edition) for drug doses.
Intravenous therapy for severely ill patients is usually indicated, but
oral therapy can be effective and may be the only practical alternative
when large numbers of people are exposed.
|
|
Prophylaxis should only be initiated after consultation with
public health officials in situations where exposure is highly likely.
The duration of prophylaxis has not been determined for most agents.
|
|
§
If susceptibility unknown. Ciprofloxacin is not FDA approved for
persons <18 years of age, but is indicated for potentially serious or
life-threatening infections (see Red Book).
|
|
If susceptibility unknown. Tetracyclines, including doxycycline, are
not FDA approved and usually contraindicated in children less than 8 years, but treatment is warranted for selected serious infections (see
2000 Red Book).
|
|
¶
Penicillin should be used only if the organism is known to be
susceptible.
|
|
#
Special media required for culture, laboratory hazard: only
immunized technicians should ordinarily process cultures.
|
|
**
Pediatric dose not established.
|
|
Centers for Disease Control and Prevention Drug Service.
404/639-3670 (weekdays, 8-4:30 ET) or 404/639-2888 (weekends,
evenings, holidays).
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