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Pediatric Terrorism and Disaster Preparedness

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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

Clinical Signs and Symptomsa 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 rashb 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
Petechiaeb 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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