Treatment of Biological Agent Exposure                                      
AGENT           CLINICAL SIGNS  TREATMENT      OTHER             SECONDARY    
                AND SYMPTOMS                                    TRANSMISSION  
Anthrax         Prophylaxis/tr  Prophylaxis/tr High mortality None except      
               eatment:        eatment:       (>90%)         aerosolized
(spore)         Fever,          ciprofloxin    even with      body fluids.     
               malaise, non-   doxycycline,   treatment.
                productive      PCN licensed                                   
               cough, pro-     vaccine.
                gressing to     IV therapy:                                    
               dypsnea,        ciprofloxin
                stridor,        doxycycline,                                   
               shock.          PCN licensed
               Incubation
                1-6 days.       vaccine.                                       
Pneumonic       High fever,     Prophylaxis/tr Antibiotic     Strict           
Plague          chills,         eatment:       treatment      isolation
                                             effec-         needed.
(bacteria)      headache        vaccine,       tive if begun  Isolation        
               hemophysis,     doxycycline,   early.         mandatory for
                                                           at
                toxemia,        TMP/sulfametho                least the first  
               dyspnea,        xazole.                       48 hours of
               stridor,
                bleeding        IV therapy:                   treatment.       
               diathesis.      streptomycin
                Incubation 2-3  (>1 yo),                                       
               days.           gentamicin,
                              chlo-
                                ramphenicol.                                   
Tularemia       Regional        Streptomycin,  Low mortality  Rare, body       
(bacteria)      lymphademepa-   gentamicin.    (about 5%).    fluid precau-
                thy, fever,     Adult                         tions only.      
               chills,         prophylaxis:
               headache,
                malaise,        doxycycline.                                   
               cutaneous
               ulcers.
                Incubation 2-                                                  
               10 days.
Q Fever         Fever, cough,   Tetracycline,  Low mortality. Does not         
(bacteria)      pleuritic       doxycycline.                  require
               chest                                        universal
                pain.                                         precautions.     
               Incubation 10+
               days
Smallpox        Malaise,        Supportive-    Supposed to be Highly           
(virus)         fever, rigors,  Vaccine        extinct        contagious.
                vomiting,       available from (doubtful).                     
               headache,       CDC.
                backache; 2-3   Immune                                         
               days later      globulin may
                lesions appear  be available                                   
               and quickly     from CDC.
                progress from   No antiviral                                   
               macules         medication
                to paupules to  available.                                     
               pustular
                vesicles.                                                      
               Incubation 16-
               17
                days.                                                          
Viral Equine    Supportive. No  Ribaviron,     Isolate        Body fluids.     
Encephalitis    antiviral       supportive     patients in    Otherwise
                              care.          single
                medication                     room with an   infectious by    
               exists.                       adjoining      vector
                                               anteroom       (mosquitoes).    
                                             stocked with
                                               PPE. Negative                   
                                             air pressure
                                               if possible.                    
Viral           Fever,          Ribaviron,     Decontaminate  Transmitted by   
Hemorrhagic     malaise,        intensive      with           bodily
Fevers          myalgias,       care,
                headache,       convalescent   hypochloride   fluids. Strict   
               vomiting,       plasma         or phenolic    barrier-
                diarrhea, easy  (Argentine     disinfectants. nursing          
               bleeding,       HF), vaccine                  techniques.
                                                           Limit
                petechiae,      (yellow                       patient          
               shock.          fever), blood                 transfers: may
                                replacement                   increase risk    
                              products                      for secondary
                                for DIC.                      transmission.    
Botulism        Ptosis,         Several        Disinfect with None.            
(toxin)         weakness,       antitoxins are hypochlorite
               dizzi-
                ness, dry       available and  and/or soap                     
               mouth, blurred  effective if   and water.
                vision,         administered   Supportive                      
               diplopia,       early. CDC     long-term
               descend-
                ing paralysis.  vaccine good   mechanical                      
               Incubation      only for A     ventilation.
                24-36 hours.    and B.                                         
Ricin (toxin)   Weakness,       Supportive -   Disinfect with None. Derived    
               fever, cough,   oxygenation    hypochlorite   from caster
                pulmonary       and hydration. and /or soap   beans.           
               edema, incuba-  No antitoxin   and water.
                tion 18-24      or vaccine                                     
               hours.          available.
Staphylococcal  Fever,          Supportive -   Disinfect with Use PPE.         
               headache,       oxygenation    hypochlo-
               chills,
Enterotoxin B   myalgias,       and hydration. ride. Most                      
(toxin)         cough, nausea,  Ventilator     victims
                                             recover.
                vomiting,       support may be                                 
               diarrhea,       required.
                Incubation 3-                                                  
               12 hours.
Source: Robert Suter, DO, MHA, FACEP, Questcara Emergency Services, Piano TX