Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

Ricin provokes a specific antibody response, and acute and convalescent sera should be obtained
for antibody titer. Tissue can also be stained using immunohistochemical methods.
Treatment. Treatment involves supportive care, including appropriate respiratory support and
treatment for pulmonary edema if required. Enteral exposure should be treated by vigorous
gastric lavage and use of cathartics.
Control measures. Protective masks are effective in preventing exposure. No vaccine is
available.
Reporting. If ricin exposure is suspected, contact your State and local health departments. If
they are unavailable, contact the CDC at 770-488-7100.
Q Fever
Q fever is caused by Coxiella burnetti, a rickettsial organism that causes usually asymptomatic
infection in farm animals (cattle, sheep, goats). It can also infect dogs, cats, rodents, and some
birds. Natural infection in people is rare. When it does occur, it usually is transmitted by
aerosolized organisms from the tissues, fluids, or excreta of infected animals. Exposure through
terrorism would likely involve aerosolization, and resulting disease would likely be similar to
naturally occurring disease.
Signs and symptoms. The incubation period is 9–39 days after exposure. Initial symptoms
include sudden onset of fever, chills, headache, weakness, lethargy, anorexia, and profuse
sweating. Approximately 50% of infected individuals have pneumonia. Liver function tests are
often abnormal—a result of granulomatous hepatitis—but jaundice is rare. Neuropathies
sometimes develop. Transmission to the fetus is common when pregnant women are infected.
The infection becomes chronic in approximately 1% of infected individuals and can manifest as
endocarditis or hepatitis.
Diagnosis. Clinically, Q fever is not easily distinguished from other causes of flu-like symptoms
and pneumonia. Coxiella can be isolated from blood cultures; however, if Q fever is suspected,
blood cultures are not recommended because of the risk of exposure of laboratory personnel.
PCR assays can identify the organism in tissue or environmental samples. Acute and
convalescent sera should be submitted for antibody titers; antibody concentration may rise only
after 2–3 weeks of illness.
Treatment and prophylaxis. Most infections resolve without specific therapy. Treatment with
doxycycline may hasten recovery in acute infection. Chronic infection may require prolonged or
repeated treatment. Chloramphenicol and ciprofloxacin are alternate choices for children