Table 4.

Prominent Early Clinical Manifestations After Exposure to Chemical-Biological Agents*

ManifestationsAgents
Respiratory
 Flu-like illnessQ fever, smallpox, tularemia, Rocky Mountain spotted fever Ebola, Lassa fever
 PharyngitisAnthrax
 Dyspnea and stridorPhosgene, Q fever, Hantavirus, tularemia, plague
 PneumonitisNerve agents
 Bronchospasm
Dermatologic
 Vesiculation petechiae, purpura, or bullae Smallpox, Ebola, Lassa fever, Hantavirus, Rocky Mountain  spotted fever
 UlcersAnthrax, tularemia
 Corrosive injury/burnsMustard gas, chlorine, ammonia
Cardiovascular
 Collapse, shockRicin, hantavirus
 BradyarrhythmiasNerve agents
Hematologic
 HemorrhageT2 toxin
Neurologic
Peripheral
 Weakness, hypotoniaNerve agents, botulism
 FasciculationsNerve agents
 Central
 Apathy, disorientation, comaEbola
 SeizuresNerve agents
 MeningitisAnthrax
Renal
 OliguriaHantavirus
Gastrointestinal
 Rebound tendernessAnthrax
 Hematemesis, melenaAnthrax
 DiarrheaShiga toxin, staphyloccal enterotoxin
  • * This table does not include all the agents listed in Table 2. Only those agents believed most likely to be used in a chemical-biological attack are included.

  • The spectrum of clinical manifestations for many of these agents can be protean. The symptoms and signs noted in this table are those that would likely make someone initially seek medical attention and are based on the route of exposure during an attack (eg, the manifestations of anthrax differ for an inhalation versus food-borne exposure). Fever, headache, vomiting, and diarrhea are common early manifestations of many illnesses.

  • Many of the diseases that cause petechiae or vesicular skin lesions will initially start as macular and/or papular rashes.