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The non-specific findings of fever, non-productive cough,
myalgia, and headache occurring in large numbers of patients in
an epidemic setting would suggest any of several infectious
respiratory pathogens, particularly influenza, adenovirus, or
mycoplasma. In a single biological warfare attack with SEB,
cases would likely have their onset within a single day, while
these other, naturally occurring, outbreaks would present over
a more prolonged interval. Naturally occurring outbreaks of Q
fever and tularemia might cause confusion, but would involve
much smaller numbers of individuals, and would more likely be
accompanied by pulmonary infiltrates.

The dyspnea of botulism is associated with obvious signs of
muscular paralysis; its cholinergic blocking effects result in
a dry respiratory tree, and patients are afebrile. Inhalation
of nerve agent may lead to weakness, dyspnea' and copious
secretions. The early clinical manifestations of inhalation
anthrax, tularemia, or plague may be similar to those of SEB.
However, rapid progression of respiratory signs and symptoms to
a stable state distinguishes SEB intoxication. Mustard
exposure would have marked vesication of the skin in addition
to the pulmonary injury.

Specific Laboratory Diagnosis. Toxin is cleared from the
serum rapidly and is difficult to detect by the time of
symptom onset. Nevertheless, specific laboratory tests are
available to detect SEB (see Section III) and serum should
be collected as early as possible after exposure. In
situations where many individuals are symptomatic, sera
should be obtained from those not yet showing evidence of
clinical disease. Most patients develop a significant
antibody response, but this may require 2-4 weeks.

THERAPY. Treatment is limited to supportive care.

PROPHYLAXIS. [(b)(l)sec 3.4(b)(2)]
  Experimental immunization has protected monkeys,
[(b)(l)sec3.4(b)(2)]


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