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File: 970207_aadcn_013.txtThe 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)] 11
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