Medical Care of Ill Disaster Evacuees: Additional Diagnoses to Consider
Historical Document
This document is provided by Centers for Disease Control and Prevention (CDC) ONLY as an historical reference for the public health community. It is no longer being maintained and the data it contains may no longer be current and/or accurate.
Common medical problems will continue to be the most prevalent conditions among evacuees. However, evacuees have been exposed to potentially contaminated flood waters and crowded living conditions, and have had many opportunities for traumatic injury therefore; clinicians also should consider some less common diagnoses when evaluating patients. This document outlines, by presenting symptoms and alphabetically, some conditions to consider when providing healthcare to evacuees.
Assistance with most diagnostic testing can be obtained through your state health department, or assistance through the CDC Emergency Operations Center.
Additional public health information about responding to natural disasters is available on the CDC Natural Disasters and Severe Weather Web site.
Altered mental status/central nervous system syndromes
Alteration of mental status may occur as a result of multiple infectious and non-infectious causes. Other features of infection (e.g., fever, elevated white blood cell count) should prompt suspicion of infectious encephalitis; in the absence of signs of infection, toxic or metabolic encephalopathies and traumatic injury should be considered. It is important to quickly exclude common etiologies of acute alteration of mental status (alcohol/drug intoxication, hypoglycemia, electrolyte imbalance, subdural hematoma). Persons with severe altered mental status should be monitored closely for ability to protect the airway. Some infectious and non-infectious etiologies of encephalopathy described in this document are listed below.
- Arboviral disease or mosquito-borne disease ( West Nile virus disease, St. Louis encephalitis virus disease)
- Aseptic/viral meningitis (enterovirus)
- Carbon monoxide poisoning
- Cholinesterase-inhibiting pesticide (e.g., organophosphates, carbamates) Poisoning
- Heat stress
- Insect repellent and insecticide poisoning
- Leptospirosis
- Meningococcal disease
- Primary amebic meningoencephalitis ([PAM], Naegleria fowleri)
- Rabies
- Scedosporium apiospermum (Pseudallesheria boydii)
- Tetanus
- Traumatic Brain Injury
Conjunctivitis
Excessive lacrimation, irritation, and hyperemia of the palpebral and bulbar conjunctivae of one or both of the eyes can be caused by chemical or physical irritation as well as by a wide variety of bacterial and viral agents, including Haemophilus influenzae, Streptococcus pneumoniae, Moraxella, adenovirus, and enterovirus. Conjunctivitis may also be a manifestation of a larger systemic infection, such as leptospirosis. Usually, tests for viral conjunctivitis may be considered; however, patients’ needs should be evaluated on a case-by-case basis. Because some of the causes of conjunctivitis may lead to outbreaks given the crowded living conditions, or specific diagnostic tests need to be considered, the following etiologies should be considered when evaluating evacuees.
Fever with poorly localized signs
Fever is one of the most common presenting complaints of patients and may indicate mild or life-threatening conditions. There are many clinical conditions, both infectious and non-infectious, that may present with fever. Most febrile conditions will present with other localizing diagnostic clues, such as rash or diarrhea. The entries listed below (not meant to be all-inclusive) may present with fever alone, or as a first symptom well before others develop.
- Adenoviruses
- Arboviral disease or mosquito-borne disease ( West Nile virus disease, St. Louis encephalitis virus disease)
- Enteroviruses (including coxsackie and echoviruses)
- Leptospirosis
- Mumps
Diarrheal illness
Diarrheal disease is caused by a wide variety of viral, bacterial, parasitic, and non-infectious agents. The primary goal in the treatment of any form of diarrhea is prevention of or appropriate correction of dehydration. No routine tests or medications are recommended for uncomplicated diarrheal illness; however, patients’ needs should be evaluated on a case-by-case basis. Patients should be encouraged to wash their hands thoroughly with soap after toileting or changing diapers and before eating or handling food for another person. Alcohol-based hand gels may be used when soap and water are not available, and when hands are not grossly soiled. Additional information is available at: Guidelines for the Management of Acute Diarrhea After a Disaster.
Possible causes of diarrheal disease among evacuees include the following:
Rashes
A wide range of pathogens, toxins, allergens, and autoimmune conditions could cause rash illness in disaster evacuees. Some of the infectious causes of rash illnesses could lead to outbreaks given the crowded living conditions evacuees have encountered and include: adenoviruses, enteroviruses, chicken pox, measles, rubella, and human parvovirus B19. Some of these and other etiologies that should be considered when evaluating an ill evacuee include the following.
- Arboviral disease or mosquito- borne disease ( West Nile virus disease, St. Louis encephalitis virus disease)
- Enteroviruses (e.g., hand-foot-and-mouth disease)
- Group A streptococcus
- Meningococcal disease
- Measles
- Rubella
- Scabies
- Ringworm (tinea pedis, tinea cruris, tinea corporis)
Skin and soft tissue lesions and infections
A variety of bacterial and fungal pathogens can infect skin and soft tissues when their integrity has been compromised by trauma, heat, water, and other factors. Below are several conditions which may present with skin findings and may be more likely to be encountered in disaster evacuees.
- Aeromonas hydrophila
- Group A streptococcus
- Lice
- Methicillin-Resistant Staphylococcus Aureus (MRSA)
- Mumps
- Non-tuberculous mycobacteria
- Pinworms
- Scabies
- Ringworm (tinea pedis, tinea cruris, tinea corporis)
- Vibrio spp. wound infections
Respiratory illness
A wide range of pathogens cause respiratory illnesses. Many are more likely to occur in evacuees because of the crowded living conditions they encountered. Some, such at tuberculosis, require a prompt public health and/or clinical response to treat and prevent additional cases. For others, treatment and control efforts are not well defined. Pathogens that may be encountered as individual cases or in outbreaks include Mycobacterium tuberculosis, Streptococcus pneumoniae,Mycoplasma, Chlamydia, adenovirus, coronaviruses, human parainfluenza viruses (HPIVs), human metapneumovirus (HMPV), influenza viruses, enteroviruses, rhinovirus, and respiratory syncytial virus. For most of these infectious agents, droplet and/or contact precautions are likely to decrease spread. Aerosol transmission is important in transmission of TB and may also occur for adenoviruses and influenza viruses. Other possible causes of respiratory illnesses include the following:
- Adenoviruses
- Cholinesterase-inhibiting pesticide (e.g., organophosphates, carbamates)
- Common bacterial pneumonias (Mycoplasma pneumoniae and Streptococcus pneumoniae[pneumococcus])
- Group A streptococcus pharyngitis
- Influenza viruses
- Legionellosis (Legionella)
- Measles
- Respiratory viruses (other)
- Pertussis (whooping cough)
- Scedosporium apiospermum (Pseudallesheria boydii)
- Tuberculosis