Clinical Recognition and Management of Patients Exposed to Biological Warfare Agents

TLDR

Concern about biological warfare agents has prompted deterrence measures and preparedness, noting that unlike chemical agents, biological diseases have longer incubation periods and are typically first identified by physicians rather than paramedics. The paper offers a primer on ten classic biological warfare agents to aid clinicians in considering them in differential diagnoses. The authors apply accepted diagnostic and epidemiologic principles to quickly identify agents and initiate appropriate therapy. Rapid identification and treatment can markedly reduce the impact of a biological terrorist attack.

Abstract

Concern regarding the use of biological agents—bacteria, viruses, or toxins—as tools of warfare or terrorism has led to measures to deter their use or, failing that, to deal with the consequences. Unlike chemical agents, which typically lead to violent disease syndromes within minutes at the site of exposure, diseases resulting from biological agents have incubation periods of days. Therefore, rather than a paramedic, it will likely be a physician who is first faced with evidence of the results of a biological attack. We provide here a primer on 10 classic biological warfare agents to increase the likelihood of their being considered in a differential diagnosis. Although the resultant diseases are rarely seen in many countries today, accepted diagnostic and epidemiologic principles apply; if the cause is identified quickly, appropriate therapy can be initiated and the impact of a terrorist attack greatly reduced.