Biowarfare and bioterrorism

Abstract

Bioterrorism is not only a reality of the times in which we live but bioweapons have been used for centuries. Critical care physicians play a major role in the recognition of and response to a bioterrorism attack. Critical care clinicians must be familiar with the diagnosis and management of the most likely bioterrorism agents, and also be adequately prepared to manage a mass casualty situation. This article reviews the epidemiology, diagnosis, and treatment of the most likely agents of biowarfare and bioterrorism.

Keywords: Anthrax; Bioterrorism; Bioweapon; Critical care; Mass casualty; Smallpox.

Fig. 1

Photomicrograph of Bacillus anthracis from an agar culture, showing spores; fuchsin-methylene blue spore stain.

Fig. 2

(A) A common or point source outbreak characterized by a rapid increase and decrease of the epidemic curve over a short period. This pattern would be seen when there is a release of a biological agent that is nontransmissible at a single point in time in a single location. (B) (bar graph) A propagated source outbreak in which the disease is transmissible from 1 person to another. In this situation, particularly early in the outbreak, the number of cases does not increase in a linear fashion, but rather peaks and troughs associated with the natural transmission cycle (incubation period and infectious period) are seen. The line shows a steady increase in cases, which suggests an extended exposure to a source, as may be seen in a bioterrorism event (although it can occur naturally on occasion, although this is uncommon).

Fig. 3

Anthrax: posteroanterior chest radiograph taken on the fourth day of illness. Note the wide mediastinum and the left pleural effusion.

Fig. 4

(A) A boy in Bangladesh in 1974 with classic smallpox; note the centrifugal distribution and similar stage of all of the lesions. (B) Close-up of the boy in Fig. 3A; note the umbilicated nature of the vesicles.

Fig. 5

Appearance of lesions in smallpox and chickenpox.