Therefore, it will likely be a physician rather than a paramedic who is first faced with evidence of disease from a biological attack. This, the third article in Epi-Log on this topic, will begin to discuss biological agents that are thought to be the most likely to be used in a bioterrorist attack. In doing so, we hope to raise awareness among clinicians and increase the likelihood of these diseases being included in a differential diagnosis, recognized and reported. Although these diseases are rarely if ever seen in the U.S. today, accepted diagnostic and epidemiologic principles apply in aiding clinicians to identify them. If the illness is recognized quickly, appropriate therapy can often be initiated and the impact of a bioterrorist attack greatly reduced.
Anthrax is thought to be the most likely agent to be used in a bioterrorist event.
Caused by the bacterium Bacillus anthracis, anthrax is primarily a zoonotic disease of herbivores. The spores of B. anthracis are extremely stable and may remain viable for many years in soil and water from which they are ingested and cause disease in animals. In the event of a bioterrorist attack, inhalational disease would be the most likely presentation after exposure to aerosolized anthrax spores. The incubation period is usually 1 to 6 days, but can be as long as 60 days. Initial symptoms of fever, malaise, fatigue, cough and mild chest discomfort are followed in 24 to 72 hours by severe respiratory distress with dyspnea, diaphoresis, stridor and cyanosis.