Table A

Table A Categories of potential biological war agents, after Centers for Disease Control¹²

Category	Characteristics	Agents
A	Easily disseminated or transmitted person to person High mortality Cause public panic and social disruption Special action for public preparedness needed	Anthrax (Bacillus anthracis); plague (Yersinia pestis); smallpox (Variola major); tularaemia (Francisella tularensis); viral haemorrhagic fevers (various); botulinum toxin (Clostridium botulinum)
B	Moderately easy to disseminate Moderate morbidity, low mortality Response requires enhancement of diagnostic capacity and surveillance	Q fever (Coxiella burnetii); brucellosis (Brucella spp); glanders (Burkholderia mallei) and melioidosis (B pseudomallei); Venezuelan, Eastern, and Western equine encephalitides; enteric pathogens�for example, Salmonella spp, Shigella spp; other toxins
C	Emerging agents Available Easy to produce and disseminate Potential for high morbidity and mortality	Nipah virus; hantaviruses; tickborne haemorrhagic fever; tickborne encephalitis; yellow fever; multidrug resistant tuberculosis (Mycobacterium tuberculosis)

Table B Clinical syndromes produced by different agents

Syndrome	Biological warfare agents	Differential diagnosis
Undifferentiated fevers	Brucellosis; most agents in early phase	Cosmopolitan viral infections; flu
Pulmonary/pneumonic	Anthrax; plague; tularaemia; Q fever; glanders and melioidosis; brucella (rarely)	Pneumococcal pneumonia; atypical community acquired pneumonia; histoplasmosis; hantavirus pulmonary syndromes; tuberculous mediastinitis or lung disease; non- infectious widening of mediastinum�aortic dissection
Fever and skin:
Focal lesion/nodes	Cutaneous anthrax; ulceroglandular tularaemia; bubonic plague	Cowpox; ecthyma; orf; spider or tick bites; cat scratch disease; ecthyma gangrenosum
Generalised rash	Smallpox; septicaemic plague; viral haemorrhagic fevers	Chickenpox; meningococcal infection; purpura secondary to any septicaemia; measles; typhoid; rickettsial infections; erythema multiforme and drug rashes; vasculitides
Gastrointestinal	Gastrointestinal anthrax; salmonellosis; shigellosis	Many causes
Neurological:
Paralysis	Botulinum toxin	Guillain-Barré syndrome; polio; stroke; myasthenia; tick paralysis; atropine poisoning; tetrodotoxin (puffer fish) poisoning
Headache/encephalitis	Equine encephalitides; anthrax meningitis	Bacterial meningitis; subarachnoid headache; viral encephalitis; many non-infectious causes