Clinical Review
Biological warfare and bioterrorism
BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7333.336 (Published 09 February 2002) Cite this as: BMJ 2002;324:336Data supplement
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
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- Correction Published: 16 March 2002; BMJ 324 doi:10.1136/bmj.324.7338.647/b
- This Week In The BMJ Published: 09 February 2002; BMJ 324 doi:10.1136/bmj.324.7333.0f
- Letter Published: 11 May 2002; BMJ 324 doi:10.1136/bmj.324.7346.1157/a
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