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      Biowarfare and Bioterrorism

      review-article
      Author(s): , MD, MSc (Public Health), FRCPC a , b , c , ∗
      Publication date (Electronic):
      Journal: Critical Care Clinics
      Publisher: Published by Elsevier Inc.
      Keywords: Bioterrorism, Mass casualty, Bioweapon, Anthrax, Smallpox, Critical care

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          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.

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          Most cited references57

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          Tularemia as a biological weapon: medical and public health management.

          D Dennis, T Inglesby, D. A Henderson … (2001)
          The Working Group on Civilian Biodefense has developed consensus-based recommendations for measures to be taken by medical and public health professionals if tularemia is used as a biological weapon against a civilian population. The working group included 25 representatives from academic medical centers, civilian and military governmental agencies, and other public health and emergency management institutions and agencies. MEDLINE databases were searched from January 1966 to October 2000, using the Medical Subject Headings Francisella tularensis, Pasteurella tularensis, biological weapon, biological terrorism, bioterrorism, biological warfare, and biowarfare. Review of these references led to identification of relevant materials published prior to 1966. In addition, participants identified other references and sources. Three formal drafts of the statement that synthesized information obtained in the formal evidence-gathering process were reviewed by members of the working group. Consensus was achieved on the final draft. A weapon using airborne tularemia would likely result 3 to 5 days later in an outbreak of acute, undifferentiated febrile illness with incipient pneumonia, pleuritis, and hilar lymphadenopathy. Specific epidemiological, clinical, and microbiological findings should lead to early suspicion of intentional tularemia in an alert health system; laboratory confirmation of agent could be delayed. Without treatment, the clinical course could progress to respiratory failure, shock, and death. Prompt treatment with streptomycin, gentamicin, doxycycline, or ciprofloxacin is recommended. Prophylactic use of doxycycline or ciprofloxacin may be useful in the early postexposure period.
          Article 0 comments Cited 242 times – based on 0 reviews     Review now
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            Bioterrorism-related inhalational anthrax: the first 10 cases reported in the United States.

            J. A. Jernigan, D S Stephens, D. A. Ashford … (2001)
            From October 4 to November 2, 2001, the first 10 confirmed cases of inhalational anthrax caused by intentional release of Bacillus anthracis were identified in the United States. Epidemiologic investigation indicated that the outbreak, in the District of Columbia, Florida, New Jersey, and New York, resulted from intentional delivery of B. anthracis spores through mailed letters or packages. We describe the clinical presentation and course of these cases of bioterrorism-related inhalational anthrax. The median age of patients was 56 years (range 43 to 73 years), 70% were male, and except for one, all were known or believed to have processed, handled, or received letters containing B. anthracis spores. The median incubation period from the time of exposure to onset of symptoms, when known (n=6), was 4 days (range 4 to 6 days). Symptoms at initial presentation included fever or chills (n=10), sweats (n=7), fatigue or malaise (n=10), minimal or nonproductive cough (n=9), dyspnea (n=8), and nausea or vomiting (n=9). The median white blood cell count was 9.8 X 10(3)/mm(3) (range 7.5 to 13.3), often with increased neutrophils and band forms. Nine patients had elevated serum transaminase levels, and six were hypoxic. All 10 patients had abnormal chest X-rays; abnormalities included infiltrates (n=7), pleural effusion (n=8), and mediastinal widening (seven patients). Computed tomography of the chest was performed on eight patients, and mediastinal lymphadenopathy was present in seven. With multidrug antibiotic regimens and supportive care, survival of patients (60%) was markedly higher (<15%) than previously reported.
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              Anthrax as a biological weapon, 2002: updated recommendations for management.

              Thomas V. Inglesby, Tara O'Toole, Donald Henderson … (2002)
              To review and update consensus-based recommendations for medical and public health professionals following a Bacillus anthracis attack against a civilian population. The working group included 23 experts from academic medical centers, research organizations, and governmental, military, public health, and emergency management institutions and agencies. MEDLINE databases were searched from January 1966 to January 2002, using the Medical Subject Headings anthrax, Bacillus anthracis, biological weapon, biological terrorism, biological warfare, and biowarfare. Reference review identified work published before 1966. Participants identified unpublished sources. The first draft synthesized the gathered information. Written comments were incorporated into subsequent drafts. The final statement incorporated all relevant evidence from the search along with consensus recommendations. Specific recommendations include diagnosis of anthrax infection, indications for vaccination, therapy, postexposure prophylaxis, decontamination of the environment, and suggested research. This revised consensus statement presents new information based on the analysis of the anthrax attacks of 2001, including developments in the investigation of the anthrax attacks of 2001; important symptoms, signs, and laboratory studies; new diagnostic clues that may help future recognition of this disease; current anthrax vaccine information; updated antibiotic therapeutic considerations; and judgments about environmental surveillance and decontamination.
              Article 0 comments Cited 135 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Michael D. Christian
                Journal
                Journal ID (nlm-ta): Crit Care Clin
                Journal ID (iso-abbrev): Crit Care Clin
                Title: Critical Care Clinics
                Publisher: Published by Elsevier Inc.
                ISSN (Print): 0749-0704
                ISSN (Electronic): 1557-8232
                Publication date PMC-release: 4 July 2013
                Publication date (Print): July 2013
                Publication date (Electronic): 4 July 2013
                Volume: 29
                Issue: 3
                Pages: 717-756
                Affiliations
                [a ]Royal Canadian Air Force, Department of National Defence, 600 University Avenue, Room 18-232-1, Toronto, Ontario M5G 1X5, Canada
                [b ]Critical Care, Mount Sinai Hospital, University Health Network, Faculty of Medicine, University of Toronto, 600 University Avenue, Room 18-232-1, Toronto, Ontario M5G 1X5, Canada
                [c ]Infectious Diseases, Mount Sinai Hospital, University Health Network, Faculty of Medicine, University of Toronto, 600 University Avenue, Room 18-232-1, Toronto, Ontario M5G 1X5, Canada
                Author notes
                [∗ ]Mount Sinai Hospital, 600 University Avenue, Room 18-232-1, Toronto, Ontario M5G 1X5, Canada. michael.christian@ 123456utoronto.ca
                Article
                Publisher ID: S0749-0704(13)00038-9
                DOI: 10.1016/j.ccc.2013.03.015
                PMC ID: 7127345
                PubMed ID: 23830660
                SO-VID: 3dc4702d-a565-4547-8e1e-bbbeb9920cde
                Copyright statement: Crown copyright © 2013 Published by Elsevier Inc. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                Subject: Article

                Keywords: bioterrorism,mass casualty,bioweapon,anthrax,smallpox,critical care
                Data availability:
                Keywords: bioterrorism, mass casualty, bioweapon, anthrax, smallpox, critical care

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