INTRODUCTION

Bioterrorism (BT), the deliberate use of microbial agents or their toxins as weapons for political gain, continues to represent a persistent global threat due to the apparent availability of these substances and the potential willingness of terrorists to deploy them against civilian targets. An actual calculation of “risk” as it relates to BT is not possible; whereas the negative consequences associated with exposure to biological agents may be quite high, the probability of exposure to these hazards is truly unknown — it remains in the unpredictable and malicious minds of terrorists. Because of the potential for catastrophic sequelae, it is important for clinicians to understand the diagnostic and therapeutic approach to illnesses caused by agents of BT to mitigate the effects of an attack.

Bioterrorism agents are considered weapons of mass terror because of their potential for large-scale morbidity and mortality; one early model postulated nearly 200 000 casualties from a release of 50 kg of aerosolized anthrax spores upwind of a population center of 500 000. Yet they possess unique properties among such weapons because, unlike conventional, chemical, and nuclear weapons, BT agents have a clinical latency period during which transmission may occur and detection is difficult. The Centers for Disease Control and Prevention (CDC) has classified BT threats into priority groupings, based on their feasibility for deployment and their potential for mortality and public health impact; this categorization (Table 120.1) has informed current biodefense strategies.