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August 6, 1997

Clinical Recognition and Management of Patients Exposed to Biological Warfare Agents

Author Affiliations

From the US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Md (Drs Franz, Jahrling, Friedlander. McClain, Bryne, Pavlin, Christopher, and Eitzen). and the Walter Reed Army Institute of Research. US Army Medical Research and Materiel Command, Washington, DC (Dr Hoover).

JAMA. 1997;278(5):399-411. doi:10.1001/jama.1997.03550050061035

Concern regarding the use of biological agents—bacteria, viruses, or toxins—as tools of warfare or terrorism has led to measures to deter their use or, failing that, to deal with the consequences. Unlike chemical agents, which typically lead to violent disease syndromes within minutes at the site of exposure, diseases resulting from biological agents have incubation periods of days. Therefore, rather than a paramedic, it will likely be a physician who is first faced with evidence of the results of a biological attack. We provide here a primer on 10 classic biological warfare agents to increase the likelihood of their being considered in a differential diagnosis. Although the resultant diseases are rarely seen in many countries today, accepted diagnostic and epidemiologic principles apply; if the cause is identified quickly, appropriate therapy can be initiated and the impact of a terrorist attack greatly reduced.