The Threat of Bioterrorism
After September 11th and the later anthrax scares, public health officials have been gearing up for another potential terrorist attack. Biological weapons are of concern because of their potential to cause mass casualties and panic.

Anthrax still remains on the minds of many people. Infection is caused by the bacterium, Bacillus anthracis. Airborne spores from the bacteria can land on the skin, be inhaled into the lungs or swallowed into the digestive tract. Initial signs of skin infection are the development of small painless, itchy bumps. The areas eventually fill with fluid and rupture, leaving behind a black, ulcerated area of skin. Inhaled anthrax causes flu-like symptoms, chest pain, breathing difficulties and eventually, shock. About 89 percent of patients with inhalation anthrax die. In the digestive tract, anthrax can cause stomach pain, nausea, vomiting, diarrhea, fever and bleeding of the gastrointestinal tract.

Smallpox is an infection caused by the Variola virus. Infection causes fever, headache, backache, weakness and a characteristic skin rash that starts on the face and arms and spreads to the rest of the body. The rash turns into fluid-filled pimples which eventually scab over. The scabs fall off, leaving permanent indentations or scars. Up to 30 percent of patients die from the infection.

Pneumonic plaque is caused by the bacteria, Yersinia pestis. Infection leads to fever, chills, weakness, cough, headache, chest pain and bloody sputum. The condition progresses very quickly. Within several days, many patients develop septic shock and die.

Botulinun toxin is a toxin produced by the bacteria, Clostridium botulinum. Patients develop excessive amounts of mucus, dry mouth, cough, difficulty swallowing, dizziness, slurred speech and muscle weakness. In severe cases, infection can cause paralysis of the muscles controlling breathing.

Tularemia is a bacterial infection caused by Francisella tularensis. Although lesser known than some of the other potential biological weapons, it is an important concern because only small amounts of the bacteria are needed to cause severe infection. Patients may develop fever, chills, headache, lymph node enlargement, sore throat, skin ulceration, eye infections or pneumonia. Some patients eventually experience respiratory failure, shock and death.

Recognition of a Bioterror Attack
Biological agents may be favored by terrorists because many of the agents are fairly easy to acquire and are colorless and odorless. Contaminants can be released into a crowd and victims will not even know they have been infected until symptoms begin to appear – often several days later. Many of the symptoms associated with bioterrorist-related infection are very general and mimic other common types of infection. By the time doctors and public health officials realize what has taken place, infection could be widespread with many cases of significant illness or death.

Early recognition of symptoms of a bioterror attack is important to stem the outbreak, reduce panic, and prevent an excessive burden on the health care system (even those with minor, unrelated symptoms will most likely seek help – overwhelming doctors and hospitals with patient loads).

Many bioterror agents cause skin symptoms. However, many family physicians and emergency room physicians aren’t trained to recognize symptoms that may raise the alarm of a potential biological exposure. Dermatologists, who are better trained in skin diseases, may be more likely to recognize the symptoms, but even their expertise is limited. A survey published last year in the Archives of Dermatology found only 55 percent of responding dermatologists believed they would be able to recognize symptoms of a bioterrorism-related skin infection.

Currently, doctors usually rely on flip charts with pictures to identify the cause of skin problems. However, the process is time-consuming and may not always be accurate. Arthur Papier, M.D. of the University of Rochester has developed a computer software program that eliminates much of the guesswork surrounding the cause of skin symptoms and speeds proper diagnosis. The software program, called VisualDX, takes into account a patient’s symptoms, medical history and travel history. The program then presents the physician with pictures of the most likely diagnoses. That enables the doctor to compare the patient’s signs with those on the computer. While textbooks may show only the most common or severe signs of a skin problem, the computer program allows doctors to look at many variations of a single infection – improving diagnostic accuracy. If a bioterrorist infection is suspected, public health officials can be contacted and other health care providers can be asked to be on the alert for patients with similar signs. Hospital personnel can then take steps to isolate and/or treat the patient and notify close contacts who may have been exposed to the infection.


AUDIENCE INQUIRY
The software program is available only to professionals. For information about the VisualDX software program: http://www.logicalimages.com/sol_vdx.html

For general information on bioterrorism and preparedness:
American Academy of Dermatology, http://www.aad.org
Centers for Disease Control and Prevention, http://www.cdc.gov