Bioterrorism beyond Anthrax

Article excerpt

In an article printed on Dec. 27, I discussed smallpox and the different options available for protecting our population. In this article I want to explore bacteria other than anthrax that are potential bioterrorism agents: namely, plague and tularemia.

Like anthrax, plague and tularemia are bacteria, and we have antibiotics than can be useful in the prevention and treatment of infection. Viruses, on the other hand, cannot be treated with antibiotics, and there are few anti-viral drugs available at this time (thus, the general way we approach viral infections involves vaccination).

Bacteria are well known to the medical profession. While doctors do not see many cases of infection caused by plague and tularemia, they resemble other illnesses and their treatment is quite similar to other diseases.

Plague is caused by a bacterium that naturally infects animals, particularly in the Southwest. As such, it is classified as a Zoonosis, that is, a disease of animals that occasionally infects man. It is most often found in rodents and their fleas. The most common symptom it causes is a skin or lymphatic infection confined to an area of the body such as an arm or leg (site of a bite).

I have seen a few cases and they were easily treated. If the patient gets no treatment and the disease progresses, it can spread to the lungs where it causes "Pneumonic plague." Unlike "regular" plague, pneumonic plague is nearly always fatal, and in this stage it is highly contagious (it is only contagious when it is in the lungs).

Pneumonic plague was the "black death" of the Middle Ages. Transmission in the pneumonic stages occurs by respiratory droplets, which can infect those who have face-to-face contact with the ill patient. All of this sounds terrible, but the good news is that antibiotics work extremely well in this disease. It is almost impossible to imagine plague becoming a serious national health issue in the Western world.

At this point, there is no vaccine against the plague, although there is one in the process of being developed. People exposed can be treated prophylactically (as those exposed to anthrax were) for seven days. …