Armies of Pestilence: CNS Infections as Potential Weapons of Mass Destruction

Abstract

SUMMARY:Infectious agents have been investigated, developed, and used by both governments and terrorist groups as weapons of mass destruction. CNS infections, though traditionally considered less often than respiratory diseases in this scenario, may be very important. Viruses responsible for encephalitides can be highly infectious in aerosol form. CNS involvement in anthrax is ominous but should change treatment. Brucellosis, plague, Q fever, and other bacteria can uncommonly manifest with meningoencephalitis and other findings. Emerging diseases may also pose threats. We review infectious agents of particular concern for purposes of biowarfare with respect to CNS manifestations and imaging features. God omnipotent is mustering in his clouds on our behalf armies of pestilence.Richard II, Act 3, Scene 3 S hakespeare had Richard II threaten his enemies with "armies of pestilence" from the clouds-a prospect that seems more plausible in our time when incidents involving anthrax, smallpox, and hemorrhagic fevers continue to make headlines. Many infectious agents have been developed during the past century for potential military use. By their nature, these are unconventional weapons more effective against unprotected, civilian targets than against soldiers; this attribute may make them attractive to terrorists. Among those organisms, some target the central nervous system. For others more commonly considered pulmonary or systemic agents, significant CNS effects may still result. Below, we review the historical background, some of the organisms considered at high risk for potential biowarfare or bioterrorism with a focus on neurologic implications, and potential future threats.

Electrocardiography Abnormalities in Macaques after Infection with Encephalitic Alphaviruses

“…The alphaviruses are grouped into New World and Old World viruses, which generally correspond with groups of signs of clinical disease; New World alphaviruses are more likely to cause encephalitis while Old World viruses tend to cause arthralgia [1][2][3][4]. In the 1930s, these mosquito-borne viruses were among the first alphaviruses to be discovered, and both the United States and Soviet Union experimented with Venezuelan Equine Encephalitis (VEEV) as a potential biological warfare agent after it was realized that VEEV was highly infectious when aerosolized [5][6][7][8][9][10]. These pathogens remain important medical and veterinary pathogens to this day [11].…”

Electrocardiography Abnormalities in Macaques after Infection with Encephalitic Alphaviruses

“…Alphaviruses are grouped into New World and Old World viruses, which generally correspond with signs of clinical disease; New World alphaviruses are more likely to cause encephalitis while Old World viruses tend to cause arthralgia [1][2][3][4]. These mosquito-borne viruses were the first alphaviruses to be isolated through the 1930s, and VEEV underwent research in later decades by the United States and the Union of Soviet Socialist Republics as a potential biological warfare agent after it was realized that VEEV was highly infectious when aerosolized [5][6][7][8][9][10]. These pathogens remain important medical and veterinary pathogens to this day [11].…”

Exposing cryptic epitopes on the Venezuelan equine encephalitis virus E1 glycoprotein prior to treatment with alphavirus cross-reactive monoclonal antibody allows blockage of replication early in infection

“…Encephalitic alphaviruses, VEEV, EEEV and WEEV are considered potential biological weapons because of the severe disease they cause and the ability to infect via aerosol ( Hart and Ketai, 2015 ; Sidwell and Smee, 2003 ). While relatively rare, natural human EEEV and VEEV infections still occur with high case fatality rates ( Aguilar et al, 2011 ; Lindsey et al, 2018 ).…”