Clinical recognition and management of patients exposed to biological warfare agents

Treatment of Neuroterrorism

“…There are 4 subspecies. Usually it is associated with zoonoses in rural areas [8]. In North America, type A, which is believed to be the most virulent strain, is predominant [45].…”

“…In North America, type A, which is believed to be the most virulent strain, is predominant [45]. F. tularensis is highly infectious: only 10 to 50 organisms are needed to cause human disease [8] if inhaled or injected. Oral ingestion requires approximately 108 organisms that lead to disease.…”

“…Human-to-human transmission has not been reported. The most likely method of deployment, therefore, would be made via aerosol, although contamination of food and water sources seem possible [8]. In a World Health Organization report from 1969, it was reported that 50 kg of aerosolized F. tularensis in an area inhabited by 5 million people would result in 19,000 deaths and 250,000 persons with severe illness [46].…”

“…In a World Health Organization report from 1969, it was reported that 50 kg of aerosolized F. tularensis in an area inhabited by 5 million people would result in 19,000 deaths and 250,000 persons with severe illness [46]. F. tularensis can survive for weeks in the environment and for years in temperatures of freezing and below [10]; however, it is easily destroyed by heat (55°C for 10 minutes) or standard disinfectant solutions, such as 10% bleach [8].…”

“…An important concept in differentiating a naturally occurring epidemic from a terrorist attack consists of recognizing an epidemiologic pattern [6]. Clues that suggest an attack include unusual age distribution or clustering of an illness [7], a rapidly increasing incidence of an illness [8], as well as an increased occurrence of an unusual illness or death in animals.…”