... The list of agents that could pose the greatest public health risk is short, but if disseminated properly they have the potential for disruption and casualty on a mass scale. ... pestis, offers the advantage of transmission from person-to-person and fairly high mortality if inhaled, although production and dissemination are difficult. Botulinum toxin is one of the most toxic substances known, and despite the fact that treatment can reduce fatality to <10%, the strain of long-term support during recovery could be crippling to a population. ... Because they are invisible, silent, odourless and tasteless, biological agents may be used as an ultimate weapon: easy to disperse (most likely by an aerosol route) and inexpensive to produce1. This essay highlights the advantages and limitations of three agents thought to head the list of potential bioterrorist weapons as well as looking at possible protective and treatment strategies.
Condition Causative agent Infectious Dose (Aerosol) Incubation Period Symptoms and Progression
(Inhalation)
Anthrax
Bacillus anthracis
8,000-50,000 spores
1-60 days
Begins with fever, fatigue, cough, headache, vomiting, chest pain and abdominal pain. ...
(Pneumonic)
Plague
Yersinia pestis 100-500 organisms 2-3 days Patients present with pneumonia, high fever, chills, headache, weakness, cough with the production of bloody sputum and clinical sepsis. ...
Botulism
Botulinum toxin produced by Clostridium botulinum 0. ... Summary of the clinical manifestations of the forms of anthrax, plague and botulism that would be the likely outcome of a bioterrorist attack with their causative agents.
Bacillus anthracis
B. anthracis is a Gram-positive, spore-forming bacterium which causes often fatal illness when it enters the body through abrasions or by inhalation or ingestion2. ... anthracis is considered fairly easy to obtain and produce in large quantities, as evidenced by production by the Aum Shinrikyo cult5 as well as by countries such as Iraq6 and the US, who weaponised anthrax spores in the 1950s and 60s7. ... anthracis as a biological weapon. ... anthracis has an auxotrophic or other attenuating mutation19. ... Because of the mortality associated with inhalational anthrax, two or more antimicrobial agents predicted to be effective are recommended22, and this proved to be effective in the treatment of two recent cases of inhalational anthrax in Washington DC15 where the patients were given ¡®triple combination¡¯ therapy and have survived to date. ... These experiments suggested possible efficacy of antitoxin therapy and recent work has highlighted two possibilities for therapeutic antitoxic agents, which when combined with antimicrobial therapy could considerably improve survival rate. ...
Yersinia pestis
The aetiological agent of plague is the Gram-negative bacterium Y. pestis and human infection most commonly occurs through a plague-infected fleas bite24. ...
The history of serious plague epidemics highlights the devastating nature of the plague agent, with an estimated 200 million deaths throughout recorded history27, although the advent of antimicrobial agents this century has significantly reduced the fatality rate. The pneumonic form of plague is the most likely clinical presentation to result from a bioterrorist attack, and this appears to be the most lethal form, being almost always fatal if treatment is not initiated within 24 hours of the onset of symptoms7. ... pestis released as an aerosol could cause pneumonic plague in as many as 150,000 persons, 36,000 of whom might be expected to die28. ... pestis is the potential for spread of plague from person-to-person via exposure to respiratory droplets from someone with pneumonic plague who is coughing at close range30. ... pestis is very sensitive to the action of sunlight and heating and does not survive for long outside the host33 and the WHO estimate that in the worst-case scenario an aerosol would be effective and infectious for only as long as an hour34. ... pestis research in the past few years. ... pestis are rare, but the finding of a multiresistant strain in Madagascar recently32 perhaps indicates a need for the development of new antimicrobial agents for the treatment of plague if used as a biological weapon.
Clostridium botulinum
C. botulinum is an anaerobic, Gram-positive, spore-forming bacterium that produces a potent neurotoxin which is the causative agent of botulism. ... It is notable that Iraq chose to weaponize more botulinum toxin than any other of its biological agents during the Gulf War, perhaps indicating more confidence in its use as a toxic agent6.
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