Symptoms of Possible Bioterrorism Agents
Anthrax
Symptoms usually appear within seven days of contact and vary depending on how the disease was contracted. Cutaneous infections occur when the bacterium enters a cut or abrasion on the skin. Skin infection begins as a raised itchy bump that resembles an insect bite but within one to two days develops into a vesicle and then a painless ulcer, usually 1 cm to 3 cm in diameter, with a characteristic black necrotic (dying) area in the center. Lymph glands in the adjacent area may swell. About 20% of untreated cases of cutaneous anthrax will result in death. Deaths are rare with appropriate antimicrobial therapy.
— Inhalation: Initial symptoms may resemble a common cold. After several days, the symptoms may progress to severe breathing problems and shock. Inhalation anthrax usually results in death in one to two days after onset of the acute symptoms.
— Intestinal: The intestinal disease form of anthrax may follow the consumption of contaminated meat and is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, and fever are followed by abdominal pain, vomiting of blood, and severe diarrhea. Intestinal anthrax results in death in 25% to 60% of cases.
Botulism
Classic symptoms include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. The symptoms are related to muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk, and respiratory muscles. In foodborne botulism, symptoms generally begin 18 to 36 hours after eating contaminated food, but they can occur as early as six hours or as late as 10 days.
Plague
Symptoms include a very swollen and tender lymph gland, fever, chills, headache, and extreme exhaustion. The pneumonic form involves a severe respiratory illness including high fever, chills, cough, breathing difficulty, and possibly bloody sputum. Naturally occurring plague is linked to rodents, rabbits, and fleas. If plague patients are not given specific antibiotic therapy, the disease can progress rapidly to death. About 14% (one in seven) of all plague cases in the United States are fatal.
Smallpox
Initially, symptoms resemble other viral illnesses, such as influenza, with fever and myalgia for two to four days. Skin lesions appear and quickly progress into a disfiguring pustular rash. The rash is most prominent on the face and extremities and scabs over in one to two weeks. Smallpox can be transmitted from respiratory droplets or from contact with skin lesions or secretions, with an average incubation period of 12 days. It is highly contagious and can lead to death in more than 30% of victims.
Source: Centers for Disease Control and Prevention, Atlanta.
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