Consensus statement ularemia, a bacterial zoono

Inhalational Tularemia Following Use as a Biological Weapon Although F tularensis could be used as

a weapon in a number of ways, the work- ing group believes that an aerosol re- lease would have the greatest adverse medical and public health conse- quences. Release in a densely popu- lated area would be expected to result in an abrupt onset of large numbers of cases of acute, nonspecific febrile ill- ness beginning 3 to 5 days later (incu- bation range, 1-14 days), with pleuro- pneumonitis developing in a significant proportion of cases during the ensuing days and weeks. Public health authori- ties would most likely become aware of an outbreak of unusual respiratory dis- ease in its early stages, but this could be difficult to distinguish from a natural outbreak of community-acquired infec- tion, especially influenza or various atypical pneumonias. The abrupt onset of large numbers of acutely ill persons, the rapid progression in a relatively high proportion of cases from upper respira- tory symptoms and bronchitis to life- threatening pleuropneumonitis and sys- temic infection affecting, among others, young, previously healthy adults and children should, however, quickly alert medical professionals and public health authorities to a critical and unexpected public health event and to bioterror- ism as a possible cause (TABLE 1). Un- til the etiology became clear, clinicians would need to work closely with epide- miologists and diagnostic laboratories to differentiate the illness from various community-acquired pneumonias and to determine if it could have resulted from use of one of several potential bio- terrorism weapons agents, such as those causing tularemia, plague, anthrax, or Q fever.2,4,29

In general, tularemia would be ex-

pected to have a slower progression of illness and a lower case-fatality rate than either inhalational plague or anthrax. Plague would most likely progress very

MANAGEMENT OF TULAREMIA AS A BIOLOGICAL WEAPON

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