APPENDIX C-1: DERMATOLOGIC MANIFESTATIONS OF DISEASES INFLICTED BY BIOLOGIC WARFARE/BIOTERRORISM

DERMATOLOGIC MANIFESTATIONS OF DISEASES INFLICTED BY BIOLOGIC WARFARE/BIOTERRORISM: INTRODUCTION

The use of microbial pathogens as potential or actual weapons of terrorism and warfare dates from antiquity. In 2001, the anthrax attacks via the U.S. postal system resulted in 12 cutaneous and 10 inhalational cases of anthrax with 4 deaths. These caused a tremendous amount of anxiety, had an impact on the U.S. postal system, and led to a functional interruption of the activities of the legislative branch of the U.S. government. The U.S. Centers for Disease Control and Prevention (CDC) has classified potential biologic agents into three categories: A, B, and C (Table C-1). Category A agents are the priority pathogens requiring special attention for public health preparedness. Many of these lead to skin signs and symptoms and are therefore of major concern to dermatologists. The potential bioterrorism diseases with dermatologic manifestations are:

• Anthrax.

• Plague.

• Smallpox.

• Smallpox vaccine (vaccinia).

• Tularemia.

• Viral hemorrhagic fevers.

Full information on plague and the viral hemorrhagic fevers as well as infections with anthrax by inhalation can be obtained at the CDC website: http://emergency.cdc.gov/agent/agentlist.asp.

Information on all of these agents and related links can be obtained at the following websites:

• www.bt.cdc.gov/agent/smallpox/diagnosis/pdf/spox-poster-full.pdf.

• http://jama.ama-assn.org/cgi/content/full/287/18/2391.