Skin diseases in bioterrorism

Abstract

These catastrophic illnesses often have distinct cutaneous findings when encountered in natural conditions, yet when disseminated as a bio-weapon, cutaneous findings may be infrequent and unhelpful. Anthrax illness is caused by the spores, not by the living bacterium. Weaponized anthrax will likely manifest as a pulmonary disease with few cutaneous findings. Haemorrhagic mediastinitis is the hallmark of pulmonary anthrax. Post-exposure prophylaxis and treatment for all forms of anthrax must continue for a full 60 days. Primary dissemination and spread of smallpox occurs via respiratory droplets, yet fomites like bedding or infected clothing may also spread the virus. Smallpox exanthem begins on the face and extremities, and progresses inward to involve the trunk. All suspected and confirmed cases of smallpox require strict negative-pressure isolation, respiratory precautions, and universal precautions. Francisella tularensis is a highly infectious organism, able to cause disease in humans from infection by as few as ten colony-forming units. Isolation is not recommended for tularemia patients, as there is no evidence that person-to-person transmission exists. Primary pulmonary plague has a mortality rate approaching 100% if not treated in the first 24 h of symptoms. © Springer Berlin Heidelberg 2009.