A clinical approach to an unidentified aerosolized bioterrorism agent: a narrative review for emergency providers

Abstract

The current heightened international political climate is accompanied by increased risk of chemical or biological agent weaponization. Historical accounts of biochemical warfare are extensive, and considering the recent use of such agents for targeted attacks, clinicians need to recognize and manage these cases. However, agent properties such as the color, odor, ability to be aerosolized, and long incubation period can introduce difficulties in the diagnostic and management approach. We searched PubMed and Scopus for a colorless, odorless, aerosolized substance with an incubation period of at least 4 hours. Data from articles were summarized and reported by agent. Based on data from the available literature, we included agents such as nerve agents, ricin, botulinum toxin, anthrax, tularemia, and psittacosis in this review. We also highlighted potential chemical and biological agents that could be weaponized and the optimal strategies for the diagnosis and treatment of patients exposed to an unknown aerosolized biological or chemical bioterrorism agent.

Keywords: Biological warfare agents; Bioterrorism; Chemical warfare agents; Emergency department; Nerve agents.

Fig. 1.

Approach to asymptomatic patient presentation in the emergency department with exposure to unknown aerosol substance. CDC, Centers for Disease Control and Prevention; PPE, personal protective equipment; IV, intravenous; 2-PAM, pralidoxime.