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O'Byrne WT, Terndrup TE, Kiefe CI, Weissman NW. A Primer on Biological Weapons for the Clinician, Part I. Johns Hopkins Advanced Studies in Medicine. 2003 Feb 1; 3:75-86.
Although the thought of an outbreak of disease caused by the intentional release of a pathogen in a major American city was alien a decade ago, the purposeful release of anthrax via the US Postal Service and the resulting deaths from inhalation anthrax have caused a sea change in thinking about biological weapons and 'bioweaponeers.' Most experts agree that a biological attack is imminent and the toll in suffering and death potentially great. In the event of a bioterrorist attack, the emergency physician and the hospital will most likely be the first clinical responders. However, some biologic agents produce initial symptoms that are nonspecific and thus may not have a high index of suspicion until severe morbidity or fatality results. It is imperative, then, that individual outpatient and ambulatory care providers consider biologic agents whenever a patient presents with nonspecific constitutional symptoms. Tbis is particularly true of physicians whose practices are comprised mainly of elderly or older adult patients. Internists, family physicians, geriatricians, and others who care for elderly people will face unique clinical challenges when faced with an attack involving a biologic agent. The purpose of this article is to address the needs of internists, family physicians, geriatricians, and their counterparts with concise and current information on the Centers for Disease Control Category A pathogens, taking into account diagnostic challenges germane to elderly populations.