Distinguishing Natural Disease vs Bioterrorism

Bioterrorism

• No known endemic exposure through the patient's residence, occupation, or through recent travel.
• A point source would become apparent for the outbreak and it would be seen in urban, crowd-generating settings.
• Unexpected severe respiratory illness in otherwise healthy persons.
• A cluster of cases of severe and fatal pneumonia, characterized by the rapid development of respiratory failure, shock, bleeding, and other signs of the systemic inflammatory response syndrome (assuming, of course, there is no other known cause).
• Cases of plague that do not respond as expected to the recommended antibiotic treatment should raise the suspicion of a bioengineered or selected resistance.