Critical Care Medicine-Infections and Immunologic Disease>>>>>Bioterrorism
Question 3#

The emergency department calls to inform you that there are multiple patients with symptoms of fever, altered mental status, respiratory failure, and shock that will be transferred to the ICU. Features that the patients may be victims of a biologic attack include all of the following EXCEPT:

A. Reports of similar cases at other hospitals and clinics
B. Large numbers of rapidly fatal cases
C. A rise in a number of patients with similar symptoms over a few hours to days and then a drop off in patients with the symptoms
D. Patients arriving from a disperse area

Correct Answer is D


Correct Answer: D

Bioterrorism refers to the use of biologic agents as weapons to further personal or political agendas. Unlike other methods of terrorism, the effects are not always immediately apparent and can be difficult to distinguish from an outbreak of a naturally occurring infectious disease. Features of a possible bioterrorism-related attack include:

  1. Rapid rise of cases (within hours or days) in a normally healthy population
  2. Number of cases rises and falls during a short period of time (few hours to days) versus more protracted course (weeks to months) seen in natural outbreaks
  3. An unusual increase in number of patients with complaints of fever, respiratory, or gastrointestinal complaints
  4. An endemic disease that occurs in large number of patients at an uncharacteristic time or in an unusual pattern
  5. Lower attack rates among people who were indoors compared to those outdoors
  6. Large number of patients arriving from single locale
  7. Large number of rapidly fatal cases
  8. Patients with uncommon disease with bioterrorism potential (eg anthrax, tularemia, plague)
  9. Increased numbers of sick or dead animals


  1. Karma M, Currie B, Kvetan V. Bioterrorism: preparing for the impossible or the improbable. Crit Care Med. 2005;33:S75-S95.
  2. Bioterrorism Readiness Plan: A Template for Healthcare Facilities. Accessed October 15, 2018.