Therapeutic challenges posed by bacterial bioterrorism threats Peter H. Gilligan Current Opinion in Microbiology 2002, 5:489-495 The events of the autumn of 2001 in the United States made it clear that the spectre of the use of microorganisms to intentionally harm humans is a reality. The current strategy to control disease outbreaks caused by the intentional release of bacteria is to use antimicrobial agents, both therapeutically and prophylactically. However, multidrug-resistant strains of bacterial bioterrorism agents occur naturally or have been bio-engineered, indicating how vulnerable this strategy is.   Introduction In April 2000, the Centers for Disease Control (CDC) in the United States released a strategic plan for responding to a bioterrorism (BT) attack [1]. In that report, they categorized several infectious agents, including three bacteria, Bacillus anthracis, Yersinia pestis, and Francisella tularensis, that were likely to be used as BT agents for three reasons. First, these agents are either easily transmitted (B. anthracis and F. tularensis) or they can be spread from person to person (Y. pestis); second, they have the potential to cause high mortality; and third, their release might result in public panic and disorder. They designated these organisms as 'category A'. A second group, designated as category B, were judged to be less dangerous but still a cause for concern. Three additional bacteria, Brucella spp., Burkholderia pseudomallei, and Burkholderia mallei, were listed. Both Brucella and B. mallei also have the potential for being used in agro-terrorism, since both are primarily animal pathogens, whereas B. psuedomallei is a human pathogen. In October 2001, the hypothetical concerns surrounding the use of microbes as BT agents became reality with the recognition of a fatal case of anthrax in a Florida man [2••]. Over the next few months, another ten individuals developed inhalational anthrax, four of whom died. Eight confirmed cutaneous cases of anthrax also occurred but with no fatalities [3••,4] . It is now clear that a series of letters containing anthrax spores, sent through the US mail, were responsible for this outbreak. Because large numbers of individuals were potentially exposed to these spores via handling tainted letters or being present when such letters were opened, thousands of individuals received antimicrobial prophylaxis, with most taking ciprofloxacin and a small minority receiving doxycyline or amoxicillin [5]. Because infections with the category-A and -B organisms listed above are so uncommon in the industrialized world, there is limited knowledge on the frequency of and how best to detect in vitro drug resistance of these organisms. The understanding of the effectiveness of various antimicrobial regimens in treating infections with these organisms or their prophylactic use is limited. In this review, these issues will be examined for the six bacterial agents listed in Table 1.   Go to the Full Article > >  As a BioMedNet member you have free full-text access to this article within BioMedNet Reviews for 14 days  You will have full-text access to all articles if your institute subscribes. Recommend a subscription to your librarian  There are 15,000 more Review articles in BioMedNet Reviews  Please send us your feedback on this magazine		BioMedNet Magazine 9th - 22nd October 2002 Magazine Home Email to a Friend Full Article PDF printer ready version   Further Reading* Bioterrorism: responding to an emerging threat [Opinion] Margaret A. Hamburg Trends in Biotechnology 2002, 20:296-298   2001: a year of major advances in anthrax toxin research [Review] Michael Mourez et al. Trends in Microbiology 2002, 10:287-293   The threat of smallpox and bioterrorism [Opinion] Patrick Berche 2001, 9:15-18   New and re-emerging infectious diseases [Meeting report] Roberto Docampo Trends in Parasitology 2002, 18:334-336   Potential applications of DNA microarrays in biodefense-related diagnostics [Review] David A. Stenger et al. Current Opinion in Biotechnology 2002, 13:208-212     * Full text access to the journal articles above is available to BioMedNet Reviews institutional subscribers       Related Links in BioMedNet Reviews Journal Table of Contents Table of Contents by email Related Full Text Articles Browse Microbiology Browse Biotechnology Browse Drug Discovery Browse Pharmaceutical Science Browse Immunology Search BioMedNet Reviews