Pulmonary manifestations of intentionally released chemical and biological agents

Recent events have underscored the importance of knowledge and understanding of biological and chemical agents that are intentionally released on civilian populations. Preparedness of the medical community to recognize and manage the resulting clinical syndromes will be a major determinant in the outcome of such attack, or a community's 'prognosis' for survival. The biological and chemical agents that have been weaponized produce diseases and toxidromes that are not commonly seen by clinicians in most parts of the United States. Patients or clusters of patients who present with febrile syndromes that are unusual for the geographic or seasonal setting should trigger notification of public health authorities and the use of state or national reference lab systems for augmented diagnostic support. In many cases, early, empiric therapy, administered before definitive diagnosis, is required for survival. The basic principles in the management of exposure to chemical agents include containment, prevention of secondary exposure, rapid decontamination, implementation of supportive and symptomatic care, and specific antidotes as indicated and available.