[Detection and identification of a biological attack]

It is difficult to detect bioterrorism attacks and to identify the castoff biological agent. The principal enigmas are the wide variety of the clinical symptoms associated with various biological agents and the fact that the attack is likely to be a covert event. The first and major indication of a bioterrorism attack could be the presence of affected patients. It is, however, extremely important to detect and identify an attack using a biological agent as early as possible. Therefore, it is crucial to be alert to such possibilities and to maintain high levels of suspicion. The aim of this article is to list all the clues, which will help us highlight the suspicion that a disease or clinical symptoms are the result of a bioterrorism attack and not a "natural" outbreak. These clues involve the recognition of a wide range of clinical patterns pertinent to biological agent attacks on the individual victim and the overall integrated epidemiological picture. Further signs also include the identification of the roots of transmission, the contagious patterns of bioterrorism agents and possible unusual findings in laboratory tests and in animals.