Bioterrorism: a clinical reality.

The intentional delivery of Bacillus anthracis spores through mailed letters or packages established the clinical reality of bioterrorism in the United States in autumn 2001. An understanding of the epidemiology, clinical manifestations, and management of the more credible biologic agents is critical to limiting morbidity and mortality from a bioterrorism attack.1-5 Children may be particularly vulnerable to a bioterrorist attack for several reasons.6 They have a more rapid respiratory rate, a lower breathing zone, increased skin permeability, higher ratio of skin surface area to mass, and less fl uid reserve than adults. Accurate and rapid diagnosis may be more diffi cult in children because of their inability to describe symptoms. Their caretakers may become ill or require quarantine during a bioterrorist event. Preventive and therapeutic agents recommended for adults exposed or potentially exposed to agents of bioterrorism have not been studied in infants and children.7