The U.S. Democratic National Convention (DNC) is due to begin on July 26 and will continue to July 29, 2004 in Boston, MA. While security is intense around the DNC, health care providers in RI are advised to be vigilant for clustered clinical syndromes of any kind, common or unusual.

Below is a brief overview of the clinical presentations and syndromic differential diagnoses of selected agents of bioterrorism. To report unusual disease activities call (401) 222-2577 or after hours call (401) 272-5952. For additional information refer to HEALTH’S web page at:

http://www.health.ri.gov/environment/biot/
and/or CDC bioterrorism site at: http://www.bt.cdc.gov/.

IF PATIENT HAS:	CONSIDER:	IN ADDITION TO:
Few days of non-specific "flu-like" symptoms with nausea, emesis, cough +/- chest discomfort, without coryza or rhinorrhea abrupt onset of respiratory distress +/- shock +/- mental status changes, with CXR abnormalities (wide mediastinum, infiltrates, pleural effusions)	Inhalational Anthrax	Bacterial mediastinitis, tularemia, ruptured aortic aneurysm, SVC syndrome, histoplasmosis, coccidioidomycosis, Q fever, psittacosis, Legionnaires’ disease, influenza, sarcoidosis.
Pruritic, painless papule vesicles(s) ulcer edematous black eschar +/- massive edema and regional adenopathy, +/- fever, evolving over 3-7 days	Cutaneous Anthrax	Recluse spider bite, atypical Lyme disease, staphylococcal lesion, Orf, glanders, tularemia, rat-bite fever, ecthyma gangrenosum, plague, rickettsialpox, atypical mycobacteria, diphtheria
Cough, fever, dyspnea, hemoptysis, lung consolidation +/- shock	Pneumonic Plague	Severe bacterial or viral pneumonia, inhalational anthrax, pulmonary infarct, pulmonary hemorrhage
Sepsis, DIC, purpura, acral gangrene	Primary Septicemic Plague	Meningococcemia, Gram-negative, streptococcal, pneumococcal or staphylococcal bacteremia with shock, overwhelming post splenectomy sepsis, acute leukemia.
Synchronous, progressive papular vesicular pustular rash on face, extremities trunk generalization +/- hemorrhagic component, with systemic toxicity and fever	Smallpox	Atypical varicella, drug eruption, Stevens-Johnson Syndrome, atypical measles, secondary syphilis, erythema multiforme, meningococcemia, monkeypox
Acute febrile illness with pleuropneumonitis, bronchiolitis +/- hilar lymphadenopathy, variable progression to respiratory failure	Inhalational Tularemia	Inhalational anthrax, influenza, mycoplasma pneumonia, Legionnaire’s disease, Q fever, Plague
Acute onset of afebrile, symmetric, descending flaccid paralysis that begins in bulbar muscles, dilated pupils, dry mucous membranes with normal mental status and absence of sensory changes.	Botulism	Brain stem CVA, Polio, myasthenia gravis, Guillain-Barre syndrome, tick paralysis, chemical intoxication.

Highlights

Public health emergencies:
What you can do to prepare

Differential Diagnoses of Selected Agents of Bioterrorism
A review of selected agents for physicians. July 21, 2004

Medical Emergency Distribution System (MEDS) Products and Tools

Bioterrorism Program
Report March 2004

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