Table 2.
Summary table of biological warfare agents
| Agent | Mortality | Potential Plastic Surgery Consultation |
|---|---|---|
| Smallpox | 30% without pre- or postexposure vaccination | • Lesions may become confluent with resultant skin slough. Potential for burn-like care and resuscitation |
| • Bacterial super-infection of skin may occur | ||
| • Vaccine complications include skin necrosis at inoculation site (ie, Vaccinia necrosum) | ||
| Anthrax | 20% in the untreated cutaneous form | • Even with prompt antibiotic therapy, cutaneous lesions progress through eschar phase |
| • Debridement relatively contraindicated due to risk of hematogenous spread and secondary pneumonic anthrax | ||
| Plague | 50% in the untreated group | • Erythematous, eroded, crusting, necrotic ulcer at primary inoculation site |
| • Incision and drainage of lymphadenopathy (buboes) is contraindicated due to the risk of hematogenous spread and subsequent, secondary pneumonic plague | ||
| • Respiratory isolation important for healthcare workers to prevent secondary pneumonic plague | ||
| VHF (ie, Ebola) | 50%-90% within 1 wk | • Mucosal and/or cutaneous ecchymoses common, can be associated with overlying skin slough |
| • Rule out acute compartment syndrome with extremity involvement | ||
| Tularemia | 80% in untreated inhalational form | • “Heaped-up” ulcer at primary inoculation site |
| • Incision and drainage of lymphadenopathy (“plague-like” buboes) is contraindicated due to the risk of hematogenous spread and secondary pneumonic tularemia | ||
| Botulism | 60% in the untreated group | • Terrorist attack likely to be in aerosolized form, causing inhalational botulism. Requiring respiratory support for flaccid paralysis |
| • If wound botulism is suspected as cause of flaccid paralysis, wide debridement is indicated |
VHF indicates viral hemorrhagic fever.