BIOTERRORISM
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1. Introduction
Historically, infectious disease outbreaks brought about by microbial species against human beings have caused far more mortality rates than war itself. Numerous cases of disease outbreaks in the past have been a major concern to health authorities, although such concerns have been partially addressed in the recent past. Examples of disease outbreaks in the past include: the infamous Bubonic Plague of the 14th century in Europe that led to the death of approximately a quarter of the continent’s population (approximately 25 million people); the influenza pandemic of 1918 to 1919 that led to the death of 21 million people; and the death of 95% of Pre-Columbian Native American people by measles, plague, small pox, influenza, and typhoid (Magner, 2009). Although there has been some response to such epidemics in the recent past, naturally occurring infections still remain the Achilles’ heel of today’s health systems.
2. Terrorism Versus Bioterrorism
Despite the dark past in healthcare systems, current issues of the use of biological agents as means of mass destruction is alarming. Most of the countries across the globe are now faced with the daunting task of terrorism control, since this is one area where biological agents find a lot of use. According to Forst, terrorism may be defined as a “premeditated and unlawful use of violence [on] non-combatant populations having symbolic significance….” (Forst, 2009). Forst mentions that the premeditated and unlawful use of violence usually has an aim of inducing or influencing changes in existing political landscapes; this is normally done through intimidation as well as destabilization of the populations in question. Such populations are identified as enemies by perpetrators of this form of violence. Bioterrorism, then, refers to a form of terrorism where biological agents are intentionally used or released to human populations, plants, animals and other living things to cause harm to them (Radosavljevic, 2012). The use of these biological agents may be to (i) influence conduct of a particular government, (ii) coerce, or (iii) intimidate a non-combatant civil population. Terrorists are most likely to use biological agents nowadays because of their easy channels of development as weapons of mass destruction, difficult detection status, and the fact that they are inexpensive to acquire them.
3. Potential Biological Agents
Though many bacteria, viruses, fungi, and toxins can be pathogenic, bioterrorists rely on a number of more viable agents to further their objectives. The most likely biological agents are selected based on a number of factors. For example, a particular biological agent has four components: (i) payload, (ii) munitions, (iii) delivery systems, and (iv) channels of dispersion. The payload is normally the agent itself while the munitions are additional components that protect the biological agent; they ensure that the agent maintains the desired potency as it is being transferred or delivered. On the other hand, the dispersion channel entails all systems in which the biological agent is going to be delivered. Such systems may include aircraft, boat or vehicles. The agent may then be dispersed in form of aerosol sprays, through food, water, or in form of explosives (though not common).
The chosen biological agent should possess three major characteristics before it can be used. For one, it should produce the desired effects consistently without fail. Secondly, it should be very contagious to allow quick spread of desired effects; the agent should also have very short as well as predictable incubation periods. The third condition that the agent ought to meet is difficulty in its identification or suspicion as a tool for bioterrorism (Radosavljevic, 2012). Based on these criteria, there are a number of biological agents that can be utilized in the local settings. These include fungal, bacterial, toxins, and viral pathogens. Under bacterial pathogens, the potential ones include Bacillus anthracis (which causes anthrax); Salmonella typhimurium (causative agent of typhoid); Escherichia coli strain 0157:H7 and Shigella species which may cause food poisoning. Other biological agents include: Yersinia pestis (causes plague); Brucella species (causes brucellosis); and toxins such as the botulinum toxin released by Clostridium botulinum; ricin toxin from Ricinus communis (castor bean); and staphylococcal enterotoxin B from Staphylococcus aureus (causes food poisoning).
All of the above biological agents fall within the first two categories of classification developed by the US Centers of Disease Control (CDC). These classification categories are (i) category A and (ii) category B. Category A consists of Bacillus anthracis and Yersinia pestis. These agents are classified as A because they are the highest priority agents; they also pose the greatest risk due to their ease in dissemination and transmission from victim to victim. Category A agents are also known to cause great mortality rates and public panic, and therefore require special attention and action by health authorities. On the other hand, category B consists of the rest of the biological agents, including the toxins. Usually, these agents have the second highest priority since they are moderate in their ease of dissemination and transmission from person to person. They also cause moderate mortality as well as morbidity, and require enhanced disease surveillance and diagnostic capacity by health authorities.
3.1 Laboratory Diagnosis of Different Biological Agents
a) Bacillus anthracis: This is the bacterium that causes anthrax. If patients are suspected to have contracted the disease, specimens collected from human samples are quickly sent to a laboratory; the laboratory should support the use of initial diagnostic as well as confirmatory tests, especially if there are many patients involved in one area. In this case, therefore, rapid diagnosis tests would involve tests for blood or other body fluids directly. Other body fluid tests refer to the spinal fluid, skin lesion swabs, and sputum. These tests should be followed by culturing the suspected organism in order to determine its identity; however, culturing should be performed using rapid tests such as the real-time polymerase chain reaction (PCR) in order to save time and allow for immediate identification. If Bacillus anthracis is found in the specimens, the bacterium may require confirmation other confirmatory and more definitive tests that take between 1 and 3 days to give results. For the Gram stain test, Bacillus anthracis may be identified as thick, long and straight bacilli with either truncated or square ends having parallel sides. The bacilli are found single or in chains or pairs of between 3 and 4 bacteria. The truncated bacilli may also look swollen at the ends, and usually give a “bamboo stick” appearance. In cases of inhalation anthrax, chest X-rays or CT scans may be performed to confirm the presence or absence of mediastinal widening or pleural effusion (common findings in patients with inhalation anthrax).
b) Yersinia pestis: For the identification or diagnosis of this bacterium, a high level clinical suspicion as well as epidemiologic history and physical examination are required. This allows timely diagnosis of plague (usually caused by this bacterium). Upon suspicion of plague, clinical specimens should be collected and taken for microbiological tests. Effective antimicrobial therapy should also begin even before results confirming the disease are out. Effective tests for this bacterium include (i) blood smears and culture, (ii) lymph node aspirates as well as culture in patients with suspected buboes, (iii) respiratory aspirates or sputum samples in patients with suspected pneumonic plagues, and (iv) cerebrospinal fluid (CSF) aspirates in patients suspected to have meningitis. These specimens may also be subjected to direct fluorescent antibody (DFA) test to detect Fraction 1 envelope (F1) antigen found in Y. pestis. This antigen is normally expressed at 37ºC and only after 24-48 hours of incubation. Further diagnostic tests for this bacterium include Immunoglobulin-M enzyme immunoassay, immunostaining, and PCR tests.
c) Brucellosis: This is a zoonotic disease brought about by infection with one of six Brucellae species. These species are a group of facultative and gram-negative coccobacilli found intracellularly. They include B. abortus (infects cattle), B. melitensis (found in goats), B. suis (infects pigs), and B. canis (infects dogs). The normal incubation period of the bacteria is 8 to 14 days, though it may take long in specific cases. Usually, diagnosis involves blood and bone marrow cultures which yield positive results in 15 to 70% and 92 %, respectively. However, a two-phased culture technique known as the Castaneda bottle may be used to improve diagnostic and isolation rate, especially from blood. For the Gram stain test, tiny, faintly staining gram-negative coccobacilli should be observed. These coccobacilli should be slow growing and must give a positive oxidase reaction, especially on sheep blood. More confirmatory tests include (i) Serum Agglutination Test (SAT) for detecting Immunoglobulin-M and Immunoglobulin-G antibodies; in this case, a titer of 1:160 or more in one specimen indicates an active disease, (ii) Enzyme-linked Immunosorbent Assays (ELISAs), and (iii) Polymerase Chain Reactions (PCR) tests.
d) Ricin toxin: Ricin is normally a cell toxin derived from the beans of the castor plant known as Ricinus communis. On inhalation, the toxin causes an acute fever, cough, chest tightness, arthralgia, and nausea within a period of 4 to 8 hours. Acute cases of respiratory distress syndrome (RDS) occur in 18 to 24 hours followed by hypoxemia and death in 36 to 72 hours. The ricin toxin can be detected in the blood by the Enzyme-linked Immunosorbent Assays (ELISAs) techniques which detect the serum and respiratory ricin antigen. Other tests are the retrospective diagnostic tests based on antibody testing, especially in acute serum (Gilchrist, 2000).
e) Staphylococcal Enterotoxin B: This is a pyrogenic (fever-causing) enterotoxin that leads to food poisoning. It is normally produced by Staphylococcus aureus. The effects of this toxin are mostly concentrated in the gastrointestinal tract (GIT) where the bacterium exerts its maximum effects. Staphylococcal food poisoning is mostly diagnosed by presenting clinical signs as well as epidemiology. Usually, the enterotoxin is found in urine, respiratory secretions (including nasal swabs), and blood for short periods of time. It can therefore be detected by ELISAs and Enzyme Chemiluminescence (ECL). More definitive tests that may be used to identify the toxin in food include (i) Polymerase Chain Reaction assays (finds S. aureus genes in food samples) and (ii) a reverse passive latex agglutination test that rapidly identifies the toxin in food. All the other biological agents are always identified through any or a combination of the above methods.
4. Laboratory Preparedness
Laboratory preparedness plays a critical part in responding to bioterrorism threats. Without the necessary laboratory preparedness, such attacks can be fatal. There are three basic tenets of laboratory preparedness that ought to be considered (Ramsay, 2001). These tenets are as follows:
I. Training: Training of laboratory staff is important because it enables the staff to recognize and respond adequately to potential biological agents. Training, in this case, would encompass knowing how to handle the biological agent and performing quick and accurate diagnostic tests for the biological agents. The laboratory staff also needs to be aware of health hazards that may arise from such biological agents as a result of poor laboratory practices; the training therefore, should focus on the maintenance of Good Laboratory Practice (GLP).
II. Communication: In any laboratory setting, communication is paramount. This becomes critical in cases of potential bioterrorism attacks which are considered emergencies. Rapid and accurate communication channels should be utilized in order to prevent further contamination among the population at risk. Communication is also necessary in laboratory settings to provide for safe and quick sample handling and processing.
III. Resource mobilization: The mobilization of resources is also a critical step toward effective laboratory preparedness. Usually, this step triggers the utilization of additional diagnostic tests (if desired) as well as epidemiological support for more effective control of biological agents.

Reference List
Forst, B. (2009). Terrorism, crime, and public policy. Cambridge: Cambridge University Press.
Gilchrist, M. (2000). Laboratory safety, management, and diagnosis of biological agents associated with bioterrorism. Washington, DC: American Society for Microbiology.
Magner, L. (2009). A history of infectious diseases and the microbial world. Westport, Conn.: Praeger.
Radosavljevic, V. (2012). Strategies in Fighting Bioterrorism. J Bioterr Biodef, 03(01).
Ramsay, S. (2001). WHO urges preparedness for biological weapon attacks. The Lancet, 358(9287), p.1070.