CLINICAL CHARACTERISTICS OF CRITICAL BIOLOGICAL AGENTS			
Disease	Signs & Symptoms	Physical Exam	Clinical Tests	Key Differential	Incubation	Duration of	Case	
				diagnosis	period	illness	Fatality	
Inhalation	Fever, malaise, cough, mild	Non-specific	Serology, gram stain,	Hantavirus pulmonary	1-6 days (up to	3-5 days	100% if	
Anthrax	chest discomfort; possible short	physical findings	culture, polymerase	syndrome (HPS),	45 days)		untreated	
	recovery phase then onset of		chain reaction (PCR);	Dissecting aortic				
	dyspnea, diaphoresis, stridor,		CXR - widened	aneurysm (no fever)				
	cyanosis, shock. Death 24-36		mediastinum, rarely					
	hours after onset of severe		pneumonia.					
	symptoms. Hemorrhagic							
	meningitis in up to 50%.							
Pneumonic	High fever, chills, headache,	Rales, hemoptysis,	Gram stain, culture,	HPS, TB, community	2-3 days	1-6 days	Usually fatal	
Plague	hemoptysis and toxemia, rapid	purpura	serum immunoassay for	acquired pneumonia			unless	
	progression to dyspnea, stridor,		capsular antigen, PCR,	(CAP), meningococcemia,			treated in	
	and cyanosis. Death from		immunohistochemical	rickettsioses			12-24 hours	
	respiratory failure, shock, and		stains (IHC)					
	bleeding.							
Tularemia	Typhoidal -- aerosol,	No adenopathy	Serology, culture, PCR,	Atypical CAP, Q fever,	1-10 days	> 2 weeks	10-35%	
	gastrointestinal, & intradermal	with typhoidal	IHC; CXR - pneumonia,	Brucellosis	(average 3-5		untreated	
	challenge. Fever, headache,	illness	mediastinal		days)			
	malaise, chest discomfort,		lymphadenopathy, or					
	anorexia, non-productive cough.		pleural effusion.					
	Pneumonia in 30-80%.							
	Oculoglandular from inoculation							
	of conjunctiva with periorbital							
	edema.							
Smallpox	Fever, back pain, vomiting,	Papules, pustules,	Guarnieri bodies on	Varicella, vaccinia,	7-17 days	4 weeks	Up to 30%;	
	malaise, headache, rigors.	or scabs of similar	Giemsa or modified	monkeypox, cowpox,	(average 12		higher in flat-	
	Papules 2-3 days later,	stage, many on	silver stain, virions on	disseminated herpes	days)		type or	
	progressing to pustular vesicles.	face/extremities,	electron microscopy,	zoster			hemorrhagic	
	Abundant on face and	palms/soles	PCR, viral isolation, IHC				disease	
	extremities initially.							
Botulism	Ptosis, blurred vision, diplopia,	No fever, patient	Serology, toxin	Guillain Barre, myasthenia	1-5 days	Death 24-72	High	
	generalized weakness, dizziness,	alert, postural	assays/anaerobic	gravis, tick paralysis,		hours or	mortality	
	dysarthria, dysphonia,	hypotension, pupils	cultures of blood/stool;	Mg++ intoxication,		respiratory	without	
	dysphagia, followed by	unreactive, normal	electromyography	organophosphate		support for	respiratory	
	symmetrical descending flaccid	sensation, variable	studies	poisoning, polio		months	support	
	paralysis and respiratory failure.	muscle weakness						
Filoviruses	Fever, severe headache,	Petechia,	Serology, PCR, IHC,	Meningococcemia,	2-19 days	Days to weeks	>80%	
(Maburg,	malaise, myalgia, maculopapular	ecchymoses,	electron microscopy	malaria, typhus,	(average 4-10			
Ebola)	rash day 5; progression to	conjunctivitis,	(EM); elevated liver	leptospirosis, borreliosis,	days)			
	pharyngitis, hematemasis,	uncontrolled	enzymes,	thrombotic				
	melena, uncontrolled bleeding;	bleeding	thrombocytopenia	thrombocytopenic				
	shock/death days 6-9			purpura (TTP),				
				rickettsiosis, hemolytic				
				uremic syndrome (HUS),				
				arenaviruses				
Arenaviruses	Fever, malaise, myalgia,	Conjunctivitis,	Serology, viral isolation,	Leptospirosis,	5-21 days	7-15 days	15-30%	
(Lassa, Junin,	headache, N/V, pharyngitis,	petechia,	PCR, IHC; leukopenia,	meningococcemia,	Lassa:			
Sabia,	cough, retrosternal pain,	ecchymoses,	thrombocytopenia,	malaria, typhus,	7-16 days			
Machupo,	bleeding, tremors of tongue and	flushing over head	proteinuria	borreliosis, rickettsiosis,	Sabia, Junin,			
Guanarito)	hands (Junin), shock, aseptic	and upper torso		TTP, HUS, filoviruses	Machupo,			
	meningitis, coma, hearing loss in				Guanarito			
	some.