Schmid G, Kaufmann A
World Health Organization, Geneva, Switzerland.
Clin Microbiol Infect. 2002 Aug;8(8):479-88. doi: 10.1046/j.1469-0691.2002.00500.x.
In the 2001 bioterrorist attack in the United States, in which at least 22 cases of anthrax occurred, there was initial uncertainty as to whether the index case was acquired from natural sources, and many of the additional cases posed diagnostic challenges to clinicians unfamiliar with the disease. The existence in Europe of terrorist groups with demonstrated violent tendencies suggests Europe is not immune to bioterrorist attack, and the same epidemiological and clinical confusion could happen here. Bacillus anthracis is distributed widely in the soils of Europe and foci of animal disease occur, notably in southern and eastern Europe. Sporadic human cases occur in these areas, and occasional additional cases have been acquired from contaminated, imported materials or acquired in countries outside of Europe, where anthrax may be common. Depending upon the intent of a bioterrorist, illness-caused B. anthracis could take one of several clinical forms-inhalational, cutaneous or gastrointestinal-and each would pose diagnostic difficulties. Understanding the epidemiologic, pathophysiologic and bioterrorism principles of anthrax are the clinician's best means of early detection of cases.
在2001年美国发生的生物恐怖袭击中，至少出现了22例炭疽病例，最初无法确定首例病例是否源自自然感染源，而且许多新增病例给不熟悉该疾病的临床医生带来了诊断难题。欧洲存在一些有暴力倾向的恐怖组织，这表明欧洲也难以避免生物恐怖袭击，同样的流行病学和临床诊断困惑也可能在此出现。炭疽芽孢杆菌在欧洲土壤中广泛分布，动物疾病疫源地也有出现，尤其是在欧洲南部和东部。在这些地区会出现散发性人类病例，偶尔也会有因接触受污染的进口材料或在欧洲以外炭疽常见的国家感染而新增的病例。根据生物恐怖分子的意图，由炭疽芽孢杆菌引发的疾病可能呈现几种临床形式之一——吸入性、皮肤性或胃肠道性——而每种形式都会带来诊断困难。了解炭疽的流行病学、病理生理学和生物恐怖主义原理是临床医生早期发现病例的最佳方法。
