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and possible, albeit somewhat more difficult, to induce
tetracycline resistance. Therefore, if there is information
indicating a biological weapon attack, prophylaxis with
ciprofloxacin (500 mg po bid), or doxycycline (100 mg po bid)
should begin. If unvaccinated, a single 0.5 ml dose of vaccine
should also be given subcutaneously. Should the attack be
confirmed as anthrax, antibiotics should be continued for at
least 4 weeks in all exposed. In addition, two 0.5 ml doses of
vaccine should be given 2 weeks apart in unvaccinated; those
previously vaccinated with fewer than three doses should
receive a single 0.5 ml booster, while vaccination probably is
not necessary for those who have received the entire three-dose
primary series. Upon discontinuation of antibiotics, patients
should be closely observed; if clinical signs of anthrax occur,
patients should be treated as indicated above. If vaccine is
not available, antibiotics should be continued beyond 4 weeks
until the patient can be closely observed upon discontinuation
of therapy.

:-       BOTULISM

CLINICAL SYNDROME

Botulism is caused by intoxication with the neurotoxin
produced by Clostridium botulinum. The toxin is a protein with
molecular weight of approximately 150,000, which binds to the
presynaptic membrane of neurons at peripheral cholinergic
synapses to prevent release of acetylcholine and block
neurotransmission. The blockage is most evident clinically in
the cholinergic autonomic nervous system and at the
neuromuscular junction.

A biological warfare attack with botulinum toxin delivered
by aerosol to the respiratory tract would be expected to cause
symptoms similar in most respects to those observed with
foodborne botulism.

Clinical Features: Symptoms of botulism may begin as early
as 3-36 hours following exposure, or as late as several days.
Initial symptoms include generalized weakness, lassitude, and
dizziness. Diminished salivation with extreme dryness of the
mouth and throat may cause complaints of a sore throat.

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