Clinical findings of chemical and biological terrorist agent exposure

	Chemical agent	Toxins	Biologic agents
Timing of symptoms	Often rapid onset (minutes to days)*	Delayed (hours to days)	Delayed (days to weeks)
Unusual fog or smoke	Not necessarily*	No	No
Multiple simultaneous victims with similar symptoms	Common, geographically concentrated	Common, geographically concentrated	Less likely, may be geographically dispersed
Fever	No	No	Yes
Respiratory distress	Often	Often	Often
Rash	No	Rare	Frequent
Vesicles	Sulfur mustard, Lewisite, and, less commonly, riot-control agents	T-2 exposure only	Some agents
Bleeding	Uncommon	Some cases	Many agents
Neuromuscular effects (eg, seizures, weakness)	Cyanide or nerve agents	Botulinum exposure	No
Failure to respond to typical therapy	Depends upon severity of exposure^¶	Sometimes^Δ	Yes (eg, multi-antibiotic resistant organisms)
Unexplained human deaths	Yes	Yes	Yes
Unexplained deaths of animals, fish, or plants	Yes	Yes	Yes

* Exposure to some liquid forms of chemical weapons may take many hours to be absorbed and cause symptoms. Morever, chemical vapors may be invisible.
¶ For example, victims exposed to pulmonary agents may have unremitting respiratory failure despite the use of advanced therapies.
Δ For many toxins, therapy is mainly supportive and may be ineffective if the dose is high or recognition has been delayed.

Data from: Madsen JM. Toxins as weapons of mass destruction. A comparison and contrast with biological-warfare and chemical-warfare agents. Clin Lab Med 2001; 21:593.

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Clinical findings of chemical and biological terrorist agent exposure