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Am Fam Physician. 2004;69(8):1860

to the editor: I read with interest the article1 on bioterrorism agents in the May 1, 2003 issue of American Family Physician. This timely piece offered useful advice to assist family physicians on an important topic. I would like to recommend some information not included in the article.

First, the method of diagnosis that is described in Table 11 for plague should include culture of bubo aspirate (for bubonic plague) in addition to sputum, blood, and cerebrospinal fluid cultures for pneumonic and septicemic plague.

Second, Table 21 only describes the treatment for inhalational anthrax. There is a separate treatment regimen for cutaneous anthrax.2 Furthermore, clinicians can consider extending the usual 60-day anthrax prophylaxis to 100 days based on the possibility that disease may occur up to 100 days after exposure.3

IN REPLY: We appreciate Dr. Campos-Outcalt's pointing out the additional information on bioterrorism infections. He correctly notes that a culture of bubo aspirate should be done if a bubo is present. However, in a bioterrorism attack, persons will be more likely to have pulmonic plague rather than bubonic plague, and this is why we chose not to list this culture in Table 1 of our article.1 Cutaneous anthrax treatment is not listed in Table 2 of our article1 because any case of cutaneous anthrax seen during a bioterrorist attack is treated as presumed inhalation anthrax until proven otherwise.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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