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©2013 UpToDate ® Print Email Bioterrorism agents that could cause outbreaks or clusters characterized by respiratory symptoms - differential diagnosis and key features Agent Time to onset Chest radiograph Fatality Onset to respiratory failure Anthrax (inhalation) 1-6 days Mediastinal widening, pleural effusions 90 percent 1-3 days Plague (pneumonic) 2-3 days Bilateral infiltrates, may have pleural effusions 90 percent Within 1 day Tularemia 2-10 days Bilateral infiltrates hilar adenopathy 30 percent w/o therapy, <5 percent with therapy Low incidence Legionella 2-10 days Variable, bilateral subsegmental infiltrates or consolidation 15 percent Variable incidence Influenza 1-2 days Variable bilateral interstitial or alveolar infiltrates 10-25 percent in those with underlying diseases Variable incidence Ricin (inhalation) 18-24 hrs Likely bilateral infiltrates/ARDS High Likely within 30 hrs Adapted from: Karwa M, Currie B, Kvetan V. Bioterrorism: Preparing for the impossible or the improbable. Crit Care Med 2005; 33:S75.