Infectious Disease and Bioterrorism

The dual issues of infectious disease and bioterrorism seemed far from our lives as many of us in practice today began our careers some years ago. Tuberculosis was bin a cageQ and smallpox and anthrax were of interest only in a historical context. Ever-improving antibiotics managed just about everything, it seemed, although the thoughtful among us were ever mindful of viral diseases and their potential for acute disease and long-term health consequences. Bioterrorism remained an obscure topic until even more recently and was thought of only in historical terms—if at all—by most physicians. Wasn’t chemical warfare something from World War I and certainly not our concern? However, as HIV crept quietly into our population in the early 1980s, the winds of change were beginning and a significant chain of events was set in motion. Serious and potentially lethal infectious diseases were back in the news and in our medical practice—as well as our operating rooms, whether or not we were aware of it. Since the first handful of cases of pneumocystis pneumonia—which were ultimately determined to be AIDS—were reported in 1981, there have been more than 900,000 reported cases in the United States and an estimated 40 million worldwide. This epidemic has profound implications, not unlike the bubonic plague or bBlack DeathQ that swept through Europe in 1348–1349, which entered the continent in Sicily from Asia in 1347 and reached epidemic proportions in Sweden by 1350. In some communities, 30% to 50% of the population died, changing the political map for generations. AIDS moves more Anesthesiology Clin N Am