Pulmonary disease from biological agents: Anthrax, plague, Q fever, and tularemia

Anthrax, plague, Q fever, and tularemia are all potential inhalational bioterrorism agents. The pulmonary manifestations of these agents can be readily confused with each other as well as other more common diseases such as influenza and atypical pneumonia. This article reviews the threat potential, microbiology, pathogenesis, clinical features, diagnosis, and treatment of each of these agents and highlights the similarities and differences between their pulmonary presentations.