Signs and Symptoms Coma: Chapter 17 Respiratory Distress: Chapter 71 Seizures: Chapter 72 Medical, Surgical, and Trauma Emergencies Environmental Emergencies, Radiological Emergencies, Bites and Stings: Chapter 90 Infectious Disease Emergencies: Chapter 94 Pulmonary Emergencies: Chapter 99 Toxicologic Emergencies: Chapter 102 BIOLOGIC AGENTS CLINICAL PEARLS AND PITFALLS Biologic attacks should be suspected when there are an unusually high number of cases, a common exposure history, and exotic disease presentations Ciprofloxacin, levofloxacin, and doxycycline are currently considered drugs of choice in the treatment and prophylaxis of anthrax, plague, and tularemia, even in children ( Tables 132.1 and 132.2 ) Current Evidence A working group convened by the Centers for Disease Control and Prevention (CDC) identified anthrax, smallpox, plague, botulism, tularemia, and the viral hemorrhagic fevers as the biologic exposures that would constitute the gravest threats to public health and security; the causative microorganisms and toxins are termed Category A agents We thus limit our focus here to these six agents ( Tables 132.3A and 132.3B ) In addition, we add a brief discussion of the phytotoxin (plant toxin) ricin because of its ready availability and ease of production Treatment protocols for these uncommon conditions are likely to evolve continuously, particularly if future incidents occur, as was the case when the mail-borne anthrax outbreak unfolded Of note, the fluoroquinolones and/or tetracyclines are currently considered drugs of choice in the treatment and prophylaxis of anthrax, plague, and tularemia Although these have often been avoided by pediatricians in the past,