When biotoxins are tools of terror. Early recognition of intentional poisoning can attenuate effects.

Toxin-mediated diseases have made humans ill for millennia. They also have been used in beneficial ways. Unfortunately, the use of biological agents as weapons of terror has now been realized, and separating naturally occurring disease from bioterroristic events has become an important public health goal. The key to timely identification of such attacks relies on education of primary care physicians, first responders, and public health officials. We must remain vigilant to unusual case presentations or clusters of similar cases and report them immediately to public health authorities.