Chapter 26, Problem 1CCS

Bioterrorism in the Mail?

Of course, John had had coughs before. As a 56-year-old man, he had experienced plenty of coughs, and fever, and nausea, but nothing like this. He was drenched in sweat as well as coughing nonproductively, all while being sick to his stomach. His symptoms were so bad that he had gone to the hospital. He was surprised when he was immediately admitted and shoved into isolation. All of his health care workers were garbed as if he had plague from the Middle Ages. He didn’t, but he did have a disease nearly as severe—John had inhalational anthrax. And he wasn’t the only patient: several others had been admitted with equally severe conditions. Bioterrorism had struck in the United States.

Eventually, in October 2001, the Centers for Disease Control and Prevention (CDC) recorded 10 cases of a very rare disease—inhalational anthrax. All 10 cases resulted from a bioterrorist who had mailed endospores of Bacillus anthracis in letters and packages.

Anthrax in the lungs progresses rapidly and is often fatal. Diagnosis is difficult because the disease is rare and because the initial manifestations of fever, fatigue, coughing , and nausea are common to many other diseases.

However, when laboratory scientists discovered large Gram-positive rods in samples of these patients’ sputum, they suspected anthrax. The diagnosis was confirmed by PCR specific for Bacillus anthracis and antibody detection of the capsule. Health care workers drained fluid from the lungs of the patients several times over the subsequent week and administered multiple antibacterial drugs, including ciprofloxacin and rifampin. Thanks to their rapid actions, six of the patients survived- a vast improvement over the historical mortality rate of over 90%.

Why was survival improved in 2001? Quick diagnosis and treatment with a combination of antibiotics, including the newly developed ciprofloxacin, may be reasons. Biodefense requires constant vigilance as well as innovation.

1. 1. In what bioterrorism threat category does the National Institute of Allergy and Infectious Diseases (NIAID) list anthrax?
2. 2. What are the other two types of anthrax?
3. 3. What are advantages of multiple antibiotic therapy?