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Volume = 341:815-826 3D""=20 September 9, 1999 3D""=20 Number=20 11
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Anthrax
Terry C. Dixon, B.S., Matthew Meselson, = Ph.D., Jeanne=20 Guillemin, Ph.D., and Philip C. Hanna, Ph.D.

 
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Anthrax=20 is an often fatal bacterial infection that occurs when = Bacillus=20 anthracis endospores enter the body through abrasions in = the skin=20 or by inhalation or ingestion.1=20 It is a zoonosis to which most mammals, especially grazing=20 herbivores, are considered susceptible. Human infections = result from=20 contact with contaminated animals or animal products, and = there are=20 no known cases of human-to-human transmission. Human anthrax = is not=20 common, and only one of us has seen a case. Cutaneous = anthrax, the=20 most common form, is usually curable. A small percentage of=20 cutaneous infections become systemic, and these can be fatal. = Systemic infection resulting from inhalation of the organism = has a=20 mortality rate approaching 100 percent, with death usually = occurring=20 within a few days after the onset of symptoms.2=20 The rate of mortality among persons with infection resulting = from=20 ingestion is variable, depending on the outbreak, but it may = also=20 approach 100 percent. Whatever the portal of entry, systemic = anthrax=20 involves massive bacteremia and toxemia with nondescript = initial=20 symptoms until the onset of hypotension, shock, and sudden = death.=20 Manifestations of advanced disease, including shock and = sudden death,=20 are believed to result from the action of the exotoxin = complex=20 secreted by anthrax bacilli.1,3=20 The efficacy of therapy, if initiated during the incubation = period,=20 and the rapid course of the disease once symptoms appear make = early=20 intervention an absolute necessity. Inglesby et al. have = provided a=20 description of the policies and strategies for dealing with = anthrax=20 as a biologic weapon.4=20 The goal of this article is to familiarize physicians with = the=20 current understanding of the pathogenesis, diagnosis, = prevention,=20 and treatment of anthrax.

Pathogenesis

Anthrax infections are initiated by endospores of B. = anthracis,=20 a gram-positive soil organism. Anthrax endospores do not = divide,=20 have no measurable metabolism, and are resistant to drying,=20 heat, ultraviolet light, gamma radiation, and many = disinfectants.5=20 In some types of soil, anthrax spores can remain dormant for=20 decades. Their hardiness and dormancy have allowed anthrax = spores=20 to be developed as biologic weapons by a number of nations,=20 although their only known use in war was by the Japanese army = in Manchuria in the 1940s.6=20 All known anthrax virulence genes are expressed by the = vegetative=20 form of B. anthracis that results from the germination = of=20 spores within the body.

The course of infection and clinical manifestations are depicted = in Figure=20 1. Endospores introduced into the body by abrasion, = inhalation,=20 or ingestion are phagocytosed by macrophages and carried to = regional=20 lymph nodes. Endospores germinate inside the macrophages and = become=20 vegetative bacteria7,8;=20 the vegetative bacteria are then released from the = macrophages,=20 multiply in the lymphatic system, and enter the bloodstream, = until=20 there are as many as 107 to 108 = organisms per=20 milliliter of blood, causing massive septicemia. Once they = have been=20 released from the macrophages, there is no evidence that an = immune=20 response is initiated against vegetative bacilli. Anthrax = bacilli=20 express virulence factors, including toxin and capsule.1=20 The resulting toxemia has systemic effects that lead to the = death of=20 the host.


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  		Figure 1. Pathophysiology = of=20 Anthrax.

Pathogenic Bacillus anthracis endospores reach a = primary=20 site in the subcutaneous layer, gastrointestinal mucosa, or = alveolar=20 spaces. For cutaneous and gastrointestinal anthrax, = low-level=20 germination occurs at the primary site, leading to local = edema and=20 necrosis. Endospores are phagocytosed by macrophages and = germinate.=20 Macrophages containing bacilli detach and migrate to the = regional=20 lymph node. Vegetative anthrax bacilli grow in the lymph = node,=20 creating regional hemorrhagic lymphadenitis. Bacteria spread = through=20 the blood and lymph and increase to high numbers, causing = severe=20 septicemia. High levels of exotoxins are produced that are=20 responsible for overt symptoms and death. In a small number = of=20 cases, systemic anthrax can lead to meningeal involvement by = means=20 of lymphatic or hematogenous spread. In cases of pulmonary = anthrax,=20 peribronchial hemorrhagic lymphadenitis blocks pulmonary = lymphatic=20 drainage, leading to pulmonary edema. Death results from = septicemia,=20 toxemia, or pulmonary complications and can occur one to = seven days=20 after exposure.

The inset shows the effects of anthrax exotoxins on = macrophages.=20 Vegetative anthrax bacilli secrete two exotoxins that are = active in=20 host cells. Edema toxin is a calmodulin-dependent adenylate = cyclase=20 that increases intracellular levels of cyclic AMP (cAMP) on = entry=20 into most types of cell. This is believed to alter water=20 homeostasis, resulting in massive edema. Lethal toxin is a = zinc=20 metalloprotease that causes a hyperinflammatory condition in = macrophages, activating the oxidative burst pathway and the = release=20 of reactive oxygen intermediates, as well as the production = of=20 proinflammatory cytokines, such as tumor necrosis factor = =20 (TNF-3D{alpha}) and interleukin-1=DF, that are responsible for = shock and=20 death. MAPKK denotes mitogen-activated protein kinase = kinase. =

 
The = major=20 virulence factors of B. anthracis are encoded on two = virulence=20 plasmids, pXO1 and pXO2. The toxin-bearing plasmid, pXO1, is = 184.5=20 kilobase pairs (kbp) in size and codes for the genes that = make up the=20 secreted exotoxins. The toxin-gene complex is composed of = protective=20 antigen, lethal factor, and edema factor.9=20 The three exotoxin components combine to form two binary = toxins.=20 Edema toxin consists of edema factor, which is a = calmodulin-dependent=20 adenylate cyclase,10<= /SUP>,11<= /SUP>=20 and protective antigen, the binding moiety that permits entry = of the=20 toxin into the host cell. Increased cellular levels of cyclic = AMP=20 upset water homeostasis and are believed to be responsible = for the=20 massive edema seen in cutaneous anthrax. Edema toxin inhibits = neutrophil function in vitro,12<= /SUP>=20 and neutrophil function is impaired in patients with = cutaneous=20 anthrax infection.13<= /SUP>=20 Lethal toxin consists of lethal factor, which is a zinc=20 metalloprotease14<= /SUP>,15<= /SUP>,16<= /SUP>=20 that inactivates mitogen-activated protein kinase kinase in = vitro,17<= /SUP>,18<= /SUP>=20 and protective antigen, which acts as the binding domain. = Lethal=20 toxin stimulates the macrophages to release tumor necrosis = factor=20 3D{alpha} and=20 interleukin-1=DF, which are partly responsible for sudden = death in=20 systemic anthrax (Figure = 1,=20 inset).3,15<= /SUP>,19<= /SUP>=20

The smaller capsule-bearing plasmid, pXO2, is 95.3 kbp in size = and=20 codes for three genes (capB, capC, and capA) involved = in=20 the synthesis of the polyglutamyl capsule.20<= /SUP>=20 The exotoxins are thought to inhibit the immune response = mounted=20 against infection, whereas the capsule inhibits phagocytosis = of=20 vegetative anthrax bacilli. The expression of all known major = virulence factors is regulated by host-specific factors such = as=20 elevated temperature (3D"=3D"=20 src=3D"http://content.nejm.org/math/ge.gif" border=3D0>37=B0C) and = carbon dioxide=20 concentration (3D"=3D" = src=3D"http://content.nejm.org/math/ge.gif"=20 border=3D0>5 percent), and by the presence of serum = components.21<= /SUP>,22<= /SUP>=20 Regulation of the expression of the toxin and capsule genes = is=20 mediated by the transcriptional activator AtxA, whose = activity=20 appears to be affected by the previously mentioned = environmental=20 conditions.23<= /SUP>,24<= /SUP>,25<= /SUP>=20 Expression of the capsule gene is also controlled by its own=20 transcriptional regulator, AcpA.26<= /SUP>=20 Both plasmids are required for full virulence; the loss of = either one=20 results in an attenuated strain. Historically, bacterial = strains for=20 anthrax vaccine were made by rendering virulent strains free = of one=20 or both plasmids. Pasteur, an avirulent pXO2-carrying strain, = is=20 encapsulated but does not express exotoxin components.1=20 Sterne, an attenuated strain that carries pXO1, can = synthesize=20 exotoxin components but does not have a capsule.1=20

Clinical=20 Manifestations

Cutaneous Anthrax

Cutaneous anthrax accounts for 95 percent of all anthrax = infections=20 in the United States.27<= /SUP>,28<= /SUP>,29<= /SUP>,30<= /SUP>=20 The name anthrax (from the Greek for coal) refers to the = typical=20 black eschar that is seen on affected areas (Figure = 2).=20 Patients often have a history of occupational contact with = animals or=20 animal products. The most common areas of exposure are the = head,=20 neck, and extremities, although any area can be involved. = Pathogenic=20 endospores are introduced subcutaneously through a cut or = abrasion.=20 There are a few case reports of transmission by insect bites, = presumably after the insect fed on an infected carcass.31<= /SUP>,32<= /SUP>=20 The primary skin lesion is usually a nondescript, painless, = pruritic=20 papule that appears three to five days after the introduction = of=20 endospores. In 24 to 36 hours, the lesion forms a vesicle = that=20 undergoes central necrosis and drying, leaving a = characteristic=20 black eschar surrounded by edema and a number of purplish=20 vesicles. The edema is usually more extensive on the head or = neck=20 than on the trunk or extremities.33<= /SUP>=20 The common description "malignant pustule" is actually a = misnomer,=20 because the cutaneous lesion is not purulent and is=20 characteristically painless. A painful, pustular eschar in a = febrile=20 patient indicates a secondary infection, most often with=20 staphylococcus or streptococcus.34<= /SUP>=20


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  		Figure 2. Cutaneous = Anthrax=20 Infection of the Hand and Cheek.

Panel A shows the characteristic blackened eschar = surrounded by=20 eroded areas and massive edema. These lesions are painless. = The=20 areas of "dried skin" represent resolving edema. Lesions = continue to=20 progress despite rigorous antibiotic treatment. Cutaneous = anthrax=20 can be self-limiting, and the lesions resolve without = scarring.=20 About 10 percent of untreated cutaneous anthrax infections = progress=20 to systemic anthrax. Panels B, C, and D show changes in the = lesion=20 on the cheek over a seven-day period. The characteristic = blackened=20 eschar is present on day 0 (Panel B). Facial edema and = ulceration=20 occur by the second day (Panel C). On day 7, the lesion is = beginning=20 to heal, and the facial edema is resolving (Panel D). The = photograph=20 in Panel A was kindly provided by Drs. Wilhelm Kobuch and = P.C.B.=20 Turnbull. The photographs in Panels B, C, and D are = reprinted from=20 Smego et al.33<= /SUP>=20 with the permission of the publisher. =

 
Alth= ough=20 cutaneous anthrax can be self-limiting, antibiotic treatment = is=20 recommended. Lesions resolve without complications or = scarring in 80=20 to 90 percent of cases. Malignant edema is a rare = complication=20 characterized by severe edema, induration, multiple bullae, = and=20 symptoms of shock.35<= /SUP>,36<= /SUP>=20 Malignant edema involving the neck and thoracic region often = leads to=20 breathing difficulties that require corticosteroid therapy or = intubation. A few cases have been reported of temporal = arteritis=20 associated with cutaneous anthrax infection and of corneal = scarring=20 from palpebral cutaneous anthrax.37<= /SUP>,38<= /SUP>=20 Histologic examination of anthrax skin lesions shows necrosis = and=20 massive edema with lymphocytic infiltrates. There is no = liquefaction=20 or abscess formation, indicating that the lesions are not=20 suppurative. Focal points of hemorrhage are evident, with = some=20 thrombosis.39<= /SUP>=20 Gram's staining reveals bacilli in the subcutaneous tissue.39<= /SUP>=20

Gastrointestinal and Oropharyngeal Anthrax

Gastrointestinal anthrax, which can be fatal, has not been = reported=20 in the United States. The symptoms appear two to five days = after=20 the ingestion of endospore-contaminated meat from diseased = animals.40<= /SUP>=20 Therefore, multiple cases can occur within individual = households.40<= /SUP>,41<= /SUP>=20 An unusually prolonged outbreak was attributed to the = consumption=20 of stored meat products.42<= /SUP>=20 It is presumed that bacterial inoculation takes place at a = breach in=20 the mucosal lining, but exactly where the endospores = germinate is=20 unknown. On pathological examination, bacilli can be seen=20 microscopically in the mucosal and submucosal lymphatic = tissue, and=20 there is gross evidence of mesenteric lymphadenitis.43<= /SUP>=20 Ulceration is always seen. It is not known whether ulceration = occurs=20 only at sites of bacterial infection or is distributed more = diffusely=20 as a result of the action of anthrax toxin.43<= /SUP>,44<= /SUP>,45<= /SUP>=20 Microscopical examination of affected tissues reveals massive = edema=20 and mucosal necrosis at infected sites.45<= /SUP>=20 Inflammatory infiltrates are seen that are similar to those = in=20 cutaneous anthrax. Gram's staining of peritoneal fluid may = reveal=20 numerous large gram-positive bacilli.40<= /SUP>,46<= /SUP>=20

Although mediastinal widening is considered pathognomonic of=20 inhalational anthrax, it has also been reported in a case of=20 gastrointestinal anthrax.47<= /SUP>=20 Associated symptoms include fever and diffuse abdominal pain = with=20 rebound tenderness. There are reports of both constipation = and=20 diarrhea; the stools are either melenic or blood-tinged.46<= /SUP>,48<= /SUP>=20 Because of ulceration of the gastrointestinal mucosa, = patients often=20 vomit material that is blood-tinged or has a coffee-ground=20 appearance. Ascites develops with concomitant reduction in = abdominal=20 pain two to four days after the onset of symptoms. The = appearance of=20 the ascites fluid ranges from clear to purulent, and it often = yields=20 colonies of B. anthracis when cultured. Morbidity is = due to=20 blood loss, fluid and electrolyte imbalances, and subsequent = shock.=20 Death results from intestinal perforation or anthrax toxemia. = If the=20 patient survives, most of the symptoms subside in 10 to 14 = days.48<= /SUP>=20

Oropharyngeal anthrax is less common than the gastrointestinal=20 form. It is also associated with the ingestion of = contaminated=20 meat. Initial symptoms include cervical edema and local=20 lymphadenopathy, which cause dysphagia and respiratory = difficulties.=20 Lesions can be seen in the oropharynx and usually have the=20 appearance of pseudomembranous ulcerations. This form is = milder than=20 the classic gastrointestinal disease and has a more favorable = prognosis.34<= /SUP>,48<= /SUP>=20

Inhalational Anthrax

Inhalational anthrax is rare, usually occurring after the = inhalation=20 of pathogenic endospores from contaminated animal hides or = products.=20 Before the introduction of hygienic measures in the 1960s, = including=20 vaccination, workers in goat-hair mills, for example, were = regularly=20 exposed to high concentrations of viable anthrax spores.=20 Nevertheless, for reasons that are not understood, few cases = of=20 inhalational anthrax occurred among them.49<= /SUP>,50<= /SUP>,51<= /SUP>=20 When dispersed in the atmosphere as an aerosol, anthrax = spores can=20 present a respiratory hazard even far downwind from the point = of=20 release, as demonstrated by animal tests on Gruinard Island = in the=20 United Kingdom,52<= /SUP>,53<= /SUP>,54<= /SUP>,55<= /SUP>=20 and by an accidental release from a military biologic = facility=20 in the city of Sverdlovsk in the former Soviet Union.2,56<= /SUP>,57<= /SUP>,58<= /SUP>=20

Inhalational anthrax is usually fatal, even with aggressive=20 antimicrobial therapy. It appears that only about one fifth = of=20 those who contracted inhalational anthrax in Sverdlovsk recovered.2=20 Anthrax spores are about 1 to 2 =B5m in diameter, a size = that is=20 optimal for inhalation and deposition in the alveolar = spaces.51<= /SUP>,59<= /SUP>,60<= /SUP>,61<= /SUP>=20 Although the lung is the initial site of contact, = inhalational=20 anthrax is not considered a true pneumonia. In most but not = all=20 cases, there is no infection in the lungs.58<= /SUP>,62<= /SUP>=20 Rather, the endospores are engulfed by alveolar macrophages = and=20 transported by them to the mediastinal and peribronchial = lymph nodes,=20 with the spores germinating en route. Anthrax bacilli = multiply in the=20 lymph nodes, causing hemorrhagic mediastinitis, and spread = throughout=20 the body in the blood.43<= /SUP>,62<= /SUP>=20

Data from the Sverdlovsk outbreak indicate a modal incubation = time=20 of approximately 10 days for inhalational anthrax. However, = the onset=20 of symptoms occurred up to six weeks after the reported date = of=20 exposure.2,57<= /SUP>=20 Such long incubation times presumably reflect the ability of = viable=20 anthrax spores to remain in the lungs for many days.51<= /SUP>,63<= /SUP>,64<= /SUP>=20 Longer incubation periods may be associated with smaller=20 inocula.

The initial symptoms most often reported are fever, = nonproductive=20 cough, myalgia, and malaise, resembling those of a viral = upper=20 respiratory tract infection. Early in the course of the = disease,=20 chest radiographs show a widened mediastinum, which is = evidence=20 of hemorrhagic mediastinitis, and marked pleural effusions.=20 After one to three days, the disease takes a fulminant course = with dyspnea, strident cough, and chills, culminating in death.34<= /SUP>,59<= /SUP>=20 In Sverdlovsk, the mean time between the onset of symptoms = and=20 death was 3 days (range, 1 to 10). Although accompanying = evidence=20 of clinical signs of pneumonia in these cases is lacking, = some=20 of the autopsies from the Sverdlovsk outbreak showed a focus = of=20 necrotizing hemorrhagic pneumonitis, possibly at the portal = of=20 infection.58<= /SUP>=20 Submucosal hemorrhages occurred in the trachea and bronchi, = with=20 hemorrhage and necrosis of peribronchial lymph nodes. = Hemorrhagic=20 mediastinal lymph nodes represent the primary lesion; = however,=20 gastrointestinal and leptomeningeal lesions are the result of = hematogenous spread.

There may be wide individual variation in susceptibility to=20 inhalational anthrax, as suggested by experimental studies in = nonhuman primates and by the absence of persons younger than = 24=20 years among the 66 deaths reported in the Sverdlovsk outbreak.2,51<= /SUP>,57<= /SUP>=20

Anthrax Meningitis

Involvement of the meninges by B. anthracis is a rare=20 complication of anthrax.65<= /SUP>=20 The most common portal of entry is the skin, from which the = organisms=20 can spread to the central nervous system by hematogenous or = lymphatic=20 routes. Anthrax meningitis also occurs in cases of pulmonary = and=20 gastrointestinal anthrax.58<= /SUP>,66<= /SUP>=20 Anthrax meningitis is almost always fatal, with death = occurring=20 one to six days after the onset of illness, despite intensive = antibiotic therapy. In the few cases in which patients have=20 survived, antibiotic therapy was combined with the = administration=20 of antitoxin, prednisone, or both.65<= /SUP>,67<= /SUP>=20 In addition to common meningeal symptoms and nuchal rigidity, = the=20 patient has fever, fatigue, myalgia, headache, nausea, = vomiting, and=20 sometimes agitation, seizures, and delirium. The initial = signs are=20 followed by rapid neurologic degeneration and death. The=20 pathological findings are consistent with a hemorrhagic = meningitis,=20 with extensive edema, inflammatory infiltrates, and numerous=20 gram-positive bacilli in the leptomeninges.43<= /SUP>,68<= /SUP>=20 The cerebrospinal fluid is often bloody and contains many=20 gram-positive bacilli.69<= /SUP>=20 Gross examination at autopsy finds extensive hemorrhage of = the=20 leptomeninges, which gives them a dark red appearance = described as=20 "cardinal's cap."58<= /SUP>=20

Diagnosis

Differential Diagnosis

Table = 1=20 summarizes the differential diagnosis of anthrax. In = cutaneous=20 anthrax, the painless, blackened, necrotic eschar is limited = to the=20 late stages of the infection. The ulcerative eschar of = cutaneous=20 anthrax must be differentiated from other papular lesions = that=20 present with regional lymphadenopathy. If the lesion is = purulent and=20 the regional lymph nodes are palpable, staphylococcal = lymphadenitis=20 is the most likely cause, although cutaneous anthrax lesions = can be=20 superinfected with pyogenic bacteria.70<= /SUP>=20

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  		Table 1. Differential = Diagnosis of=20 Clinical Manifestations of Anthrax. =

 
The = initial=20 symptoms of inhalational anthrax are nondescript or "flulike" = and are=20 similar to those of atypical pneumonia from other causes. The = prognosis is improved if early treatment is implemented, so = that a=20 high level of suspicion is necessary if there is a chance of = exposure=20 to anthrax. The cardiopulmonary collapse associated with a = history of=20 radiographic evidence of mediastinal widening in the late = stages of=20 inhalational anthrax must be differentiated from = cardiovascular=20 collapse with noninfectious causes, such as dissecting or = ruptured=20 aortic aneurysm and the superior vena cava syndrome. Anthrax=20 infection is unusual in that mediastinal changes can be = detected=20 early in the course of infection by chest radiography, = although=20 similar pictures can be seen in acute bacterial mediastinitis = and=20 fibrous mediastinitis due to Histoplasma capsulatum.71<= /SUP>=20 Less specific findings include pleural effusions and = radiographic=20 evidence of pulmonary edema. Silicosis, siderosis, alveolar=20 proteinosis, and sarcoidosis are often alternative causes of = chronic=20 mediastinitis in patients with the relevant occupational = history and=20 previous chest radiographs demonstrating long-standing = mediastinal=20 widening.

When ingestion of contaminated meat is suspected, the symptoms = of=20 an acute abdomen should be considered as possible early signs = of=20 intestinal anthrax infection. Hemorrhagic meningitis caused = by=20 anthrax must be distinguished from subarachnoid hemorrhage by = computed tomography without contrast. To distinguish hemorrhagic=20 meningitis caused by B. anthracis from that caused by = other=20 bacteria, Gram's staining and culture of cerebrospinal fluid=20 should be performed.68<= /SUP>=20 In addition to the above indictors, the clinician should = consider=20 anthrax if there is a history of contact with materials that = may be=20 contaminated with spores, such as infected farm animals and = imported=20 hides, or of travel to places where anthrax is endemic. = Because of=20 the remote possibility of an anthrax aerosol attack, = clinicians=20 should be alert to any sudden deaths of previously healthy = persons=20 from undiagnosed disease and report them promptly to the = Centers for=20 Disease Control and Prevention and other appropriate public = health=20 officials.

Bacteriologic Tests

B. anthracis is a nonmotile, gram-positive, aerobic rod = 1.2=20 to 10 =B5m in length and 0.5 to 2.5 =B5m in width that = is capable=20 of forming central or terminal spores (Figure = 3).72<= /SUP>=20 It is part of the B. cereus group of bacilli, which = consists=20 of B. cereus, B. anthracis, B. thurin-giensis, and B.=20 mycoides.73<= /SUP>=20 The bacteria in this group tend to be dismissed by clinical=20 microbiology laboratories as contaminants unless the = physician=20 specifically requests testing.73<= /SUP>=20 Except for B. anthracis, all members of this group are = resistant to penicillin because they produce chromosomally = encoded=20 beta-lactamases.74<= /SUP>=20 B. anthracis is easy to differentiate from other = members of=20 the B. cereus group by observing the morphologic = features of=20 the colony on a blood-agar plate. Colonies of most B.=20 anthracis isolates are nonhemolytic and are white to = gray, often=20 looking like ground glass.75<= /SUP>=20 The unusually tenacious colonies are able to retain their = shape when=20 manipulated. When inoculated onto nutrient agar containing = 0.7=20 percent bicarbonate and grown overnight at 37=B0C in the = presence of 5=20 to 20 percent carbon dioxide, B. anthracis will form = its=20 characteristic poly-d-glutamic acid capsule.76<= /SUP>=20 These colonies have a mucoid appearance, and the capsule can = be=20 demonstrated microscopically in a colony smear stained with=20 McFadyean's polychrome methylene blue or India ink.75<= /SUP>=20 Blood samples obtained from patients late in the course of = infection=20 and stained in the same manner will reveal large numbers of=20 encapsulated bacilli. Bacilli can also be observed in and = cultured=20 from ascites fluid, pleural effusions, cerebrospinal fluid = (in cases=20 of meningitis),77<= /SUP>=20 and fluid carefully expressed from the eschar, although = expressing=20 eschar fluid is not recommended because it can cause = dissemination of=20 the pathogen.78<= /SUP>=20


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  		Figure 3. = Photomicrographs of=20 Bacillus anthracis Vegetative Cells and Spores.

Panel A shows a Gram's stain of B. anthracis = vegetative=20 bacteria. The bacterial cells exhibit gram-positive staining = (purple=20 filaments) (x600). Panel = B shows=20 an electron photomicrograph of a B. anthracis spore=20 (arrowhead) partially surrounded by the pseudopod of a = cultured=20 macrophage (x137,000). = The bar=20 represents 1 =B5m. =

 
Pati= ents=20 with systemic disease often die before positive blood = cultures can be=20 obtained, making early diagnosis and treatment crucial. If = the=20 samples are likely to be contaminated with other bacillus = species,=20 polymyxin=96lysozyme=96EDTA=96thallous acetate agar is used = as a selective=20 medium for B. anthracis.79<= /SUP>=20 The API 50 CH test strip (API Laboratory Products, Plainview, = N.Y.) can be used in conjunction with the API 20E test strip = to=20 identify a number of bacillus species, including B. anthracis.80<= /SUP>=20 Blood cultures in cases of systemic anthrax infection are = almost=20 always positive, because of the large numbers of bacterial = cells=20 in the circulation.1=20 Cultures of tissue from skin lesions, however, are not useful = diagnostically, because the rate of positive cultures does = not exceed=20 60 to 65 percent, probably owing to the use of antimicrobial = therapy=20 or the microbicidal activity of local antagonistic skin = flora.81<= /SUP>=20 There are reports of clinical isolates of B. anthracis = that=20 are resistant to penicillin.31<= /SUP>,82<= /SUP>=20 Because of the potential for drug-resistant strains, = including=20 deliberately modified strains, antibiotic-susceptibility = testing=20 should be performed on all isolates.

Serologic and Immunologic Tests

The major immunogenic proteins of B. anthracis appear to = be=20 capsular antigens and the exotoxin components. Specific = enzyme-linked=20 immunosorbent assays (ELISAs) that show a quadrupling of the=20 titer of antibodies against these components are diagnostic = of=20 past infection or vaccination. The most reliable indicators = are the=20 titers of antibody to protective antigen and to capsular=20 components.73<= /SUP>,83<= /SUP>,84<= /SUP>=20 In studies of the measurement of antibody titers by ELISA, = the=20 sensitivity of possible indicators was as follows: 72 percent = for=20 protective antigen, 95 to 100 percent for capsule antigens, = 42=20 percent for lethal factor, and 26 percent for edema factor.85<= /SUP>=20 Enzyme-linked immunoelectrotransfer blotting provided a = higher=20 specificity when used in conjunction with ELISA-based = testing.85<= /SUP>=20 Indirect microhemagglutination gives results similar to those = obtained with ELISA but has certain drawbacks, including the = short=20 shelf life of antigen-sensitized red-cell preparations, the = limited=20 reproducibility of the test, and longer preparation times.86<= /SUP>=20

Immunologic detection of the exotoxins in blood during systemic=20 infection is possible with similar tests if antibodies to = anthrax=20 toxins are available, but those tests are unreliable for = diagnosis.=20 Thus, although these tests are of epidemiologic value, they=20 have little diagnostic value in acute illness.83<= /SUP>=20 During systemic infections, antibodies to toxin or capsular=20 components cannot be detected until late in the course of the = disease, often when it is too late to initiate treatment.73<= /SUP>=20 In treated infections, no increase in the antitoxin antibody = titer is=20 seen. The anthraxin skin test, consisting of subdermal = injection of a=20 commercially produced chemical extract of an attenuated = strain of=20 B. anthracis, is available for the diagnosis of acute = and=20 previous cases of anthrax.81<= /SUP>,87<= /SUP>,88<= /SUP>=20 In one study the skin test diagnosed 82 percent of cases one = to three=20 days after the onset of symptoms and 99 percent of cases by = the end=20 of the fourth week.81<= /SUP>=20 The skin test may be suitable for both rapid diagnosis of = acute cases=20 and the retrospective analysis of anthrax infections. =

New Molecular Diagnostic Methods

New diagnostic techniques have focused on the use of the = polymerase=20 chain reaction to amplify markers specific to B. anthracis = or=20 the B. cereus group. Two markers, vrrA89<= /SUP>=20 and Ba813,90<= /SUP>,91<= /SUP>,92<= /SUP>=20 have been the subject of extensive study. Other methods using = the polymerase chain reaction to amplify specific virulence=20 plasmid markers harbored by different anthrax strains may = soon=20 become available.56<= /SUP>,93<= /SUP>,94<= /SUP>,95<= /SUP>,96<= /SUP>=20 These new rapid methods may become useful in the clinical = setting,=20 where early diagnosis is crucial.

Prevention and=20 Treatment

Prophylaxis, Vaccination, and Decontamination

Prophylaxis for asymptomatic patients with suspected exposure = to=20 anthrax spores can be achieved with a six-week course of = doxycycline=20 or ciprofloxacin. If the suspected dose of spores is high, a = longer=20 course of antibiotics is warranted. Extended treatment is = needed for=20 total pulmonary clearance of spores, which are not affected = by the=20 presence of antibiotics.63<= /SUP>,97<= /SUP>=20

The standard anthrax vaccine in the United States is approved = by=20 the Food and Drug Administration and is routinely administered = to=20 persons at risk for exposure to anthrax spores. The existing = supplies=20 are currently being used to immunize all military personnel.=20 Designated "anthrax vaccine adsorbed" (AVA), it is an = aluminum=20 hydroxide=96precipitated preparation of protective antigen = from=20 attenuated, nonencapsulated B. anthracis cultures of the=20 Sterne strain.98<= /SUP>,99<= /SUP>=20 Two inoculations with AVA afforded substantial protection = against=20 inhalational anthrax in rhesus monkeys,10= 0=20 and a limited trial of a similar vaccine in humans indicated=20 that it afforded considerable protection against cutaneous = anthrax.10= 1=20 AVA is administered subcutaneously in a 0.5-ml dose that is=20 repeated at 2 and 4 weeks and at 6, 12, and 18 months.10= 2=20 Boosters are then given annually. For those receiving = antibiotic=20 prophylaxis for suspected exposure, AVA may be given = concurrently.=20 There is a need for vaccines with better protection and a=20 simpler schedule. Vaccines now being tested include = preparations=20 of protective antigen subunits with different adjuvants,=20 protective antigen purified from recombinant sources, and = live=20 vaccines based on anthrax strains with auxotrophic = mutations.10= 3,10= 4,10= 5,10= 6,10= 7,10= 8,10= 9,11= 0,11= 1,11= 2,11= 3=20 Live attenuated endospore-based vaccines were widely used in=20 the Soviet Union for both humans and livestock and remain in=20 use in the Russian Federation today.10= 3=20 The ability of any vaccine to protect humans in the event of = aerosol=20 attack, as in biologic terrorism or warfare, cannot be tested = directly and therefore must remain a concern.11= 4=20

A textile mill contaminated with anthrax spores was = decontaminated=20 with vaporized formaldehyde,11= 5=20 and soil decontamination at Gruinard Island was achieved with = formaldehyde in seawater.11= 6=20 Although decontamination is desirable, the risk that = resuspension=20 of a deposited aerosol will lead to inhalational anthrax is=20 much less than the risk due to a primary aerosol.11= 7,11= 8=20 Autoclaving and incineration are acceptable procedures for = the=20 decontamination of laboratory materials.

Treatment

          &n= bsp; Antibiotics

Table = 2=20 summarizes pharmacologic therapy for anthrax. Penicillin and=20 doxycycline are used for the treatment of anthrax. Intravenous=20 administration is recommended in cases of inhalational,=20 gastrointestinal, and meningeal anthrax. Cutaneous anthrax = with signs=20 of systemic involvement, extensive edema, or lesions on the = head and=20 neck also requires intravenous therapy. Streptomycin had a=20 synergistic effect with penicillin in experiments and may = also be=20 given for inhalational anthrax. Despite early and vigorous=20 treatment, the prognosis of patients with inhalational,=20 gastrointestinal, or meningeal anthrax remains poor. = Antibiotic=20 therapy should be continued for at least 14 days after = symptoms=20 abate.67<= /SUP>,78<= /SUP>=20 In cutaneous anthrax, treatment with oral penicillin renders=20 lesions sterile after 24 hours, although they still progress = to=20 eschar formation. Chloramphenicol, erythromycin, tetracycline, = or=20 ciprofloxacin can be administered to patients who are allergic = to=20 penicillin. If resistance to penicillin and doxycycline is = suspected=20 and antibiotic-susceptibility data are not available, = ciprofloxacin=20 may be administered empirically. Doxycycline and tetracycline = are not=20 recommended for pregnant women or children, and the effects = of=20 ciprofloxacin in pregnant women have not been determined.4=20

View = this=20 table:
[in=20 this window]
[in a new window]
  		Table 2. Pharmacologic = Therapy for=20 Bacillus anthracis Infection and Its Sequelae. =

 
For = culturing cutaneous lesions, gentle sampling with a moist, = sterile=20 applicator is preferred. Excision of the eschar is contraindicated=20 and might hasten systemic dissemination. Lesions should be = covered=20 with sterile dressings that are changed regularly. Soiled = dressings=20 should be autoclaved and properly disposed of. In cases of = extensive=20 edema, meningitis, or swelling in the head-and-neck region,=20 corticosteroid therapy should be initiated.11= 9,12= 0=20 Supportive therapy should be initiated to prevent septic = shock and=20 fluid and electrolyte imbalance, and to maintain airway = patency.=20

          &n= bsp; Potential=20 New Treatments

The current understanding that anthrax is a toxigenic condition=20 suggests the potential of antitoxin therapy. The central = importance=20 of lethal toxin is supported by much research. Early = experiments=20 in which antibiotics were administered to animals at = different=20 stages of infection found a principle of "no return"; once = the=20 infection had reached a certain point, the animal was doomed, = even after removal of the microbes. Test animals injected=20 intravenously with purified lethal toxin died in a manner = very=20 similar to that of animals that died of the natural = infection.3,15<= /SUP>,19<= /SUP>=20 Lethal-toxin=96deficient strains are highly attenuated.12= 1,12= 2=20 Prior immunity (passive or active) to the lethal-toxin = proteins=20 protects animals from endospore challenge.63<= /SUP>,12= 3=20 Finally, toxin-affected macrophages produce the = proinflammatory=20 cytokines that mediate the shock and sudden death that occur = in=20 anthrax.3,15<= /SUP>,19<= /SUP>=20 Unfortunately, antitoxin preparations are not currently = available in=20 the United States. In addition, the recent discovery that = lethal=20 toxin acts as a zinc metalloprotease inside target cells and = the=20 identification of potential target substrates may provide new = insights for use in designing drugs that directly inhibit the = toxicity of lethal factor in vivo.14<= /SUP>,17<= /SUP>,18<= /SUP>=20

Future=20 Challenges

Anthrax holds an important place in the development of modern=20 medicine and has long been intertwined with human history. = Anthrax=20 is believed to have been one of the Egyptian plagues at the=20 time of Moses, and cases were clearly recorded by the ancient = Romans.12= 4=20 The anthrax bacillus was the model first used in the = development of=20 Koch's postulates and is considered the first "germ" proved = to cause=20 human disease.12= 5=20 Pasteur later generated a capsule-null anthrax strain that = was the=20 first vaccine made from live attenuated bacteria for use in = humans.12= 6=20 At the birth of cellular immunology, Metchnikoff used the = anthrax=20 bacillus to examine the ability of his newly discovered = macrophages=20 to kill microbes.12= 7=20 Today, investigators are using B. anthracis and its = toxins in=20 an attempt to understand early events in the infectious = process and=20 the molecular basis of inflammation.3,15<= /SUP>,19<= /SUP>=20

Unfortunately, new issues have arisen beyond those related to=20 scientific inquiry. No casualty-producing terrorist use of = anthrax=20 has occurred, and the Federal Bureau of Investigation has = stated=20 that it has "no intelligence that state sponsors of = terrorism,=20 international terrorist groups, or domestic terrorist groups=20 are currently planning to use these deadly weapons in the = United=20 States."12= 8=20 However, the incidence of hoaxes has greatly increased with = recent=20 publicity about anthrax, providing a challenge to law = enforcement.12= 9=20 Recent revelations regarding the development of anthrax = weapons by=20 the former Soviet Union and by Iraq, and of attempts to = develop such=20 weapons by the Aum Shinrikyo cult in Japan, make the = potential use of=20 B. anthracis in biologic terrorism a legitimate = concern.4,12= 9=20 New strains resistant to antibiotics or containing additional = virulence factors could be misused with the intent of = confounding=20 treatment or prophylaxis.11= 4,13= 0=20 Whether our medical system would be able to provide = appropriate=20 prophylaxis and therapy in the event of a large-scale = exposure=20 to pathogenic endospores remains uncertain, even doubtful. It = has now become relevant for physicians to refamiliarize = themselves=20 with clinical anthrax.

Supported in part by grants (AI-08649 and AI-40644) = and a=20 Medical Scientist Training award from the National Institutes = of=20 Health, by a grant (IRG-158 K) from the American Cancer = Society,=20 and by Duke University Medical Center.

We are indebted to Arthur Friedlander, M.D., Julia Chosy, Tanya=20 Dixon, John Ireland, Matthew Weiner, and Kenneth Alexander,=20 M.D., Ph.D., for their reading and critical discussion of the = manuscript.


Source Information

From the Department of Microbiology, Duke University = Medical=20 Center, Durham, N.C. (T.C.D., P.C.H.); the Department of Molecular and = Cellular=20 Biology, Harvard University, Cambridge, Mass. (M.M.); the Department of=20 Sociology, Boston College, Chestnut Hill, Mass. (J.G.); and the = Department of=20 Microbiology and Immunology, University of Michigan Medical School, Ann = Arbor=20 (P.C.H.).

Address reprint requests to Dr. Hanna at 1150 W = Medical, 5641=20 MS II, Department of Microbiology and Immunology, University of Michigan = Medical=20 School, Ann Arbor, MI 48104, or at dixont@umich.edu.

References

  1. Hanna P. Anthrax pathogenesis and host response. Curr = Top=20 Microbiol Immunol 1998;225:13-35.[Medline]
  2. Meselson M, Guillemin J, Hugh-Jones M, et al. The = Sverdlovsk=20 anthrax outbreak of 1979. Science 1994;266:1202-1208.[Medline]
  3. Hanna PC, Acosta D, Collier RJ. On the role of = macrophages in=20 anthrax. Proc Natl Acad Sci U S A 1993;90:10198-10201.[Abstract]=20
  4. Inglesby TV, Henderson DA, Bartlett JG, et al. Anthrax = as a=20 biological weapon: medical and public health management. JAMA=20 1999;281:1735-1745.[Abstract/Full Text]<= /A>=20
  5. Watson A, Keir D. Information on which to base = assessments of risk=20 from environments contaminated with anthrax spores. Epidemiol Infect=20 1994;113:479-490.[Medline]
  6. Harris SH. Factories of death: Japanese secret = biological warfare,=20 1932-1945, and the American cover-up. London: Routledge, 1994.
  7. Ross JM. The pathogenesis of anthrax following the = administration=20 of spores by the respiratory route. J Pathol Bacteriol = 1957;73:485-494. =
  8. Guidi-Rontani C, Weber-Levy M, Labruyere E, Mock M. = Germination of=20 Bacillus anthracis spores within alveolar macrophages. Mol Microbiol=20 1999;31:9-17.[Medline]
  9. Leppla SH. The anthrax toxin complex. In: Alouf J, Freer = JH, eds.=20 Sourcebook of bacterial protein toxins. London: Academic Press, = 1991:277-302.
  10. Leppla SH. Anthrax toxin edema factor: a bacterial = adenylate=20 cyclase that increases cyclic AMP concentrations of eukaryotic cells. = Proc=20 Natl Acad Sci U S A 1982;79:3162-3166.[Medline]
  11. Leppla SH. Bacillus anthracis calmodulin-dependent = adenylate=20 cyclase: chemical and enzymatic properties and interactions with = eucaryotic=20 cells. Adv Cyclic Nucleotide Protein Phosphorylation Res = 1984;17:189-198.[Medline]
  12. O'Brien J, Friedlander A, Dreier T, Ezzell J, Leppla S. = Effects=20 of anthrax toxin components on human neutrophils. Infect Immun=20 1985;47:306-310.[Medline]
  13. Alexeyev OA, Morozov VG, Suzdaltseva TV, Mishukov AS, = Steinberg=20 LA. Impaired neutrophil function in the cutaneous form of anthrax. = Infection=20 1994;22:281-282.[Medline]
  14. Hammond SE, Hanna PC. Lethal factor active-site = mutations affect=20 catalytic activity in vitro. Infect Immun 1998;66:2374-2378.[Abstract/Full Text]= =20
  15. Hanna PC, Kruskal BA, Ezekowitz RA, Bloom BR, Collier = RJ. Role of=20 macrophage oxidative burst in the action of anthrax lethal toxin. Mol = Med=20 1994;1:7-18.[Medline]
  16. Klimpel KR, Arora N, Leppla SH. Anthrax toxin lethal = factor=20 contains a zinc metalloprotease consensus sequence which is required = for=20 lethal toxin activity. Mol Microbiol 1994;13:1093-1100.[Medline]
  17. Duesbery NS, Webb CP, Leppla SH, et al. Proteolytic = inactivation=20 of MAP-kinase-kinase by anthrax lethal factor. Science = 1998;280:734-737.[Abstract/Full Text]<= /A>=20
  18. Vitale G, Pellizzari R, Recchi C, Napolitani G, Mock M, = Montecucco C. Anthrax lethal factor cleaves the N-terminus of MAPKKs = and=20 induces tyrosine/threonine phosphorylation of MAPKs in cultured = macrophages.=20 Biochem Biophys Res Commun 1998;248:706-711.[Medline]
  19. Hanna PC, Kochi S, Collier RJ. Biochemical and = physiological=20 changes induced by anthrax lethal toxin in J774 macrophage-like cells. = Mol=20 Biol Cell 1992;3:1269-1277.[Abstract]=20
  20. Makino S-I, Uchida I, Terakado N, Sasakawa C, Yoshikawa = M.=20 Molecular characterization and protein analysis of the cap region, = which is=20 essential for encapsulation in Bacillus anthracis. J Bacteriol=20 1989;171:722-730.[Medline]
  21. Makino S, Sasakawa C, Uchida I, Terakado N, Yoshikawa = M. Cloning=20 and CO2-dependent expression of the genetic region for=20 encapsulation from Bacillus anthracis. Mol Microbiol = 1988;2:371-376.[Medline]
  22. Dai Z, Sirard J-C, Mock M, Koehler TM. The atxA gene = product=20 activates transcription of the anthrax toxin genes and is essential = for=20 virulence. Mol Microbiol 1995;16:1171-1181.[Medline]
  23. Dai Z, Koehler TM. Regulation of anthrax toxin = activator gene=20 (atxA) expression in Bacillus anthracis: temperature, not = CO2/bicarbonate,=20 affects AtxA synthesis. Infect Immun 1997;65:2576-2582.[Abstract]=20
  24. Uchida I, Hornung JM, Thorne CB, Klimpel KR, Leppla SH. = Cloning=20 and characterization of a gene whose product is a trans-activator of = anthrax=20 toxin synthesis. J Bacteriol 1993;175:5329-5338.[Abstract]=20
  25. Uchida I, Makino S, Sekizaki T, Terakado N. Cross-talk = to the=20 genes for Bacillus anthracis capsule synthesis by atxA, the gene = encoding the=20 trans-activator of anthrax toxin synthesis. Mol Microbiol = 1997;23:1229-1240.[Medline]
  26. Vietri NJ, Marrero R, Hoover TA, Welkos SL. = Identification and=20 characterization of a trans-activator involved in the regulation of=20 encapsulation by Bacillus anthracis. Gene 1995;152:1-9.[Medline]
  27. Taylor JP, Dimmitt DC, Ezzell JW, Whitford H. = Indigenous human=20 cutaneous anthrax in Texas. South Med J 1993;86:1-4.[Medline]
  28. Human cutaneous anthrax -- North Carolina, 1987. Arch = Dermatol=20 1988;124:1324-1324.[Medline]
  29. Leads from the MMWR: human cutaneous anthrax -- North = Carolina,=20 1987. JAMA 1988;260:616-616.[Medline]
  30. Human cutaneous anthrax -- North Carolina, 1987. MMWR = Morb Mortal=20 Wkly Rep 1988;37:413-414.[Medline]
  31. Bradaric N, Punda-Polic V. Cutaneous anthrax due to=20 penicillin-resistant Bacillus anthracis transmitted by an insect bite. = Lancet=20 1992;340:306-307.[Medline]
  32. Turell MJ, Knudson GB. Mechanical transmission of = Bacillus=20 anthracis by stable flies (Stomoxys calcitrans) and mosquitoes (Aedes = aegypti=20 and Aedes taeniorhynchus). Infect Immun 1987;55:1859-1861.[Medline]
  33. Smego RA Jr, Gebrian B, Desmangels G. Cutaneous = manifestations of=20 anthrax in rural Haiti. Clin Infect Dis 1998;26:97-102.[Medline]
  34. Edwards MS. Anthrax. In: Feigin RD, Cherry JD, eds. = Textbook of=20 pediatric infectious diseases. 3rd ed. Vol. 1. Philadelphia: W.B. = Saunders,=20 1992:1053-6. =
  35. Doganay M, Bakir M, Dokmetas I. A case of cutaneous = anthrax with=20 toxaemic shock. Br J Dermatol 1987;117:659-662.[Medline]
  36. Kutluk MT, Secmeer G, Kanra G, Celiker A, Aksoyek H. = Cutaneous=20 anthrax. Cutis 1987;40:117-118.[Medline]
  37. Doganay M, Aygen B, Inan M, Kandemir O, Turnbull P. = Temporal=20 artery inflammation as a complication of anthrax. J Infect = 1994;28:311-314.[Medline]
  38. Yorston D, Foster A. Cutaneous anthrax leading to = corneal=20 scarring from cicatricial ectropion. Br J Ophthalmol = 1989;73:809-811.[Abstract] =
  39. Mallon E, McKee PH. Extraordinary case report: = cutaneous anthrax.=20 Am J Dermatopathol 1997;19:79-82.[Medline]
  40. LaForce FM. Anthrax. Clin Infect Dis = 1994;19:1009-1014.[Medline]
  41. de Lalla F, Ezzell JW, Pellizzer G, et al. Familial = outbreak of=20 agriculture anthrax in an area of northern Italy. Eur J Clin Microbiol = Infect=20 Dis 1992;11:839-842.[Medline]
  42. Batykin V, Vygodchikov G, Sazshina Y. Outbreak of = intestinal=20 anthrax in Yarolslavl. J Hyg Epidemiol 1929;1:25-30.
  43. Dutz W, Kohout E. Anthrax. Pathol Annu = 1971;6:209-248.[Medline]
  44. Dutz W, Saidi F, Kohout E. Gastric anthrax with massive = ascites.=20 Gut 1970;11:352-354.[Medline]
  45. Dutz W, Kohout-Dutz E. Anthrax. Int J Dermatol = 1981;20:203-206.[Medline]
  46. Nalin DR, Sultana B, Sahunja R, et al. Survival of a = patient with=20 intestinal anthrax. Am J Med 1977;62:130-132.[Medline]
  47. Paulet R, Caussin C, Coudray JM, Selcer D, de Rohan = Chabot P.=20 Forme visc=E9rale de charbon humain import=E9e d'Africa. Presse Med=20 1994;23:477-478.[Medline]
  48. Alizad A, Ayoub EM, Makki N. Intestinal anthrax in a = two-year-old=20 child. Pediatr Infect Dis J 1995;14:394-395.[Medline]
  49. Dahlgren CM, Buchanan LM, Decker HM, Freed SW, Phillips = CR,=20 Brachman PS. Bacillus anthracis aerosols in goat hair processing = mills. Am J=20 Hyg 1960;72:24-31.
  50. Albrink WS, Brooks SM, Biron RE, Kopel M. Human = inhalation=20 anthrax: a report of three fatal cases. Am J Pathol = 1960;36:457-471. =
  51. Brachman PS, Kaufman AF, Dalldorf FG. Industrial = inhalation=20 anthrax. Bacteriol Rev 1966;30:646-659.[Medline]
  52. Manchee RJ, Broster MG, Henstridge RM, Stagg AJ, = Melling J.=20 Anthrax island. Nature 1982;296:598-598.
  53. Manchee RJ. Bacillus anthracis on Gruinard Island. = Nature=20 1981;294:254-255.[Medline]
  54. Sterne M. Anthrax island. Nature 1982;295:362-362.[Medline]
  55. Wynn J. Anthrax island: why worry? Nature = 1982;298:506-507.[Medline]
  56. Jackson PJ, Hugh-Jones ME, Adair DM, et al. PCR = analysis of=20 tissue samples from the 1979 Sverdlovsk anthrax victims: the presence = of=20 multiple Bacillus anthracis strains in different victims. Proc Natl = Acad Sci U=20 S A 1998;95:1224-1229.[Abstract/Full Text]=20
  57. Guillemin J. Anthrax: the investigation of a deadly = outbreak.=20 Berkeley: University of California Press (in press).
  58. Abramova FA, Grinberg LM, Yampolskaya OV, Walker DH. = Pathology of=20 inhalational anthrax in 42 cases from the Sverdlovsk outbreak of 1979. = Proc=20 Natl Acad Sci U S A 1993;90:2291-2294.[Abstract]=20
  59. Penn CC, Klotz SA. Anthrax pneumonia. Semin Respir = Infect=20 1997;12:28-30.[Medline]
  60. Brachman PS. Inhalation anthrax. Ann N Y Acad Sci = 1980;353:83-93.[Medline]
  61. Brachman PS. Anthrax. Ann N Y Acad Sci = 1970;174:577-582.[Medline]
  62. Albrink WS. Pathogenesis of inhalation anthrax. = Bacteriol Rev=20 1961;25:268-273.
  63. Friedlander AM, Welkos SL, Pitt ML, et al. Postexposure = prophylaxis against experimental inhalation anthrax. J Infect Dis=20 1993;167:1239-1243.[Medline]
  64. Henderson DW, Peacock S, Belton FC. Observations on the = prophylaxis of experimental pulmonary anthrax in the monkey. J Hyg = (Lond)=20 1956;54:28-36. =
  65. Tahernia AC, Hashemi G. Survival in anthrax meningitis. = Pediatrics 1972;50:329-333.[Medline]
  66. Tabatabaie P, Syadati A. Bacillus anthracis as a cause = of=20 bacterial meningitis. Pediatr Infect Dis J 1993;12:1035-1037.[Medline]
  67. Tahernia AC. Treatment of anthrax in children. Arch Dis = Child=20 1967;42:181-182.[Medline]
  68. Rangel RA, Gonzalez DA. Bacillus anthracic meningitis. = Neurology=20 1975;25:525-530.[Abstract]=20
  69. Pluot M, Vital C, Aubertin J, Croix JC, Pire JC, Poisot = D.=20 Anthrax meningitis: report of two cases with autopsies. Acta = Neuropathol=20 (Berl) 1976;36:339-345.[Medline]
  70. Aksaray N, Cinaz P, Coskun U, Serbest M, Koksal F. = Cutaneous=20 anthrax. Trop Geogr Med 1990;42:168-171.[Medline]
  71. Wheat J. Histoplasma. In: Gorbach SL, Bartlett JG, = Blacklow NR,=20 eds. Infectious diseases. 2nd ed. Philadelphia: W.B. Saunders, = 1998:2335-44.
  72. Claus D, Berkeley RCW. Genus Bacillus. In: Sneath PHA, = ed.=20 Bergey's manual of systematic bacteriology. Vol. 2. Baltimore: = Williams &=20 Wilkins, 1986:1105-39.=20
  73. Turnbull PCB, Kramer JM. Bacillus. In: Balows A, ed. = Manual of=20 clinical microbiology. 5th ed. Washington, D.C.: American Society for=20 Microbiology, 1991:296-303.
  74. Penn CC, Klotz SA. Bacillus anthracis and other aerobic = spore=20 formers. In: Gorbach SL, Bartlett JG, Blacklow NR, eds. Infectious = diseases.=20 2nd ed. Philadelphia: W.B. Saunders, 1998:1747-50.
  75. Parry JM, Turnbull PCB, Gibson JR. A color atlas of = Bacillus=20 species. London: Wolfe Medical, 1983:272.
  76. Green BD, Battisti L, Koehler TM, Thorne CB, Ivins BE.=20 Demonstration of a capsule plasmid in Bacillus anthracis. Infect Immun = 1985;49:291-297.[Medline]
  77. Penn CC, Klotz SA. Anthrax. In: Gorbach SL, Bartlett = JG, Blacklow=20 NR, eds. Infectious diseases. 2nd ed. Philadelphia: W.B. Saunders,=20 1998:1575-8.
  78. Gold H. Treatment of anthrax. Fed Proc = 1967;26:1563-1568.[Medline]
  79. Knisely RF. Selective medium for Bacillus anthracis. J = Bacteriol=20 1966;92:784-786.[Medline]
  80. Logan NA, Carman JA, Melling J, Berkeley RCW. = Identification of=20 Bacillus anthracis by API tests. J Med Microbiol 1985;20:75-85.[Abstract]=20
  81. Shlyakhov E, Rubinstein E. Evaluation of the anthraxin = skin test=20 for diagnosis of acute and past human anthrax. Eur J Clin Microbiol = Infect Dis=20 1996;15:242-245.[Medline]
  82. Lalitha MK, Thomas MK. Penicillin resistance in = Bacillus=20 anthracis. Lancet 1997;349:1522-1522.[Medline]
  83. Harrison LH, Ezzell JW, Abshire TG, Kidd S, Kaufmann = AF.=20 Evaluation of serologic tests for diagnosis of anthrax after an = outbreak of=20 cutaneous anthrax in Paraguay. J Infect Dis 1989;160:706-710.[Medline]
  84. Turnbull PC, Doganay M, Lindeque PM, Aygen B, = McLaughlin J.=20 Serology and anthrax in humans, livestock and Etosha National Park = wildlife.=20 Epidemiol Infect 1992;108:299-313.[Medline]
  85. Sirisanthana T, Nelson KE, Ezzell JW, Abshire TG. = Serological=20 studies of patients with cutaneous and oral-oropharyngeal anthrax from = northern Thailand. Am J Trop Med Hyg 1988;39:575-581.[Medline]
  86. Johnson-Winegar A. Comparison of enzyme-linked = immunosorbent and=20 indirect hemagglutination assays for determining anthrax antibodies. J = Clin=20 Microbiol 1984;20:357-361.[Medline]
  87. Pfisterer RM. Eine Milzbrandepidemie in der Schweiz: = Klinische,=20 diagnostische und epidemiologische Aspekte einer weitgehend = vergessenen=20 Krankheit. Schweiz Med Wochenschr 1991;121:813-825.[Medline]
  88. Shlyakhov E, Rubinstein E, Novikov I. Anthrax = post-vaccinal=20 cell-mediated immunity in humans: kinetics pattern. Vaccine = 1997;15:631-636.[Medline]
  89. Andersen GL, Simchock JM, Wilson KH. Identification of = a region=20 of genetic variability among Bacillus anthracis strains and related = species. J=20 Bacteriol 1996;178:377-384.[Abstract]=20
  90. Patra G, Vaissaire J, Weber-Levy M, Le Doujet C, Mock = M.=20 Molecular characterization of Bacillus strains involved in outbreaks = of=20 anthrax in France in 1997. J Clin Microbiol 1998;36:3412-3414.[Abstract/Full Text]=20
  91. Patra G, Sylvestre P, Ramisse V, Therasse J, Guesdon = JL.=20 Isolation of a specific chromosomic DNA sequence of Bacillus anthracis = and its=20 possible use in diagnosis. FEMS Immunol Med Microbiol = 1996;15:223-231.[Medline]
  92. Ramisse V, Patra G, Garrigue H, Guesdon JL, Mock M.=20 Identification and characterization of Bacillus anthracis by multiplex = PCR=20 analysis of sequences on plasmids pXO1 and pXO2 and chromosomal DNA. = FEMS=20 Microbiol Lett 1996;145:9-16.[Medline]
  93. Keim P, Kalif A, Schupp J, et al. Molecular evolution = and=20 diversity in Bacillus anthracis as detected by amplified fragment = length=20 polymorphism markers. J Bacteriol 1997;179:818-824.[Abstract]=20
  94. Klevytskya A, Schupp J, Price LB, et al. A multiplexed=20 fluorescent PCR genotyping system based on ten highly informative = single-locus=20 markers for B. anthracis strain identification. Presented at the Third = International Conference on Anthrax, Plymouth, England, 1998. = abstract.
  95. Price LB, Hugh-Jones M, Jackson PJ, Keim P. Genetic = diversity in=20 the protective antigen gene of Bacillus anthracis. J Bacteriol=20 1999;181:2358-2362.[Abstract/Full Text]= =20
  96. Jackson PJ, Walthers EA, Kalif AS, et al. = Characterization of the=20 variable-number tandem repeats in vrrA from different Bacillus = anthracis=20 isolates. Appl Environ Microbiol 1997;63:1400-1405.[Abstract]=20
  97. Vancurik J. Causes of the failure of antibiotic = prophylaxis of=20 inhalation anthrax and clearance of the spores from the lungs. Folia = Microbiol=20 (Praha) 1966;11:459-464.[Medline]
  98. Vaccine against anthrax. BMJ 1965;5464:717-718.[Medline]
  99. Anthrax vaccine. Med Lett Drugs Ther 1998;40:52-53.[Medline]
  100. Ivins BE, Fellows P, Pitt ML, et al. Efficacy of = standard human=20 anthrax vaccine against Bacillus anthracis aerosol spore challenge in = rhesus=20 monkeys. Salisbury Med Bull 1996;87:125-6.
  101. Brachman PS, Gold H, Plotkin SA, Fekety FR, Werrin M, = Ingraham=20 NR. Field evaluation of a human anthrax vaccine. Am J Public Health=20 1962;52:632-645.
  102. Franz DR, Jahrling PB, Friedlander AM, et al. Clinical = recognition and management of patients exposed to biological warfare = agents.=20 JAMA 1997;278:399-411.[Abstract]=20
  103. Shlyakhov EN, Rubinstein E. Human live anthrax vaccine = in the=20 former USSR. Vaccine 1994;12:727-730.[Medline]
  104. Pezard C, Weber M, Sirard JC, Berche P, Mock M. = Protective=20 immunity induced by Bacillus anthracis toxin-deficient strains. Infect = Immun=20 1995;63:1369-1372.[Abstract]=20
  105. Pezard C, Sirard JC, Mock M. Protective immunity = induced by=20 Bacillus anthracis toxin mutant strains. Adv Exp Med Biol = 1996;397:69-72.[Medline]
  106. Miller J, McBride BW, Manchee RJ, Moore P, Baillie LW. = Production and purification of recombinant protective antigen and = protective=20 efficacy against Bacillus anthracis. Lett Appl Microbiol = 1998;26:56-60.[Medline]
  107. Little SF, Knudson GB. Comparative efficacy of = Bacillus=20 anthracis live spore vaccine and protective antigen vaccine against = anthrax in=20 the guinea pig. Infect Immun 1986;52:509-512.[Medline]
  108. Ivins BE, Welkos SL, Knudson GB, Little SF. = Immunization against=20 anthrax with aromatic compound-dependent (Aro-) mutants of Bacillus = anthracis=20 and with recombinant strains of Bacillus subtilis that produce anthrax = protective antigen. Infect Immun 1990;58:303-308.[Medline]
  109. Ivins BE, Welkos SL, Little SF, Crumrine MH, Nelson = GO.=20 Immunization against anthrax with Bacillus anthracis protective = antigen=20 combined with adjuvants. Infect Immun 1992;60:662-668.[Abstract]=20
  110. Ivins BE, Fellows PF, Nelson GO. Efficacy of a = standard human=20 anthrax vaccine against Bacillus anthracis spore challenge in = guinea-pigs.=20 Vaccine 1994;12:872-874.[Medline]
  111. Coulson NM, Fulop M, Titball RW. Bacillus anthracis = protective=20 antigen, expressed in Salmonella typhimurium SL 3261, affords = protection=20 against anthrax spore challenge. Vaccine 1994;12:1395-1401.[Medline]
  112. Baillie L, Moir A, Manchee R. The expression of the = protective=20 antigen of Bacillus anthracis in Bacillus subtilis. J Appl Microbiol=20 1998;84:741-746.[Medline]
  113. Baillie LW, Moore P, McBride BW. A heat-inducible = Bacillus=20 subtilis bacteriophage phi 105 expression system for the production of = the=20 protective antigen of Bacillus anthracis. FEMS Microbiol Lett = 1998;163:43-47.[Medline]
  114. Hanna P. How anthrax kills. Science 1998;280:1671, = 1673-1671,=20 1674.
  115. Young LS, Feeley JC, Brachman PS. Vaporized = formaldehyde=20 treatment of a textile mill contaminated with Bacillus anthracis. Arch = Environ=20 Health 1970;20:400-403.[Medline]
  116. Manchee RJ, Broster MG, Stagg AJ, Hibbs SE. = Formaldehyde=20 dilution effectively inactivates spores of Bacillus anthracis on the = Scottish=20 island of Gruinard. Appl Environ Microbiol 1994;60:4167-4171.[Abstract]=20
  117. Birensvige A. Inhalation hazard from reaerosolized = biological=20 agents: a review. Aberdeen, Md.: Army Chemical Research, Development = and=20 Engineering Center, 1992.
  118. Davids DE, Lejeune AR. Secondary aerosol hazard in the = field.=20 Raulston, Alta.: Suffield Defence Research Establishment, 1981.
  119. Knudson GB. Treatment of anthrax in man: history and = current=20 concepts. Mil Med 1986;151:71-77.[Medline]
  120. Doust JY, Sarkarzadeh A, Kavoossi K. Corticosteroid in = treatment=20 of malignant edema of chest wall and neck (anthrax). Dis Chest=20 1968;53:773-774.[Medline]
  121. Cataldi A, Labruyere E, Mock M. Construction and=20 characterization of a protective antigen-deficient Bacillus anthracis = strain.=20 Mol Microbiol 1990;4:1111-1117.[Medline]
  122. Pezard C, Berche P, Mock M. Contribution of individual = toxin=20 components to virulence of Bacillus anthracis. Infect Immun = 1991;59:3472-3477.[Medline]
  123. Turnbull PC, Leppla SH, Broster MG, Quinn CP, Melling = J.=20 Antibodies to anthrax toxin in humans and guinea pigs and their = relevance to=20 protective immunity. Med Microbiol Immunol (Berl) = 1988;177:293-303.[Medline]
  124. Dirckx JH. Virgil on anthrax. Am J Dermatopathol = 1981;3:191-195.[Medline]
  125. Koch R. The aetiology of anthrax based on the ontogeny = of the=20 anthrax bacillus. Beitr Biol Pflanz 1877;2:277-82.
  126. Pasteur L. De l'att=E9nuation des virus et de leur = retour =E0 la=20 virulence. C R Acad Sci III 1881;92:429-435.
  127. Metchnikoff E. Immunity in infective diseases. = Cambridge,=20 England: Cambridge University Press, 1905.
  128. Ember LR. Bioterrorism: combating the threat. Chem Eng = News=20 1999;77:8-17. =
  129. Bioterrorism alleging use of anthrax and interim = guidelines for=20 management -- United States, 1998. MMWR Morb Mortal Wkly Rep = 1999;48:69-74.[Medline]
  130. Pomerantsev AP, Staritsin NA, Mockov Yu V, Marinin LI. = Expression of cereolysine AB genes in Bacillus anthracis vaccine = strain=20 ensures protection against experimental hemolytic anthrax infection. = Vaccine=20 1997;15:1846-1850.[Medline]

 
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N Engl J Med 2000; 342:61-62, Jan 6, 2000.=20 Correspondence

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  • Webb, G. F., Blaser, M. J. (2002). Mailborne transmission of = anthrax:=20 Modeling and implications. Proc. Natl. Acad. Sci. U. S. A. = 99:=20 7027-7032 [Abstract] [Full = Text]=20  =20
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  • Weir, E. (2000). Anthrax: of bison and bioterrorism. Can Med = Assoc=20 J 163: 608-608 [Full Text] =  =20
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  • (2001). Anthrax. Journal Watch Dermatology 2001: 6-6 = [Full = Text]=20  =20
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  • Swartz, M. N. (2001). Recognition and Management of Anthrax -- An = Update.=20 N Engl J Med 345: 1621-1626 [Full = Text]=20  =20
  • Bush, L. M., Abrams, B. H., Beall, A., Johnson, C. C. (2001). = Index Case=20 of Fatal Inhalational Anthrax Due to Bioterrorism in the United = States. N=20 Engl J Med 345: 1607-1610 [Full = Text]=20  =20
  • The Editors, (2001). After September 11. N Engl J Med = 345:=20 1490-1490 [Full = Text]=20  =20
  • Kim, H. J., Jun, W. B., Hong Lee, S., Ho Rho, M. (2001). CT and MR = Findings of Anthrax Meningoencephalitis: Report of Two Cases and = Review of the=20 Literature. AJNR Am J Neuroradiol 22: 1303-1305 [Abstract] [Full = Text]=20  =20
  • Khan, A. S., Ashford, D. A. (2001). Ready or Not -- Preparedness = for=20 Bioterrorism. N Engl J Med 345: 287-289 [Full = Text]=20  =20
  • Qi, Y., Patra, G., Liang, X., Williams, L. E., Rose, S., Redkar, = R. J.,=20 DelVecchio, V. G. (2001). Utilization of the rpoB Gene as a Specific=20 Chromosomal Marker for Real-Time PCR Detection of Bacillus anthracis.=20 Appl. Environ. Microbiol. 67: 3720-3727 [Abstract]= [Full Text] =  =20
  • Brumlik, M. J., Szymajda, U., Zakowska, D., Liang, X., Redkar, R. = J.,=20 Patra, G., Del Vecchio, V. G. (2001). Use of Long-Range Repetitive = Element=20 Polymorphism-PCR To Differentiate Bacillus anthracis Strains. = Appl.=20 Environ. Microbiol. 67: 3021-3028 [Abstract]= [Full Text] =  =20
  • Welkos, S., Little, S., Friedlander, A., Fritz, D., Fellows, P. = (2001).=20 The role of antibodies to Bacillus anthracis and anthrax toxin = components in=20 inhibiting the early stages of infection by anthrax spores.=20 Microbiology 147: 1677-1685 [Abst= ract]=20 [Full=20 Text]  =20
  • Sellman, B. R., Mourez, M., John Collier, R. (2001). = Dominant-Negative=20 Mutants of a Toxin Subunit: An Approach to Therapy of Anthrax.=20 Science 292: 695-697 [Abs= tract]=20 [Full=20 Text]  =20
  • Furmanski, M., Hanna, P. C., Dixon, T. C. (2000). Anthrax. N = Engl J=20 Med 342: 61-62 [Full = Text]=20  =20
  • Boneva, R. S., Folks, T. M., Chapman, L. E. (2001). Infectious = Disease=20 Issues in Xenotransplantation. Clin. Microbiol. Rev. 14: 1-14 = [Abstract]=20 [Full Text] =  =20
  • Jortani, S. A., Snyder, J. W., Valdes, R. Jr (2000). The Role of = the=20 Clinical Laboratory in Managing Chemical or Biological Terrorism. = Clin=20 Chem 46: 1883-1893 [Abstrac= t]=20 [Full = Text]=20  =20
  • Hayden, G. F (1999). Alliteration in medicine: a puzzling = profusion of=20 p's. BMJ 319: 1605-1608 [Abstract]= [Full = Text]=20  

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