Fatal Inhalational Anthrax in a 94-Year-Old Connecticut Woman

Abstract

We describe the 11th case of bioterrorism-related inhalational anthrax reported in the United States. The presenting clinical features of this 94-year-old woman were subtle and nondistinctive. The diagnosis was recognized because blood cultures were obtained prior to administration of antibiotics, emphasizing the importance of this diagnostic test in evaluating ill patients who have been exposed to Bacillus anthracis. The patient's clinical course was characterized by progression of respiratory insufficiency, pleural effusions and pulmonary edema, and, ultimately, death. Although her B anthracis bacteremia was rapidly sterilized after initiation of antibiotic therapy, viable B anthracis was present in postmortem mediastinal lymph node specimens. The source of exposure to B anthracis in this patient is not known. Exposure to mail that was cross-contaminated as it passed through postal facilities contaminated with B anthracis spores is one hypothesis under investigation.

Development of an Inhalational Bacillus anthracis Exposure Therapeutic Model in Cynomolgus Macaques

“…Consistent with what has been observed in human inhalational anthrax cases (3,14), the majority of NHPs in the present study had increased total WBC counts and alterations in WBC differentials following aerosol exposure. The increase in WBC and neutrophil counts, followed by the later increase in lymphocytes for surviving challenged animals, may be due to an initial innate response, followed by the cell-mediated immune response elicited by the infection.…”

Re-aerosolization ofBacillus thuringiensisspores from concrete and turf

“…The extrapolation from primate data to the human health risk resulting from the inhalation of spores either from an initial release or from re-aerosolization is contentious: the lethal median dose in humans has been estimated by Keim and Kaufmann (1999) to range from 2500 to 55 000 spores while Peters and Hartley (2002) report inhalational infectivity from only a few spores. Such lower estimations of lethal dose correlate with earlier predictions (Brachman, 1980) and case histories of infection (Barakat et al 2002). The subject of dose and lethality for B. anthracis has recently been reviewed (Toth et al 2013) and the existing data re-modelled.…”

Multigeneration Cross Contamination of Mail with Bacillus Species Spores by Tumbling

“…However, the data presented here demonstrate that a significant amount of cross contamination occurs in a very short period of time as envelopes contact and interact with one another in postal trays, bins, and bags during processing and sorting and while mail is being handled by a carrier on the delivery route. These findings support the possibility that the letters bagged and tested with the Leahy letter, which preceded the Leahy and Daschle letters through the sorting machine by several minutes, may have been contaminated as a result of envelope-to-envelope interaction in the plastic bag or elsewhere during processing and transit (2).…”