The Threat of Anthrax Terrorism

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The Threat of Anthrax Terrorism

• Nick Colovos, MD FAAEM
• Assistant Clinical Professor of Emergency
  Medicine
• Allegheny General Hospital
• Pittsburgh, Pennsylvania

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Anthrax
It's not that bad, is it ?
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April 2 1979
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Compound 19

• Weapons Grade Anthrax Spores
• Accidental Release
• 66 deaths reported

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Robert Koch

• 1897
• Endospores
• Organism causes disease

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Bacillus anthracis

• Very Large
• Gram-Positive
• Spore forming rod
• 1-1.5 X 4-10um

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Anthrax-How do you get it?

• Inoculation through an open wound in the skin.
• Ingestion eating contaminated meat.
• Inhalation breathing in spores.
• Route has the Highest Mortality

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Anthrax on the Skin

• Direct Contact
• Cutaneous anthrax
• Appears in 1-5 days
• Painless lesion

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Pathogenicity

• Direct Contact
• Cutaneous anthrax
• Appears in 1-5 days
• Painless lesion
• Contagious

(JAMA. 19992811735-1745)
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80-90 Fatality Rate

• Ingestion
• Abdominal pain
• Bloody Diarrhea
• Intestinal infarctions
• Tonsillar Involvement

GI Anthrax intestinal infarction
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Inhalation Anthrax

• Size Matters
• 1800s Wool Sorters
• 1-5 micrometers
• 10,000 spores will cause disease

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Size Matters

• Envelope
• 100 microns
• Talc Powder
• 30 microns
• Anthrax Spores
• 1-5 microns

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Introduction of Spores

• Infection begins with inhalation of spores.
• Alveolar macrophages engulf the spores.
• Transport to the lymph system

Department of Radiologic Pathology AFIP 2001
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Mediastinum involved

• Germination of the organism in the lymphatic
  system.
• Exotoxin production
• Results are hemorrhage and edema

Department of Radiologic Pathology AFIP 2001
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Anthrax Histopathology

• The organisms are found in the pulmonary
  lymphatics surrounding pulmonary arterioles and
  bronchi.

High-power photomicrograph of the same specimen
better demonstrates the bacilli (arrow)
Department of Radiologic Pathology AFIP 2001
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Anthrax Histopathology

• Toxin elaborated by the bacilli within
  intrathoracic lymph nodes results in hemorrhage.

Note edema and hemorrhage infiltrating the
mediastinal fat.
Department of Radiologic Pathology AFIP 2001
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The Flu vs. Anthrax

• Flu
• Symptoms 5 days after exposure
• Muscle aches
• Fever
• Chills headache

• Anthrax
• Symptoms 7 days after exposure
• Muscle aches
• Fever
• Chills headache

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The Flu vs. Anthrax

• Flu
• Fever continues
• scratchy sore throat, cough.
• runny nose

• Anthrax
• Exhaustion
• Dry cough

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The Flu vs. Anthrax

• Flu
• Cough more severe
• Fever starts to decline

• Anthrax
• Symptoms worsen
• Short of Breath
• Nausea
• Chest discomfort
• Lungs begin to fill with fluid

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The Flu vs. Anthrax

• Flu
  
• Fever and body aches disappear

• Anthrax
• High fever
• labored breathing
• body slips into shock
• loss of consciousness

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The Flu vs. Anthrax

• Flu
• Cough and malaise may
• continue for up to two weeks.

• Anthrax
• If treatment isn't begun soon enough, death
  occurs within hours or days

• In some cases serious complications result in
  pneumonia and even death

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Postal Worker

• October 19, 2001
• Three day history of fever chills and chest
  heaviness.
• Mediastinum is widening.

Department of Radiologic Pathology AFIP 2001
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Postal Worker Inhalational Anthrax

• Cross-section through the chest.
• CT scan reveals enlarged lymphnodes
• Pleural effusions are also of note.

Department of Radiologic Pathology AFIP 2001
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Pulmonary Anthrax
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Postal Worker

• Oct. 23, 2001
• Pleural Effusions

Department of Radiologic Pathology AFIP 2001
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Weaponization ?
Photo from Col Vedders Text USAMRIID
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British 1942

• Target German Livestock
• Anthrax Cakes
• South Isle of Gruinard
• Soil contaminate with Anthrax 1987

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City of Sverdlosvk

• Dr. Faina Abramova
• Chief Pathologist

The Cardinals Cap
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Round them Up

• No evidence of person to person transmission
• Quarantine is not required
• Universal precautions

Larry Wayne Harris. AP Photo
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US Biological Weapons Programs

• Ended in 1972

Photo Fort Detrick MD. By N.Colovos
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Weaponization

• 5 lbs Anthrax spores
• Air Dispersal
• ½ of DC population will die

Sec. Defense William Cohen
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Controversy

• 1990s, inspection teams discovered that Iraq
  produced 8,500 liters of anthrax spores

• An amount believed capable of killing every man,
  woman and child on earth

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Medical Countermeasures

• Anthrax Vaccine
• Anthrax Vaccination at a National Guard base in
  Fort Wayne, Ind. Time Magazine Photo Matt
  Sullivan/The Journal Gazette/AP

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Controversy

• 1997
• Vaccinate Military
• 400,000 vaccinated
• Of 2.4 million
• Common Reaction
• 66 women
• 30 men

Photo Vaccine reaction. By N.Colovos
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Iraqi CBW Capabilities

• Biological Warfare
• Botulinum toxin (11,800 liters)
• Anthrax (8,825 liters)
• Clostridium perfringens toxin (gas gangrene) (340
  liters)
• Live agent weaponization of BW in Dec 90. 150
  bombs and 50 warheads deployed to forward storage
  locations
• Three 2,000-liter anthrax spray tanks stored,
  ready for use after Dec 1990

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The Past Holds the Answers to Our Future