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Anthrax

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Anthrax
Anthrax PHIL 2033.png
A skin lesion with black eschar characteristic of anthrax
SpecialtyInfectious disease
SymptomsSkin form: small blister with surrounding swelling
Inhalational form: fever, chest pain, shortness of breath
Intestinal form: nausea, vomiting, diarrhea, abdominal pain
Injection form: fever, abscess[1]
Usual onset1 day to 2 months post contact[1]
CausesBacillus anthracis[2]
Risk factorsWorking with animals, travelers, postal workers, military personnel[3]
Diagnostic methodBased on antibodies or toxin in the blood, microbial culture[4]
PreventionAnthrax vaccination, antibiotics[3][5]
TreatmentAntibiotics, antitoxin[6]
Prognosis20–80% die without treatment[5][7]
Frequency>2,000 cases per year[8]

Anthrax is an infection caused by the bacterium Bacillus anthracis.[2] It can occur in four forms: skin, lungs, intestinal, and injection.[9] Symptom onset occurs between one day and more than two months after the infection is contracted.[1] The skin form presents with a small blister with surrounding swelling that often turns into a painless ulcer with a black center.[1] The inhalation form presents with fever, chest pain and shortness of breath.[1] The intestinal form presents with diarrhea (which may contain blood), abdominal pains, nausea and vomiting.[1] The injection form presents with fever and an abscess at the site of drug injection.[1]

According to the USA's Centers for Disease Control and Prevention, the first clinical descriptions of cutaneous anthrax were given by Maret in 1752 and Fournier in 1769. Before that anthrax had been described only through historical accounts. The Prussian scientist Robert Koch (1843–1910) was the first to identify Bacillus anthracis as the bacterium that causes anthrax.

Anthrax is spread by contact with the bacterium's spores, which often appear in infectious animal products.[10] Contact is by breathing or eating or through an area of broken skin.[10] It does not typically spread directly between people.[10] Risk factors include people who work with animals or animal products, travelers, and military personnel.[3] Diagnosis can be confirmed by finding antibodies or the toxin in the blood or by culture of a sample from the infected site.[4]

Anthrax vaccination is recommended for people at high risk of infection.[3] Immunizing animals against anthrax is recommended in areas where previous infections have occurred.[10] A two-month course of antibiotics such as ciprofloxacin, levofloxacin and doxycycline after exposure can also prevent infection.[5] If infection occurs, treatment is with antibiotics and possibly antitoxin.[6] The type and number of antibiotics used depend on the type of infection.[5] Antitoxin is recommended for those with widespread infection.[5]

A rare disease, human anthrax is most common in Africa and central and southern Asia.[11] It also occurs more regularly in Southern Europe than elsewhere on the continent and is uncommon in Northern Europe and North America.[12] Globally, at least 2,000 cases occur a year, with about two cases a year in the United States.[8][13] Skin infections represent more than 95% of cases.[7] Without treatment the risk of death from skin anthrax is 23.7%.[5] For intestinal infection the risk of death is 25 to 75%, while respiratory anthrax has a mortality of 50 to 80%, even with treatment.[5][7] Until the 20th century anthrax infections killed hundreds of thousands of people and animals each year.[14] Anthrax has been developed as a weapon by a number of countries.[7] In herbivorous animals infection occurs when they eat or breathe in the spores while grazing.[11] Animals may become infected by killing and/or eating infected animals.[11]

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Bacillus anthracis

Bacillus anthracis

Bacillus anthracis is a gram-positive and rod-shaped bacterium that causes anthrax, a deadly disease to livestock and, occasionally, to humans. It is the only permanent (obligate) pathogen within the genus Bacillus. Its infection is a type of zoonosis, as it is transmitted from animals to humans. It was discovered by a German physician Robert Koch in 1876, and became the first bacterium to be experimentally shown as a pathogen. The discovery was also the first scientific evidence for the germ theory of diseases.

Abscess

Abscess

An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends beyond the swelling. Carbuncles and boils are types of abscess that often involve hair follicles, with carbuncles being larger.

Centers for Disease Control and Prevention

Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgia.

Endospore

Endospore

An endospore is a dormant, tough, and non-reproductive structure produced by some bacteria in the phylum Bacillota. The name "endospore" is suggestive of a spore or seed-like form, but it is not a true spore. It is a stripped-down, dormant form to which the bacterium can reduce itself. Endospore formation is usually triggered by a lack of nutrients, and usually occurs in gram-positive bacteria. In endospore formation, the bacterium divides within its cell wall, and one side then engulfs the other. Endospores enable bacteria to lie dormant for extended periods, even centuries. There are many reports of spores remaining viable over 10,000 years, and revival of spores millions of years old has been claimed. There is one report of viable spores of Bacillus marismortui in salt crystals approximately 250 million years old. When the environment becomes more favorable, the endospore can reactivate itself into a vegetative state. Most types of bacteria cannot change to the endospore form. Examples of bacterial species that can form endospores include Bacillus cereus, Bacillus anthracis, Bacillus thuringiensis, Clostridium botulinum, and Clostridium tetani.

Anthrax vaccine

Anthrax vaccine

Anthrax vaccines are vaccines to prevent the livestock and human disease anthrax, caused by the bacterium Bacillus anthracis.

Ciprofloxacin

Ciprofloxacin

Ciprofloxacin is a fluoroquinolone antibiotic used to treat a number of bacterial infections. This includes bone and joint infections, intra-abdominal infections, certain types of infectious diarrhea, respiratory tract infections, skin infections, typhoid fever, and urinary tract infections, among others. For some infections it is used in addition to other antibiotics. It can be taken by mouth, as eye drops, as ear drops, or intravenously.

Levofloxacin

Levofloxacin

Levofloxacin, sold under the brand name Levaquin among others, is an antibiotic medication. It is used to treat a number of bacterial infections including acute bacterial sinusitis, pneumonia, H. pylori, urinary tract infections, chronic prostatitis, and some types of gastroenteritis. Along with other antibiotics it may be used to treat tuberculosis, meningitis, or pelvic inflammatory disease. Use is generally recommended only when other options are not available. It is available by mouth, intravenously, and in eye drop form.

Doxycycline

Doxycycline

Doxycycline is a broad-spectrum tetracycline class antibiotic used in the treatment of infections caused by bacteria and certain parasites. It is used to treat bacterial pneumonia, acne, chlamydia infections, Lyme disease, cholera, typhus, and syphilis. It is also used to prevent malaria in combination with quinine. Doxycycline may be taken by mouth or by injection into a vein.

Antibiotic

Antibiotic

An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of such infections. They may either kill or inhibit the growth of bacteria. A limited number of antibiotics also possess antiprotozoal activity. Antibiotics are not effective against viruses such as the common cold or influenza; drugs which inhibit growth of viruses are termed antiviral drugs or antivirals rather than antibiotics. They are also not effective against fungi; drugs which inhibit growth of fungi are called antifungal drugs.

Antitoxin

Antitoxin

An antitoxin is an antibody with the ability to neutralize a specific toxin. Antitoxins are produced by certain animals, plants, and bacteria in response to toxin exposure. Although they are most effective in neutralizing toxins, they can also kill bacteria and other microorganisms. Antitoxins are made within organisms, and can be injected into other organisms, including humans, to treat an infectious disease. This procedure involves injecting an animal with a safe amount of a particular toxin. The animal's body then makes the antitoxin needed to neutralize the toxin. Later, blood is withdrawn from the animal. When the antitoxin is obtained from the blood, it is purified and injected into a human or other animal, inducing temporary passive immunity. To prevent serum sickness, it is often best to use an antitoxin obtained from the same species.

Northern Europe

Northern Europe

The northern region of Europe has several definitions. A restrictive definition may describe Northern Europe as being roughly north of the southern coast of the Baltic Sea, which is about 54°N, or may be based on other geographical factors such as climate and ecology.

Anthrax weaponization

Anthrax weaponization

Anthrax weaponization is the development and deployment of the bacterium Bacillus anthracis or, more commonly, its spore, as a biological weapon. As a biological weapon, anthrax has been used in biowarfare and bioterrorism since 1914. However, in 1975 the Biological Weapons Convention prohibited the "development, production and stockpiling" of biological weapons. It has since been used in bioterrorism.

Etymology

The English name comes from anthrax (ἄνθραξ), the Greek word for coal,[15][16] possibly having Egyptian etymology,[17] because of the characteristic black skin lesions developed by people with a cutaneous anthrax infection. The central black eschar surrounded by vivid red skin has long been recognised as typical of the disease. The first recorded use of the word "anthrax" in English is in a 1398 translation of Bartholomaeus Anglicus' work De proprietatibus rerum (On the Properties of Things, 1240).[18]

Anthrax was historically known by a wide variety of names indicating its symptoms, location and groups considered most vulnerable to infection. They included Siberian plague, Cumberland disease, charbon, splenic fever, malignant edema, woolsorter's disease and la maladie de Bradford.[19]

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Greek language

Greek language

Greek is an independent branch of the Indo-European family of languages, native to Greece, Cyprus, southern Italy, southern Albania, and other regions of the Balkans, the Black Sea coast, Asia Minor, and the Eastern Mediterranean. It has the longest documented history of any Indo-European language, spanning at least 3,400 years of written records. Its writing system is the Greek alphabet, which has been used for approximately 2,800 years; previously, Greek was recorded in writing systems such as Linear B and the Cypriot syllabary. The alphabet arose from the Phoenician script and was in turn the basis of the Latin, Cyrillic, Armenian, Coptic, Gothic, and many other writing systems.

Egyptian language

Egyptian language

The Egyptian language or Ancient Egyptian is a dead Afro-Asiatic language that was spoken in ancient Egypt. It is known today from a large corpus of surviving texts which were made accessible to the modern world following the decipherment of the ancient Egyptian scripts in the early 19th century. Egyptian is one of the earliest written languages, first being recorded in the hieroglyphic script in the late 4th millennium BC. It is also the longest-attested human language, with a written record spanning over 4000 years. Its classical form is known as Middle Egyptian, the vernacular of the Middle Kingdom of Egypt which remained the literary language of Egypt until the Roman period. By the time of classical antiquity the spoken language had evolved into Demotic, and by the Roman era it had diversified into the Coptic dialects. These were eventually supplanted by Arabic after the Muslim conquest of Egypt, although Bohairic Coptic remains in use as the liturgical language of the Coptic Church.

Lesion

Lesion

A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. Lesion is derived from the Latin laesio "injury". Lesions may occur in plants as well as animals.

Eschar

Eschar

An eschar is a slough or piece of dead tissue that is cast off from the surface of the skin, particularly after a burn injury, but also seen in gangrene, ulcer, fungal infections, necrotizing spider bite wounds, tick bites associated with spotted fevers and exposure to cutaneous anthrax. The term ‘eschar’ is not interchangeable with ‘scab’. An eschar contains necrotic tissue whereas a scab is composed of dried blood and exudate.

Bartholomaeus Anglicus

Bartholomaeus Anglicus

Bartholomaeus Anglicus, also known as Bartholomew the Englishman and Berthelet, was an early 13th-century Scholastic of Paris, a member of the Franciscan order. He was the author of the compendium De proprietatibus rerum, dated c.1240, an early forerunner of the encyclopedia and a widely cited book in the Middle Ages. Bartholomew also held senior positions within the church and was appointed Bishop of Łuków in what is now Poland, although he was not consecrated to that position.

Cumberland County, New South Wales

Cumberland County, New South Wales

Cumberland County is a county in the State of New South Wales, Australia. Most of the Sydney metropolitan area is located within the County of Cumberland.

Bradford

Bradford

Bradford is a city in West Yorkshire, England. Bradford had a population of 349,561 at the 2011 census. It is the second-largest subdivision of the West Yorkshire Built-up Area after Leeds, which is approximately 8.6 miles (14 km) to the east. The City of Bradford district had a population of 546,412, making it the 7th most populous district in England.

Signs and symptoms

Skin

Skin lesion from anthrax
Skin lesion from anthrax
Skin anthrax lesion on the neck
Skin anthrax lesion on the neck

Cutaneous anthrax, also known as hide-porter's disease, is when anthrax occurs on the skin. It is the most common form (>90% of anthrax cases). It is the least dangerous form (low mortality with treatment, 23.7% mortality without).[20][5] Cutaneous anthrax presents as a boil-like skin lesion that eventually forms an ulcer with a black center (eschar). The black eschar often shows up as a large, painless, necrotic ulcer (beginning as an irritating and itchy skin lesion or blister that is dark and usually concentrated as a black dot, somewhat resembling bread mold) at the site of infection. In general, cutaneous infections form within the site of spore penetration between two and five days after exposure. Unlike bruises or most other lesions, cutaneous anthrax infections normally do not cause pain. Nearby lymph nodes may become infected, reddened, swollen, and painful. A scab forms over the lesion soon, and falls off in a few weeks. Complete recovery may take longer.[21] Cutaneous anthrax is typically caused when B. anthracis spores enter through cuts on the skin. This form is found most commonly when humans handle infected animals and/or animal products.[22]

Injection

In December 2009, an outbreak of anthrax occurred among injecting heroin users in the Glasgow and Stirling areas of Scotland, resulting in 14 deaths.[23] The source of the anthrax is believed to have been dilution of the heroin with bone meal in Afghanistan.[24] Injected anthrax may have symptoms similar to cutaneous anthrax, with the exception of black areas,[25] and may also cause infection deep into the muscle and spread faster. [26] This can cause it to be harder to recognise and treat.

Lungs

Inhalation anthrax usually develops within a week after exposure, but may take up to 2 months. During the first few days of illness, most people have fever, chills, and fatigue. These symptoms may be accompanied by cough, shortness of breath, chest pain, and nausea or vomiting, making inhalation anthrax difficult to distinguish from influenza and community-acquired pneumonia. This is often described as the prodromal period.[27]

Over the next day or so, shortness of breath, cough, and chest pain become more common, and complaints not involving the chest such as nausea, vomiting, altered mental status, sweats, and headache develop in one-third or more of people. Upper respiratory tract symptoms occur in only a quarter of people, and muscle pains are rare. Altered mental status or shortness of breath generally brings people to healthcare and marks the fulminant phase of illness.

It infects the lymph nodes in the chest first, rather than the lungs themselves, a condition called hemorrhagic mediastinitis, causing bloody fluid to accumulate in the chest cavity, thereby causing shortness of breath. The second (pneumonia) stage occurs when the infection spreads from the lymph nodes to the lungs. Symptoms of the second stage develop suddenly within hours or days after the first stage. Symptoms include high fever, extreme shortness of breath, shock, and rapid death within 48 hours in fatal cases.[28]

Gastrointestinal

Gastrointestinal (GI) infection is most often caused by consuming anthrax-infected meat and is characterized by diarrhea, potentially with blood, abdominal pains, acute inflammation of the intestinal tract, and loss of appetite.[29] Occasional vomiting of blood can occur. Lesions have been found in the intestines and in the mouth and throat. After the bacterium invades the gastrointestinal system, it spreads to the bloodstream and throughout the body, while continuing to make toxins.[30]

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Boil

Boil

A boil, also called a furuncle, is a deep folliculitis, which is an infection of the hair follicle. It is most commonly caused by infection by the bacterium Staphylococcus aureus, resulting in a painful swollen area on the skin caused by an accumulation of pus and dead tissue. Boils which are expanded are basically pus-filled nodules. Individual boils clustered together are called carbuncles. Most human infections are caused by coagulase-positive S. aureus strains, notable for the bacteria's ability to produce coagulase, an enzyme that can clot blood. Almost any organ system can be infected by S. aureus.

Ulcer

Ulcer

An ulcer is a discontinuity or break in a bodily membrane that impedes normal function of the affected organ. According to Robbins's pathology, "ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing out of inflamed necrotic tissue." Common forms of ulcers recognized in medicine include:Ulcer (dermatology), a discontinuity of the skin or a break in the skin. Pressure ulcers, also known as bedsores Genital ulcer, an ulcer located on the genital area Ulcerative dermatitis, a skin disorder associated with bacterial growth often initiated by self-trauma Anal fissure, a.k.a. an ulcer or tear near the anus or within the rectum Diabetic foot ulcer, a major complication of the diabetic foot Corneal ulcer, an inflammatory or infective condition of the cornea Mouth ulcer, an open sore inside the mouth. Aphthous ulcer, a specific type of oral ulcer also known as a canker sore Peptic ulcer, a discontinuity of the gastrointestinal mucosa Venous ulcer, a wound thought to occur due to improper functioning of valves in the veins Stress ulcer, an ulcer located within the stomach and proximal duodenum Ulcerative sarcoidosis, a cutaneous condition affecting people with sarcoidosis Ulcerative lichen planus, a rare variant of lichen planus Ulcerative colitis, a form of inflammatory bowel disease (IBD). Ulcerative disposition, a disorder or discomfort that causes severe abdominal distress, often associated with chronic gastritis

Eschar

Eschar

An eschar is a slough or piece of dead tissue that is cast off from the surface of the skin, particularly after a burn injury, but also seen in gangrene, ulcer, fungal infections, necrotizing spider bite wounds, tick bites associated with spotted fevers and exposure to cutaneous anthrax. The term ‘eschar’ is not interchangeable with ‘scab’. An eschar contains necrotic tissue whereas a scab is composed of dried blood and exudate.

Bruise

Bruise

A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur close enough to the epidermis such that the bleeding causes a visible discoloration. The bruise then remains visible until the blood is either absorbed by tissues or cleared by immune system action. Bruises which do not blanch under pressure can involve capillaries at the level of skin, subcutaneous tissue, muscle, or bone. Bruises are not to be confused with other similar-looking lesions. (Such lesions include petechia, purpura, and ecchymosis.

Glasgow

Glasgow

Glasgow is the most populous city in Scotland and the fourth-most populous city in the United Kingdom, as well as being the 27th largest city by population in Europe. In 2020, it had an estimated population of 635,640. The city was made a county of itself in 1893, prior to which it had been in the historic county of Lanarkshire. The city now forms the Glasgow City Council area, one of the 32 council areas of Scotland, and is governed by Glasgow City Council. It is situated on the River Clyde in the country's West Central Lowlands.

Stirling

Stirling

Stirling is a city in central Scotland, 26 miles (42 km) northeast of Glasgow and 37 miles (60 km) north-west of Edinburgh. The market town, surrounded by rich farmland, grew up connecting the royal citadel, the medieval old town with its merchants and tradesmen, the Old Bridge and the port. Located on the River Forth, Stirling is the administrative centre for the Stirling council area, and is traditionally the county town of Stirlingshire. Proverbially it is the strategically important "Gateway to the Highlands".

Bone meal

Bone meal

Bone meal is a mixture of finely and coarsely ground animal bones and slaughter-house waste products. It is used as a dietary supplement to supply calcium (Ca) and phosphorus (P) to monogastric livestock in the form of hydroxiapathite. As a slow-release organic fertilizer, it supplies phosphorus, calcium, and a small amount of nitrogen to plants.

Influenza

Influenza

Influenza, commonly known as "the flu", is an infectious disease caused by influenza viruses. Symptoms range from mild to severe and often include fever, runny nose, sore throat, muscle pain, headache, coughing, and fatigue. These symptoms begin from one to four days after exposure to the virus and last for about 2–8 days. Diarrhea and vomiting can occur, particularly in children. Influenza may progress to pneumonia, which can be caused by the virus or by a subsequent bacterial infection. Other complications of infection include acute respiratory distress syndrome, meningitis, encephalitis, and worsening of pre-existing health problems such as asthma and cardiovascular disease.

Community-acquired pneumonia

Community-acquired pneumonia

Community-acquired pneumonia (CAP) refers to pneumonia contracted by a person outside of the healthcare system. In contrast, hospital-acquired pneumonia (HAP) is seen in patients who have recently visited a hospital or who live in long-term care facilities. CAP is common, affecting people of all ages, and its symptoms occur as a result of oxygen-absorbing areas of the lung (alveoli) filling with fluid. This inhibits lung function, causing dyspnea, fever, chest pains and cough.

Mediastinitis

Mediastinitis

Mediastinitis is inflammation of the tissues in the mid-chest, or mediastinum. It can be either acute or chronic. It is thought to be due to four different etiologies:direct contamination hematogenous or lymphatic spread extension of infection from the neck or retroperitoneum extension from the lung or pleura

Hematemesis

Hematemesis

Hematemesis is the vomiting of blood. It is always an important sign. It can be confused with hemoptysis or epistaxis (nosebleed), which are more common. The source is generally the upper gastrointestinal tract, typically above the suspensory muscle of duodenum. It may be caused by ulcers, tumors of the stomach or esophagus, varices, prolonged and vigorous retching, gastroenteritis, ingested blood, or certain drugs.

Cause

Bacteria

Photomicrograph of a Gram stain of the bacterium Bacillus anthracis, the cause of the anthrax disease
Photomicrograph of a Gram stain of the bacterium Bacillus anthracis, the cause of the anthrax disease

Bacillus anthracis is a rod-shaped, Gram-positive, obligate aerobe bacterium about 1 by 9 μm in size.[2] It was shown to cause disease by Robert Koch in 1876 when he took a blood sample from an infected cow, isolated the bacteria, and put them into a mouse.[31] The bacterium normally rests in spore form in the soil, and can survive for decades in this state. Herbivores are often infected while grazing, especially when eating rough, irritant, or spiky vegetation; the vegetation has been hypothesized to cause wounds within the gastrointestinal tract, permitting entry of the bacterial spores into the tissues. Once ingested or placed in an open wound, the bacteria begin multiplying inside the animal or human and typically kill the host within a few days or weeks. The spores germinate at the site of entry into the tissues and then spread by the circulation to the lymphatics, where the bacteria multiply.

The production of two powerful exotoxins and lethal toxin by the bacteria causes death. Veterinarians can often tell a possible anthrax-induced death by its sudden occurrence, and by the dark, nonclotting blood that oozes from the body orifices. Most anthrax bacteria inside the body after death are outcompeted and destroyed by anaerobic bacteria within minutes to hours post mortem. However, anthrax vegetative bacteria that escape the body via oozing blood or through the opening of the carcass may form hardy spores. These vegetative bacteria are not contagious.[32] One spore forms per one vegetative bacterium. The triggers for spore formation are not yet known, though oxygen tension and lack of nutrients may play roles. Once formed, these spores are very hard to eradicate.

The infection of herbivores (and occasionally humans) by the inhalational route normally begins with inhaled spores being transported through the air passages into the tiny air sacs (alveoli) in the lungs. The spores are then picked up by scavenger cells (macrophages) in the lungs and are transported through small vessels (lymphatics) to the lymph nodes in the central chest cavity (mediastinum). Damage caused by the anthrax spores and bacilli to the central chest cavity can cause chest pain and difficulty breathing. Once in the lymph nodes, the spores germinate into active bacilli that multiply and eventually burst the macrophages, releasing many more bacilli into the bloodstream to be transferred to the entire body. Once in the bloodstream, these bacilli release three proteins named lethal factor, edema factor, and protective antigen. The three are not toxic by themselves, but their combination is incredibly lethal to humans.[33] Protective antigen combines with these other two factors to form lethal toxin and edema toxin, respectively. These toxins are the primary agents of tissue destruction, bleeding, and death of the host. If antibiotics are administered too late, even if the antibiotics eradicate the bacteria, some hosts still die of toxemia because the toxins produced by the bacilli remain in their systems at lethal dose levels.

Exposure

The spores of anthrax are able to survive in harsh conditions for decades or even centuries.[34] Such spores can be found on all continents, including Antarctica.[35] Disturbed grave sites of infected animals have been known to cause infection after 70 years.[36]

Historically, inhalational anthrax was called woolsorters' disease because it was an occupational hazard for people who sorted wool.[37] Today, this form of infection is extremely rare in advanced nations, as almost no infected animals remain.

Occupational exposure to infected animals or their products (such as skin, wool, and meat) is the usual pathway of exposure for humans. Workers who are exposed to dead animals and animal products are at the highest risk, especially in countries where anthrax is more common. Anthrax in livestock grazing on open range where they mix with wild animals still occasionally occurs in the United States and elsewhere.

Many workers who deal with wool and animal hides are routinely exposed to low levels of anthrax spores, but most exposure levels are not sufficient to develop anthrax infections. A lethal infection is reported to result from inhalation of about 10,000–20,000 spores, though this dose varies among host species.[38] Little documented evidence is available to verify the exact or average number of spores needed for infection.

Mode of infection

Inhalational anthrax, mediastinal widening
Inhalational anthrax, mediastinal widening

Anthrax can enter the human body through the intestines (ingestion), lungs (inhalation), or skin (cutaneous) and causes distinct clinical symptoms based on its site of entry. In general, an infected human is quarantined. However, anthrax does not usually spread from an infected human to an uninfected human.[39] If the disease is fatal to the person's body, though, its mass of anthrax bacilli becomes a potential source of infection to others and special precautions should be used to prevent further contamination. Inhalational anthrax, if left untreated until obvious symptoms occur, is usually fatal.[39]

Anthrax can be contracted in laboratory accidents or by handling infected animals, their wool, or their hides.[40] It has also been used in biological warfare agents and by terrorists to intentionally infect as exemplified by the 2001 anthrax attacks.[41]

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Gram stain

Gram stain

In microbiology and bacteriology, Gram stain, is a method of staining used to classify bacterial species into two large groups: gram-positive bacteria and gram-negative bacteria. The name comes from the Danish bacteriologist Hans Christian Gram, who developed the technique in 1884.

Bacillus anthracis

Bacillus anthracis

Bacillus anthracis is a gram-positive and rod-shaped bacterium that causes anthrax, a deadly disease to livestock and, occasionally, to humans. It is the only permanent (obligate) pathogen within the genus Bacillus. Its infection is a type of zoonosis, as it is transmitted from animals to humans. It was discovered by a German physician Robert Koch in 1876, and became the first bacterium to be experimentally shown as a pathogen. The discovery was also the first scientific evidence for the germ theory of diseases.

Robert Koch

Robert Koch

Heinrich Hermann Robert Koch was a German physician and microbiologist. As the discoverer of the specific causative agents of deadly infectious diseases including tuberculosis, cholera, and anthrax, he is regarded as one of the main founders of modern bacteriology. As such he is popularly nicknamed the father of microbiology, and as the father of medical bacteriology. His discovery of the anthrax bacterium in 1876 is considered as the birth of modern bacteriology. His discoveries directly provided proofs for the germ theory of diseases, and the scientific basis of public health.

Macrophage

Macrophage

Macrophages are a type of white blood cell of the innate immune system that engulfs and digests pathogens, such as cancer cells, microbes, cellular debris, and foreign substances, which do not have proteins that are specific to healthy body cells on their surface. The process is called phagocytosis, which acts to defend the host against infection and injury.

Lymphatic system

Lymphatic system

The lymphatic system, or lymphoid system, is an organ system in vertebrates that is part of the immune system, and complementary to the circulatory system. It consists of a large network of lymphatic vessels, lymph nodes, lymphatic or lymphoid organs, and lymphoid tissues. The vessels carry a clear fluid called lymph back towards the heart, for re-circulation.

Mediastinum

Mediastinum

The mediastinum is the central compartment of the thoracic cavity. Surrounded by loose connective tissue, it is an undelineated region that contains a group of structures within the thorax, namely the heart and its vessels, the esophagus, the trachea, the phrenic and cardiac nerves, the thoracic duct, the thymus and the lymph nodes of the central chest.

Anthrax lethal factor endopeptidase

Anthrax lethal factor endopeptidase

Anthrax lethal factor endopeptidase is an enzyme that catalyzes the hydrolysis of mitogen-activated protein kinase kinases. This enzyme is a component of the lethal factor produced by the bacterium Bacillus anthracis. The preferred cleavage site can be denoted by BBBBxHxH, in which B denotes a basic amino acid Arg or Lys, H denotes a hydrophobic amino acid, and x is any amino acid.

Monkey

Monkey

Monkey is a common name that may refer to most mammals of the infraorder Simiiformes, also known as the simians. Traditionally, all animals in the group now known as simians are counted as monkeys except the apes, which constitutes an incomplete paraphyletic grouping; however, in the broader sense based on cladistics, apes (Hominoidea) are also included, making the terms monkeys and simians synonyms in regards to their scope.

Bacilli

Bacilli

Bacilli is a taxonomic class of bacteria that includes two orders, Bacillales and Lactobacillales, which contain several well-known pathogens such as Bacillus anthracis. Bacilli are almost exclusively gram-positive bacteria.

Red blood cell

Red blood cell

Red blood cells (RBCs), also referred to as red cells, red blood corpuscles (in humans or other animals not having nucleus in red blood cells), haematids, erythroid cells or erythrocytes (from Greek erythros for "red" and kytos for "hollow vessel", with -cyte translated as "cell" in modern usage), are the most common type of blood cell and the vertebrate's principal means of delivering oxygen (O2) to the body tissues—via blood flow through the circulatory system. RBCs take up oxygen in the lungs, or in fish the gills, and release it into tissues while squeezing through the body's capillaries.

Cerebrospinal fluid

Cerebrospinal fluid

Cerebrospinal fluid (CSF) is a clear, colorless body fluid found within the tissue that surrounds the brain and spinal cord of all vertebrates.

Livestock

Livestock

Livestock are the domesticated animals raised in an agricultural setting to provide labor and produce diversified products for consumption such as meat, eggs, milk, fur, leather, and wool. The term is sometimes used to refer solely to animals who are raised for consumption, and sometimes used to refer solely to farmed ruminants, such as cattle, sheep, goats, and pigs. Horses are considered livestock in the United States. The USDA classifies pork, veal, beef, and lamb (mutton) as livestock, and all livestock as red meat. Poultry and fish are not included in the category. The latter is likely due to the fact that fish products are not governed by the USDA, but by the FDA.

Mechanism

The lethality of the anthrax disease is due to the bacterium's two principal virulence factors: the poly-D-glutamic acid capsule, which protects the bacterium from phagocytosis by host neutrophils, and the tripartite protein toxin, called anthrax toxin. Anthrax components: protective antigen (PA), edema factor (EF), and lethal factor (LF).[42] PA plus LF produces lethal toxin, and PA plus EF produces edema toxin. These toxins cause death and tissue swelling (edema), respectively. To enter the cells, the edema and lethal factors use another protein produced by B. anthracis called protective antigen, which binds to two surface receptors on the host cell. A cell protease then cleaves PA into two fragments: PA20 and PA63. PA20 dissociates into the extracellular medium, playing no further role in the toxic cycle. PA63 then oligomerizes with six other PA63 fragments forming a heptameric ring-shaped structure named a prepore. Once in this shape, the complex can competitively bind up to three EFs or LFs, forming a resistant complex.[33] Receptor-mediated endocytosis occurs next, providing the newly formed toxic complex access to the interior of the host cell. The acidified environment within the endosome triggers the heptamer to release the LF and/or EF into the cytosol.[43] It is unknown how exactly the complex results in the death of the cell.

Edema factor is a calmodulin-dependent adenylate cyclase. Adenylate cyclase catalyzes the conversion of ATP into cyclic AMP (cAMP) and pyrophosphate. The complexation of adenylate cyclase with calmodulin removes calmodulin from stimulating calcium-triggered signaling, thus inhibiting the immune response.[33] To be specific, LF inactivates neutrophils (a type of phagocytic cell) by the process just described so they cannot phagocytose bacteria. Throughout history, lethal factor was presumed to cause macrophages to make TNF-alpha and interleukin 1, beta (IL1B). TNF-alpha is a cytokine whose primary role is to regulate immune cells, as well as to induce inflammation and apoptosis or programmed cell death. Interleukin 1, beta is another cytokine that also regulates inflammation and apoptosis. The overproduction of TNF-alpha and IL1B ultimately leads to septic shock and death. However, recent evidence indicates anthrax also targets endothelial cells that line serous cavities such as the pericardial cavity, pleural cavity, and peritoneal cavity, lymph vessels, and blood vessels, causing vascular leakage of fluid and cells, and ultimately hypovolemic shock and septic shock.

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Polyglutamic acid

Polyglutamic acid

Polyglutamic acid (PGA) is a polymer of the amino acid glutamic acid (GA). Gamma PGA - the form where the peptide bonds are between the amino group of GA and the carboxyl group at the end of the GA side chain - is a major constituent of the Japanese food nattō. Gamma PGA is formed by bacterial fermentation.

Anthrax toxin

Anthrax toxin

Anthrax toxin is a three-protein exotoxin secreted by virulent strains of the bacterium, Bacillus anthracis—the causative agent of anthrax. The toxin was first discovered by Harry Smith in 1954. Anthrax toxin is composed of a cell-binding protein, known as protective antigen (PA), and two enzyme components, called edema factor (EF) and lethal factor (LF). These three protein components act together to impart their physiological effects. Assembled complexes containing the toxin components are endocytosed. In the endosome, the enzymatic components of the toxin translocate into the cytoplasm of a target cell. Once in the cytosol, the enzymatic components of the toxin disrupts various immune cell functions, namely cellular signaling and cell migration. The toxin may even induce cell lysis, as is observed for macrophage cells. Anthrax toxin allows the bacteria to evade the immune system, proliferate, and ultimately kill the host animal. Research on anthrax toxin also provides insight into the generation of macromolecular assemblies, and on protein translocation, pore formation, endocytosis, and other biochemical processes.

Antigen

Antigen

In immunology, an antigen (Ag) is a molecule or molecular structure or any foreign particulate matter or a pollen grain that can bind to a specific antibody or T-cell receptor. The presence of antigens in the body may trigger an immune response. The term antigen originally referred to a substance that is an antibody generator. Antigens can be proteins, peptides, polysaccharides, lipids, or nucleic acids.

Edema

Edema

Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels tight, the area may feel heavy, and joint stiffness. Other symptoms depend on the underlying cause.

Protease

Protease

A protease is an enzyme that catalyzes proteolysis, breaking down proteins into smaller polypeptides or single amino acids, and spurring the formation of new protein products. They do this by cleaving the peptide bonds within proteins by hydrolysis, a reaction where water breaks bonds. Proteases are involved in many biological functions, including digestion of ingested proteins, protein catabolism, and cell signaling.

Calmodulin

Calmodulin

Calmodulin (CaM) (an abbreviation for calcium-modulated protein) is a multifunctional intermediate calcium-binding messenger protein expressed in all eukaryotic cells. It is an intracellular target of the secondary messenger Ca2+, and the binding of Ca2+ is required for the activation of calmodulin. Once bound to Ca2+, calmodulin acts as part of a calcium signal transduction pathway by modifying its interactions with various target proteins such as kinases or phosphatases.

Pyrophosphate

Pyrophosphate

In chemistry, pyrophosphates are phosphorus oxyanions that contain two phosphorus atoms in a P–O–P linkage. A number of pyrophosphate salts exist, such as disodium pyrophosphate (Na2H2P2O7) and tetrasodium pyrophosphate (Na4P2O7), among others. Often pyrophosphates are called diphosphates. The parent pyrophosphates are derived from partial or complete neutralization of pyrophosphoric acid. The pyrophosphate bond is also sometimes referred to as a phosphoanhydride bond, a naming convention which emphasizes the loss of water that occurs when two phosphates form a new P–O–P bond, and which mirrors the nomenclature for anhydrides of carboxylic acids. Pyrophosphates are found in ATP and other nucleotide triphosphates, which are important in biochemistry. The term pyrophosphate is also the name of esters formed by the condensation of a phosphorylated biological compound with inorganic phosphate, as for dimethylallyl pyrophosphate. This bond is also referred to as a high-energy phosphate bond.

Neutrophil

Neutrophil

Neutrophils are the least abundant type of granulocytes and make up 40% to 70% of all white blood cells in humans. They form an essential part of the innate immune system, with their functions varying in different animals.

Cytokine

Cytokine

Cytokines are a broad and loose category of small proteins important in cell signaling. Cytokines are peptides and cannot cross the lipid bilayer of cells to enter the cytoplasm. Cytokines have been shown to be involved in autocrine, paracrine and endocrine signaling as immunomodulating agents.

Apoptosis

Apoptosis

Apoptosis is a form of programmed cell death that occurs in multicellular organisms. Biochemical events lead to characteristic cell changes (morphology) and death. These changes include blebbing, cell shrinkage, nuclear fragmentation, chromatin condensation, DNA fragmentation, and mRNA decay. The average adult human loses between 50 and 70 billion cells each day due to apoptosis. For an average human child between eight and fourteen years old, approximately twenty to thirty billion cells die per day.

Pleural cavity

Pleural cavity

The pleural cavity, pleural space, or interpleural space is the potential space between the pleurae of the pleural sac that surrounds each lung. A small amount of serous pleural fluid is maintained in the pleural cavity to enable lubrication between the membranes, and also to create a pressure gradient.

Peritoneal cavity

Peritoneal cavity

The peritoneal cavity is a potential space between the parietal peritoneum and visceral peritoneum. The parietal and visceral peritonea are layers of the peritoneum named depending on their function/location. It is one of the spaces derived from the coelomic cavity of the embryo, the others being the pleural cavities around the lungs and the pericardial cavity around the heart.

Diagnosis

Possible edema and necrosis in a case of injection anthrax.
Possible edema and necrosis in a case of injection anthrax.

Various techniques may be used for the direct identification of B. anthracis in clinical material. Firstly, specimens may be Gram stained. Bacillus spp. are quite large in size (3 to 4 μm long), they may grow in long chains, and they stain Gram-positive. To confirm the organism is B. anthracis, rapid diagnostic techniques such as polymerase chain reaction-based assays and immunofluorescence microscopy may be used.[44]

All Bacillus species grow well on 5% sheep blood agar and other routine culture media. Polymyxin-lysozyme-EDTA-thallous acetate can be used to isolate B. anthracis from contaminated specimens, and bicarbonate agar is used as an identification method to induce capsule formation. Bacillus spp. usually grow within 24 hours of incubation at 35 °C, in ambient air (room temperature) or in 5% CO2. If bicarbonate agar is used for identification, then the medium must be incubated in 5% CO2. B. anthracis colonies are medium-large, gray, flat, and irregular with swirling projections, often referred to as having a "medusa head" appearance, and are not hemolytic on 5% sheep blood agar. The bacteria are not motile, susceptible to penicillin, and produce a wide zone of lecithinase on egg yolk agar. Confirmatory testing to identify B. anthracis includes gamma bacteriophage testing, indirect hemagglutination, and enzyme-linked immunosorbent assay to detect antibodies.[45] The best confirmatory precipitation test for anthrax is the Ascoli test.

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Gram stain

Gram stain

In microbiology and bacteriology, Gram stain, is a method of staining used to classify bacterial species into two large groups: gram-positive bacteria and gram-negative bacteria. The name comes from the Danish bacteriologist Hans Christian Gram, who developed the technique in 1884.

Polymerase chain reaction

Polymerase chain reaction

The polymerase chain reaction (PCR) is a method widely used to rapidly make millions to billions of copies of a specific DNA sample, allowing scientists to take a very small sample of DNA and amplify it to a large enough amount to study in detail. PCR was invented in 1983 by the American biochemist Kary Mullis at Cetus Corporation; Mullis and biochemist Michael Smith, who had developed other essential ways of manipulating DNA, were jointly awarded the Nobel Prize in Chemistry in 1993.

Immunofluorescence

Immunofluorescence

Immunofluorescence is a technique used for light microscopy with a fluorescence microscope and is used primarily on biological samples. This technique uses the specificity of antibodies to their antigen to target fluorescent dyes to specific biomolecule targets within a cell, and therefore allows visualization of the distribution of the target molecule through the sample. The specific region an antibody recognizes on an antigen is called an epitope. There have been efforts in epitope mapping since many antibodies can bind the same epitope and levels of binding between antibodies that recognize the same epitope can vary. Additionally, the binding of the fluorophore to the antibody itself cannot interfere with the immunological specificity of the antibody or the binding capacity of its antigen. Immunofluorescence is a widely used example of immunostaining and is a specific example of immunohistochemistry. This technique primarily makes use of fluorophores to visualise the location of the antibodies.

Medusa

Medusa

In Greek mythology, Medusa, also called Gorgo, was one of the three monstrous Gorgons, generally described as winged human females with living venomous snakes in place of hair. Those who gazed into her eyes would turn to stone. Most sources describe her as the daughter of Phorcys and Ceto, although the author Hyginus makes her the daughter of Gorgon and Ceto.

Alberto Ascoli

Alberto Ascoli

Alberto Ascoli was an Italian serologist, hygienist and physiological chemist, who developed a test for anthrax.

Prevention

Precautions are taken to avoid contact with the skin and any fluids exuded through natural body openings of a deceased body that is suspected of harboring anthrax.[46] The body should be put in strict quarantine. A blood sample is collected and sealed in a container and analyzed in an approved laboratory to ascertain if anthrax is the cause of death. The body should be sealed in an airtight body bag and incinerated to prevent the transmission of anthrax spores. Microscopic visualization of the encapsulated bacilli, usually in very large numbers, in a blood smear stained with polychrome methylene blue (McFadyean stain) is fully diagnostic, though the culture of the organism is still the gold standard for diagnosis. Full isolation of the body is important to prevent possible contamination of others.[46]

Protective, impermeable clothing and equipment such as rubber gloves, rubber apron, and rubber boots with no perforations are used when handling the body. No skin, especially if it has any wounds or scratches, should be exposed. Disposable personal protective equipment is preferable, but if not available, decontamination can be achieved by autoclaving. Used disposable equipment is burned and/or buried after use. All contaminated bedding or clothing is isolated in double plastic bags and treated as biohazard waste.[46] Respiratory equipment capable of filtering small particles, such the US National Institute for Occupational Safety and Health- and Mine Safety and Health Administration-approved high-efficiency respirator, is worn.[47]

Vaccines

Vaccines against anthrax for use in livestock and humans have had a prominent place in the history of medicine. The French scientist Louis Pasteur developed the first effective vaccine in 1881.[48][49][50] Human anthrax vaccines were developed by the Soviet Union in the late 1930s and in the US and UK in the 1950s. The current FDA-approved US vaccine was formulated in the 1960s.

Currently administered human anthrax vaccines include acellular (United States) and live vaccine (Russia) varieties. All currently used anthrax vaccines show considerable local and general reactogenicity (erythema, induration, soreness, fever) and serious adverse reactions occur in about 1% of recipients.[51] The American product, BioThrax, is licensed by the FDA and was formerly administered in a six-dose primary series at 0, 2, 4 weeks and 6, 12, 18 months, with annual boosters to maintain immunity. In 2008, the FDA approved omitting the week-2 dose, resulting in the currently recommended five-dose series.[52] This five-dose series is available to military personnel, scientists who work with anthrax and members of the public who do jobs which cause them to be at-risk.[53] New second-generation vaccines currently being researched include recombinant live vaccines and recombinant subunit vaccines. In the 20th century the use of a modern product (BioThrax) to protect American troops against the use of anthrax in biological warfare was controversial.[54]

Antibiotics

Preventive antibiotics are recommended in those who have been exposed.[5] Early detection of sources of anthrax infection can allow preventive measures to be taken. In response to the anthrax attacks of October 2001, the United States Postal Service (USPS) installed biodetection systems (BDSs) in their large-scale mail processing facilities. BDS response plans were formulated by the USPS in conjunction with local responders including fire, police, hospitals, and public health. Employees of these facilities have been educated about anthrax, response actions, and prophylactic medication. Because of the time delay inherent in getting final verification that anthrax has been used, prophylactic antibiotic treatment of possibly exposed personnel must be started as soon as possible.

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Rubber glove

Rubber glove

A rubber glove is a glove made out of natural rubber or Synthetic rubber. The term ‘rubber’ refers to durable, waterproof and elastic material made from natural or synthetic latex. Rubber gloves can be unsupported or supported. Its primary purpose is protection of the hands while performing tasks involving chemicals. Rubber gloves can be worn during dishwashing to protect the hands from detergent and allow the use of hotter water. Sometimes caregivers will use rubber gloves during the diaper changing process to prevent contact with the child's fecal material/urine. Health professionals use medical gloves rather than rubber gloves when performing surgical operations.

National Institute for Occupational Safety and Health

National Institute for Occupational Safety and Health

The National Institute for Occupational Safety and Health is the United States federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is part of the Centers for Disease Control and Prevention (CDC) within the U.S. Department of Health and Human Services. Despite its name, it is not part of the National Institutes of Health. Its current director is John Howard.

Mine Safety and Health Administration

Mine Safety and Health Administration

The Mine Safety and Health Administration (MSHA) is a large agency of the United States Department of Labor which administers the provisions of the Federal Mine Safety and Health Act of 1977 to enforce compliance with mandatory safety and health standards as a means to eliminate fatal accidents, to reduce the frequency and severity of nonfatal accidents, to minimize health hazards, and to promote improved safety and health conditions in the nation's mines. MSHA carries out the mandates of the Mine Act at all mining and mineral processing operations in the United States, regardless of size, number of employees, commodity mined, or method of extraction. David Zatezalo was sworn in as Assistant Secretary of Labor for Mine Safety and Health, and head of MSHA, on November 30, 2017. He served until January 20, 2021. Jeannette Galanais served as Acting Assistant Secretary by President Joe Biden on February 1, 2021 until Christopher Williamson took office on April 11, 2022.

Louis Pasteur

Louis Pasteur

Louis Pasteur was a French chemist and microbiologist renowned for his discoveries of the principles of vaccination, microbial fermentation, and pasteurization, the last of which was named after him. His research in chemistry led to remarkable breakthroughs in the understanding of the causes and preventions of diseases, which laid down the foundations of hygiene, public health and much of modern medicine. His works are credited to saving millions of lives through the developments of vaccines for rabies and anthrax. He is regarded as one of the founders of modern bacteriology and has been honored as the "father of bacteriology" and the "father of microbiology".

Soviet Union

Soviet Union

The Soviet Union, officially the Union of Soviet Socialist Republics (USSR), was a transcontinental country that spanned much of Eurasia from 1922 to 1991. A flagship communist state, it was nominally a federal union of fifteen national republics; in practice, both its government and its economy were highly centralized until its final years. It was a one-party state governed by the Communist Party of the Soviet Union, with the city of Moscow serving as its capital as well as that of its largest and most populous republic: the Russian SFSR. Other major cities included Leningrad, Kiev, Minsk, Tashkent, Alma-Ata, and Novosibirsk. It was the largest country in the world, covering over 22,402,200 square kilometres (8,649,500 sq mi) and spanning eleven time zones.

Reactogenicity

Reactogenicity

In clinical trials, reactogenicity is the capacity of a vaccine to produce common, "expected" adverse reactions, especially excessive immunological responses and associated signs and symptoms, including fever and sore arm at the injection site. Other manifestations of reactogenicity typically identified in such trials include bruising, redness, induration, and swelling.

Erythema

Erythema

Erythema is redness of the skin or mucous membranes, caused by hyperemia in superficial capillaries. It occurs with any skin injury, infection, or inflammation. Examples of erythema not associated with pathology include nervous blushes.

Fever

Fever

Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using values between 37.2 and 38.3 °C in humans. The increase in set point triggers increased muscle contractions and causes a feeling of cold or chills. This results in greater heat production and efforts to conserve heat. When the set point temperature returns to normal, a person feels hot, becomes flushed, and may begin to sweat. Rarely a fever may trigger a febrile seizure, with this being more common in young children. Fevers do not typically go higher than 41 to 42 °C.

Recombinant subunit vaccine

Recombinant subunit vaccine

Recombinant subunit vaccines are biological preparations that are composed of microbial subunits produced using recombinant DNA technology. They act to provide active acquired immunity to infectious diseases. The first recombinant subunit vaccine was produced in the mid-1980s to protect people from Hepatitis B. Notable recombinant subunit vaccines licensed include ENGERIX-B, GARDASIL-9, FLUBLOK(influenza), SHINGRIX and NUVAXOVID.

Biological warfare

Biological warfare

Biological warfare, also known as germ warfare, is the use of biological toxins or infectious agents such as bacteria, viruses, insects, and fungi with the intent to kill, harm or incapacitate humans, animals or plants as an act of war. Biological weapons are living organisms or replicating entities. Entomological (insect) warfare is a subtype of biological warfare.

United States Postal Service

United States Postal Service

The United States Postal Service (USPS), also known as the Post Office, U.S. Mail, or Postal Service, is an independent agency of the executive branch of the United States federal government responsible for providing postal service in the U.S., including its insular areas and associated states. It is one of the few government agencies explicitly authorized by the U.S. Constitution. The USPS, as of 2021, has 516,636 career employees and 136,531 non-career employees.

Treatment

Anthrax, and antibiotics

Anthrax cannot be spread from person to person, except in the rare case of skin exudates from cutaneous anthrax.[55] However, a person's clothing and body may be contaminated with anthrax spores. Effective decontamination of people can be accomplished by a thorough wash-down with antimicrobial soap and water. Wastewater is treated with bleach or another antimicrobial agent.[56] Effective decontamination of articles can be accomplished by boiling them in water for 30 minutes or longer. Chlorine bleach is ineffective in destroying spores and vegetative cells on surfaces, though formaldehyde is effective. Burning clothing is very effective in destroying spores. After decontamination, there is no need to immunize, treat, or isolate contacts of persons ill with anthrax unless they were also exposed to the same source of infection.

Antibiotics

Early antibiotic treatment of anthrax is essential; delay significantly lessens chances for survival. Treatment for anthrax infection and other bacterial infections includes large doses of intravenous and oral antibiotics, such as fluoroquinolones (ciprofloxacin), doxycycline, erythromycin, vancomycin, or penicillin. FDA-approved agents include ciprofloxacin, doxycycline, and penicillin.[57] In possible cases of pulmonary anthrax, early antibiotic prophylaxis treatment is crucial to prevent possible death. Many attempts have been made to develop new drugs against anthrax, but existing drugs are effective if treatment is started soon enough.

Monoclonal antibodies

In May 2009, Human Genome Sciences submitted a biologic license application (BLA, permission to market) for its new drug, raxibacumab (brand name ABthrax) intended for emergency treatment of inhaled anthrax.[58] On 14 December 2012, the US Food and Drug Administration approved raxibacumab injection to treat inhalational anthrax. Raxibacumab is a monoclonal antibody that neutralizes toxins produced by B. anthracis.[59] In March 2016, FDA approved a second anthrax treatment using a monoclonal antibody which neutralizes the toxins produced by B. anthracis. Obiltoxaximab is approved to treat inhalational anthrax in conjunction with appropriate antibacterial drugs, and for prevention when alternative therapies are not available or appropriate.[60]

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Antimicrobial

Antimicrobial

An antimicrobial is an agent that kills microorganisms or stops their growth. Antimicrobial medicines can be grouped according to the microorganisms they act primarily against. For example, antibiotics are used against bacteria, and antifungals are used against fungi. They can also be classified according to their function. Agents that kill microbes are microbicides, while those that merely inhibit their growth are called bacteriostatic agents. The use of antimicrobial medicines to treat infection is known as antimicrobial chemotherapy, while the use of antimicrobial medicines to prevent infection is known as antimicrobial prophylaxis.

Formaldehyde

Formaldehyde

Formaldehyde is a naturally occurring organic compound with the formula CH2O and structure H−CHO. The pure compound is a pungent, colourless gas that polymerises spontaneously into paraformaldehyde, hence it is stored as an aqueous solution (formalin), which is also used to store animal specimens. It is the simplest of the aldehydes. The common name of this substance comes from its similarity and relation to formic acid.

Ciprofloxacin

Ciprofloxacin

Ciprofloxacin is a fluoroquinolone antibiotic used to treat a number of bacterial infections. This includes bone and joint infections, intra-abdominal infections, certain types of infectious diarrhea, respiratory tract infections, skin infections, typhoid fever, and urinary tract infections, among others. For some infections it is used in addition to other antibiotics. It can be taken by mouth, as eye drops, as ear drops, or intravenously.

Doxycycline

Doxycycline

Doxycycline is a broad-spectrum tetracycline class antibiotic used in the treatment of infections caused by bacteria and certain parasites. It is used to treat bacterial pneumonia, acne, chlamydia infections, Lyme disease, cholera, typhus, and syphilis. It is also used to prevent malaria in combination with quinine. Doxycycline may be taken by mouth or by injection into a vein.

Erythromycin

Erythromycin

Erythromycin is an antibiotic used for the treatment of a number of bacterial infections. This includes respiratory tract infections, skin infections, chlamydia infections, pelvic inflammatory disease, and syphilis. It may also be used during pregnancy to prevent Group B streptococcal infection in the newborn, as well as to improve delayed stomach emptying. It can be given intravenously and by mouth. An eye ointment is routinely recommended after delivery to prevent eye infections in the newborn.

Vancomycin

Vancomycin

Vancomycin is a glycopeptide antibiotic medication used to treat a number of bacterial infections. It is recommended intravenously as a treatment for complicated skin infections, bloodstream infections, endocarditis, bone and joint infections, and meningitis caused by methicillin-resistant Staphylococcus aureus. Blood levels may be measured to determine the correct dose. Vancomycin is also taken by mouth as a treatment for severe Clostridium difficile colitis. When taken by mouth it is poorly absorbed.

Penicillin

Penicillin

Penicillins are a group of β-lactam antibiotics originally obtained from Penicillium moulds, principally P. chrysogenum and P. rubens. Most penicillins in clinical use are synthesised by P. chrysogenum using deep tank fermentation and then purified. A number of natural penicillins have been discovered, but only two purified compounds are in clinical use: penicillin G and penicillin V. Penicillins were among the first medications to be effective against many bacterial infections caused by staphylococci and streptococci. They are still widely used today for different bacterial infections, though many types of bacteria have developed resistance following extensive use.

Human Genome Sciences

Human Genome Sciences

Human Genome Sciences (HGS) was a biopharmaceutical corporation founded in 1992 by Craig Venter, Alan Walton and Wally Steinberg. It uses the human DNA sequence to develop protein and antibody drugs. It had drugs under development to treat such diseases as hepatitis C, systemic lupus erythmatosis, anthrax, and cancer. It collaborated with other biotechnology and pharmaceutical companies for development partnerships and licensing.

Raxibacumab

Raxibacumab

Raxibacumab is a human monoclonal antibody intended for the prophylaxis and treatment of inhaled anthrax. Its efficacy has been proven in rabbits and monkeys. In December 2012 raxibacumab was approved in the United States for the treatment of inhalational anthrax due to Bacillus anthracis in combination with appropriate antibacterial drugs, and for prophylaxis of inhalational anthrax when alternative therapies are not available or are not appropriate.

Monoclonal antibody

Monoclonal antibody

A monoclonal antibody is an antibody produced from a cell lineage made by cloning a unique white blood cell. All subsequent antibodies derived this way trace back to a unique parent cell.

Obiltoxaximab

Obiltoxaximab

Obiltoxaximab, sold under the brand name Anthim, is a monoclonal antibody medication designed for the treatment of exposure to Bacillus anthracis spores.

Prognosis

Cutaneous anthrax is rarely fatal if treated,[61] because the infection area is limited to the skin, preventing the lethal factor, edema factor, and protective antigen from entering and destroying a vital organ. Without treatment, up to 20% of cutaneous skin infection cases progress to toxemia and death.[62]

Before 2001, fatality rates for inhalation anthrax were 90%; since then, they have fallen to 45%.[27] People that progress to the fulminant phase of inhalational anthrax nearly always die, with one case study showing a death rate of 97%.[63] Anthrax meningoencephalitis is also nearly always fatal.[64]

Gastrointestinal anthrax infections can be treated, but usually result in fatality rates of 25% to 60%, depending upon how soon treatment commences.

Injection anthrax is the rarest form of anthrax, and has only been seen to have occurred in a group of heroin injecting drug users. [65]

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Epidemiology

Globally, at least 2,000 cases occur a year.[8]

United States

The last fatal case of natural inhalational anthrax in the United States occurred in California in 1976, when a home weaver died after working with infected wool imported from Pakistan. To minimize the chance of spreading the disease, the body was transported to UCLA in a sealed plastic body bag within a sealed metal container for autopsy.[66]

Gastrointestinal anthrax is exceedingly rare in the United States, with only two cases on record. The first case was reported in 1942, according to the Centers for Disease Control and Prevention.[67] During December 2009, the New Hampshire Department of Health and Human Services confirmed a case of gastrointestinal anthrax in an adult female.

In 2007 two cases of cutaneous anthrax were reported in Danbury, Connecticut. The case involved a maker of traditional African-style drums who was working with a goat hide purchased from a dealer in New York City which had been previously cleared by Customs. While the hide was being scraped, a spider bite led to the spores entering the bloodstream. His son also became infected.[68]

The CDC investigated the source of the December 2009 infection and the possibility that it was contracted from an African drum recently used by the woman taking part in a drum circle.[69] The woman apparently inhaled anthrax, in spore form, from the hide of the drum. She became critically ill, but with gastrointestinal anthrax rather than inhaled anthrax, which made her unique in American medical history. The building where the infection took place was cleaned and reopened to the public and the woman recovered. The New Hampshire state epidemiologist, Jodie Dionne-Odom, stated "It is a mystery. We really don't know why it happened."[70]

Croatia

In July 2022, dozens of cattle in a nature park in Lonjsko Polje, a flood plain by the Sava river, died of anthrax and 6 people have been hospitalized with light, skin-related symptoms.[71]

United Kingdom

In November 2008, a drum maker in the United Kingdom who worked with untreated animal skins died from anthrax.[72] In December 2009, an outbreak of anthrax occurred among heroin addicts in the Glasgow and Stirling areas of Scotland, resulting in 14 deaths.[23] The source of the anthrax is believed to have been dilution of the heroin with bone meal in Afghanistan.[24]

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University of California, Los Angeles

University of California, Los Angeles

The University of California, Los Angeles (UCLA), is a public land-grant research university in Los Angeles, California. UCLA's academic roots were established in 1881 as a teachers college then known as the southern branch of the California State Normal School. This school was absorbed with the official founding of UCLA as the Southern Branch of the University of California in 1919, making it the second-oldest of the 10-campus University of California system.

Danbury, Connecticut

Danbury, Connecticut

Danbury is a city in Fairfield County, Connecticut, United States, located approximately 50 miles (80 km) northeast of New York City. Danbury's population as of 2022 was 87,642. It is the seventh largest city in Connecticut.

Centers for Disease Control and Prevention

Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgia.

Drum circle

Drum circle

A drum circle is any group of people playing (usually) hand-drums and percussion in a circle. They are distinct from a drumming group or troupe in that the drum circle is an end in itself rather than preparation for a performance. They can range in size from a handful of players to circles with thousands of participants. Drum circles are related to other community-based music gatherings such as flute circles or vocal improvisation groups.

Lonjsko Polje

Lonjsko Polje

Lonjsko Polje is the largest protected wetland in both Croatia and the entire Danube basin. It covers an area of 505.6 square kilometres (195.2 sq mi), extending along the river Sava from the areas east of Sisak, the lower course of the river Lonja for which it is named, to the areas west of Nova Gradiška, along the course of the river Veliki Strug.

Sava

Sava

The Sava is a river in Central and Southeast Europe, a right-bank and the longest tributary of the Danube. It flows through Slovenia, Croatia and along its border with Bosnia and Herzegovina, and finally through Serbia, feeding into the Danube in its capital, Belgrade. The Sava forms the main northern limit of the Balkan Peninsula, and the southern edge of the Pannonian Plain.

Glasgow

Glasgow

Glasgow is the most populous city in Scotland and the fourth-most populous city in the United Kingdom, as well as being the 27th largest city by population in Europe. In 2020, it had an estimated population of 635,640. The city was made a county of itself in 1893, prior to which it had been in the historic county of Lanarkshire. The city now forms the Glasgow City Council area, one of the 32 council areas of Scotland, and is governed by Glasgow City Council. It is situated on the River Clyde in the country's West Central Lowlands.

Stirling

Stirling

Stirling is a city in central Scotland, 26 miles (42 km) northeast of Glasgow and 37 miles (60 km) north-west of Edinburgh. The market town, surrounded by rich farmland, grew up connecting the royal citadel, the medieval old town with its merchants and tradesmen, the Old Bridge and the port. Located on the River Forth, Stirling is the administrative centre for the Stirling council area, and is traditionally the county town of Stirlingshire. Proverbially it is the strategically important "Gateway to the Highlands".

Bone meal

Bone meal

Bone meal is a mixture of finely and coarsely ground animal bones and slaughter-house waste products. It is used as a dietary supplement to supply calcium (Ca) and phosphorus (P) to monogastric livestock in the form of hydroxiapathite. As a slow-release organic fertilizer, it supplies phosphorus, calcium, and a small amount of nitrogen to plants.

History

Discovery

Robert Koch, a German physician and scientist, first identified the bacterium that caused the anthrax disease in 1875 in Wollstein (now Wolsztyn - a town in Poland).[31][73] His pioneering work in the late 19th century was one of the first demonstrations that diseases could be caused by microbes. In a groundbreaking series of experiments, he uncovered the lifecycle and means of transmission of anthrax. His experiments not only helped create an understanding of anthrax but also helped elucidate the role of microbes in causing illness at a time when debates still took place over spontaneous generation versus cell theory. Koch went on to study the mechanisms of other diseases and won the 1905 Nobel Prize in Physiology or Medicine for his discovery of the bacterium causing tuberculosis.[74]

Although Koch arguably made the greatest theoretical contribution to understanding anthrax, other researchers were more concerned with the practical questions of how to prevent the disease. In Britain, where anthrax affected workers in the wool, worsted, hides, and tanning industries, it was viewed with fear. John Henry Bell, a doctor born & based in Bradford, first made the link between the mysterious and deadly "woolsorter's disease" and anthrax, showing in 1878 that they were one and the same.[75] In the early 20th century, Friederich Wilhelm Eurich, the German bacteriologist who settled in Bradford with his family as a child, carried out important research for the local Anthrax Investigation Board. Eurich also made valuable contributions to a Home Office Departmental Committee of Inquiry, established in 1913 to address the continuing problem of industrial anthrax.[76] His work in this capacity, much of it collaboration with the factory inspector G. Elmhirst Duckering, led directly to the Anthrax Prevention Act (1919).

First vaccination

Louis Pasteur inoculating sheep against anthrax
Louis Pasteur inoculating sheep against anthrax

Anthrax posed a major economic challenge in France and elsewhere during the 19th century. Horses, cattle, and sheep were particularly vulnerable, and national funds were set aside to investigate the production of a vaccine. French scientist Louis Pasteur was charged with the production of a vaccine, following his successful work in developing methods that helped to protect the important wine and silk industries.[77]

In May 1881, Pasteur – in collaboration with his assistants Jean-Joseph Henri Toussaint, Émile Roux and others – performed a public experiment at Pouilly-le-Fort to demonstrate his concept of vaccination. He prepared two groups of 25 sheep, one goat, and several cattle. The animals of one group were injected with an anthrax vaccine prepared by Pasteur twice, at an interval of 15 days; the control group was left unvaccinated. Thirty days after the first injection, both groups were injected with a culture of live anthrax bacteria. All the animals in the unvaccinated group died, while all of the animals in the vaccinated group survived.[78]

After this apparent triumph, which was widely reported in the local, national, and international press, Pasteur made strenuous efforts to export the vaccine beyond France. He used his celebrity status to establish Pasteur Institutes across Europe and Asia, and his nephew, Adrien Loir, travelled to Australia in 1888 to try to introduce the vaccine to combat anthrax in New South Wales.[79] Ultimately, the vaccine was unsuccessful in the challenging climate of rural Australia, and it was soon superseded by a more robust version developed by local researchers John Gunn and John McGarvie Smith.[80]

The human vaccine for anthrax became available in 1954. This was a cell-free vaccine instead of the live-cell Pasteur-style vaccine used for veterinary purposes. An improved cell-free vaccine became available in 1970.[81]

Engineered strains

  • The Sterne strain of anthrax, named after the Trieste-born immunologist Max Sterne, is an attenuated strain used as a vaccine, which contains only the anthrax toxin virulence plasmid and not the polyglutamic acid capsule expressing plasmid.
  • Strain 836, created by the Soviet bioweapons program in the 1980s, was later called by the Los Angeles Times "the most virulent and vicious strain of anthrax known to man".[82][83]
  • The virulent Ames strain, which was used in the 2001 anthrax attacks in the United States, has received the most news coverage of any anthrax outbreak. The Ames strain contains two virulence plasmids, which separately encode for a three-protein toxin, called anthrax toxin, and a polyglutamic acid capsule.
  • Nonetheless, the Vollum strain, developed but never used as a biological weapon during the Second World War, is much more dangerous. The Vollum (also incorrectly referred to as Vellum) strain was isolated in 1935 from a cow in Oxfordshire. This same strain was used during the Gruinard bioweapons trials. A variation of Vollum, known as "Vollum 1B", was used during the 1960s in the US and UK bioweapon programs. Vollum 1B is widely believed[84] to have been isolated from William A. Boyles, a 46-year-old scientist at the US Army Biological Warfare Laboratories at Camp (later Fort) Detrick, Maryland, who died in 1951 after being accidentally infected with the Vollum strain.
  • US Air Force researchers have developed a vaccine strain to produce an improved anthrax vaccine which requires a minimal number of injections to achieve and maintain long-term immunity. It is designated as the Alls/Gifford (Curlicue) strain.[85]

Discover more about History related topics

List of anthrax outbreaks

List of anthrax outbreaks

This page lists notable outbreaks of anthrax, a disease of humans and other mammals caused by Bacillus anthracis, organized by year.

Germ theory of disease

Germ theory of disease

The germ theory of disease is the currently accepted scientific theory for many diseases. It states that microorganisms known as pathogens or "germs" can lead to disease. These small organisms, too small to be seen without magnification, invade humans, other animals, and other living hosts. Their growth and reproduction within their hosts can cause disease. "Germ" refers to not just a bacterium but to any type of microorganism, such as protists or fungi, or even non-living pathogens that can cause disease, such as viruses, prions, or viroids. Diseases caused by pathogens are called infectious diseases. Even when a pathogen is the principal cause of a disease, environmental and hereditary factors often influence the severity of the disease, and whether a potential host individual becomes infected when exposed to the pathogen. Pathogens are disease-carrying agents that can pass from one individual to another, both in humans and animals. Infectious diseases are caused by biological agents such as pathogenic microorganisms as well as parasites.

Cell theory

Cell theory

In biology, cell theory is a scientific theory first formulated in the mid-nineteenth century, that living organisms are made up of cells, that they are the basic structural/organizational unit of all organisms, and that all cells come from pre-existing cells. Cells are the basic unit of structure in all organisms and also the basic unit of reproduction.

Hide (skin)

Hide (skin)

A hide or skin is an animal skin treated for human use. The word "hide" is related to the German word Haut, which means skin. The industry defines hides as "skins" of large animals e.g. cow, buffalo; while skins refer to "skins" of smaller animals: goat, sheep, deer, pig, fish, alligator, snake, etc. Common commercial hides include leather from cattle and other livestock animals, buckskin, alligator skin and snake skin. All are used for shoes, clothes, leather bags, belts, or other fashion accessories. Leather is also used in cars, upholstery, interior decorating, horse tack and harnesses. Skins are sometimes still gathered from hunting and processed at a domestic or artisanal level but most leather making is now industrialized and large-scale. Various tannins are used for this purpose. Hides are also used as processed chews for dogs or other pets.

John Henry Bell

John Henry Bell

John Henry Bell was a British medical doctor and researcher who is best known for contributing to the study of anthrax.

Bradford

Bradford

Bradford is a city in West Yorkshire, England. Bradford had a population of 349,561 at the 2011 census. It is the second-largest subdivision of the West Yorkshire Built-up Area after Leeds, which is approximately 8.6 miles (14 km) to the east. The City of Bradford district had a population of 546,412, making it the 7th most populous district in England.

Friederich Wilhelm Eurich

Friederich Wilhelm Eurich

Dr. Friederich Eurich (1867–1945) was a German bacteriologist.

Germans

Germans

Germans are the natives or inhabitants of Germany, and sometimes more broadly any people who are of German descent or native speakers of the German language. The constitution of Germany defines a German as a German citizen. During the 19th and much of the 20th century, discussions on German identity were dominated by concepts of a common language, culture, descent, and history. Today, the German language is widely seen as the primary, though not exclusive, criterion of German identity. Estimates on the total number of Germans in the world range from 100 to 150 million, and most of them live in Germany.

Bacteriologist

Bacteriologist

A bacteriologist is a microbiologist, or similarly trained professional, in bacteriology -- a subdivision of microbiology that studies bacteria, typically pathogenic ones. Bacteriologists are interested in studying and learning about bacteria, as well as using their skills in clinical settings. This includes investigating properties of bacteria such as morphology, ecology, genetics and biochemistry, phylogenetics, genomics and many other areas related to bacteria like disease diagnostic testing. Alongside human and animal healthcare providers, they may carry out various functions as medical scientists, veterinary scientists, or diagnostic technicians in locations like clinics, blood banks, hospitals, laboratories and animal hospitals. Bacteriologists working in public health or biomedical research help develop vaccines for public use.

Home Office

Home Office

The Home Office (HO), also known as the Home Department, is a ministerial department of His Majesty's Government, responsible for immigration, security, and law and order. As such, it is responsible for policing in England and Wales, fire and rescue services in England, visas and immigration, and the Security Service (MI5). It is also in charge of government policy on security-related issues such as drugs, counter-terrorism, and ID cards. It was formerly responsible for His Majesty's Prison Service and the National Probation Service, but these have been transferred to the Ministry of Justice.

France

France

France, officially the French Republic, is a country primarily located in Western Europe. It also includes overseas regions and territories in the Americas and the Atlantic, Pacific and Indian Oceans, giving it one of the largest discontiguous exclusive economic zones in the world. Its metropolitan area extends from the Rhine to the Atlantic Ocean and from the Mediterranean Sea to the English Channel and the North Sea; overseas territories include French Guiana in South America, Saint Pierre and Miquelon in the North Atlantic, the French West Indies, and many islands in Oceania and the Indian Ocean. Its eighteen integral regions span a combined area of 643,801 km2 (248,573 sq mi) and contain over 68 million people.

Louis Pasteur

Louis Pasteur

Louis Pasteur was a French chemist and microbiologist renowned for his discoveries of the principles of vaccination, microbial fermentation, and pasteurization, the last of which was named after him. His research in chemistry led to remarkable breakthroughs in the understanding of the causes and preventions of diseases, which laid down the foundations of hygiene, public health and much of modern medicine. His works are credited to saving millions of lives through the developments of vaccines for rabies and anthrax. He is regarded as one of the founders of modern bacteriology and has been honored as the "father of bacteriology" and the "father of microbiology".

Society and culture

Site cleanup

Anthrax spores can survive for very long periods of time in the environment after release. Chemical methods for cleaning anthrax-contaminated sites or materials may use oxidizing agents such as peroxides, ethylene oxide, Sandia Foam,[86] chlorine dioxide (used in the Hart Senate Office Building),[87] peracetic acid, ozone gas, hypochlorous acid, sodium persulfate, and liquid bleach products containing sodium hypochlorite. Nonoxidizing agents shown to be effective for anthrax decontamination include methyl bromide, formaldehyde, and metam sodium. These agents destroy bacterial spores. All of the aforementioned anthrax decontamination technologies have been demonstrated to be effective in laboratory tests conducted by the US EPA or others.[88]

Decontamination techniques for Bacillus anthracis spores are affected by the material with which the spores are associated, environmental factors such as temperature and humidity, and microbiological factors such as the spore species, anthracis strain, and test methods used.[89]

A bleach solution for treating hard surfaces has been approved by the EPA.[90] Chlorine dioxide has emerged as the preferred biocide against anthrax-contaminated sites, having been employed in the treatment of numerous government buildings over the past decade.[91] Its chief drawback is the need for in situ processes to have the reactant on demand.

To speed the process, trace amounts of a nontoxic catalyst composed of iron and tetroamido macrocyclic ligands are combined with sodium carbonate and bicarbonate and converted into a spray. The spray formula is applied to an infested area and is followed by another spray containing tert-butyl hydroperoxide.[92]

Using the catalyst method, complete destruction of all anthrax spores can be achieved in under 30 minutes.[92] A standard catalyst-free spray destroys fewer than half the spores in the same amount of time.

Cleanups at a Senate Office Building, several contaminated postal facilities, and other US government and private office buildings, a collaborative effort headed by the Environmental Protection Agency[93] showed decontamination to be possible, but time-consuming and costly. Clearing the Senate Office Building of anthrax spores cost $27 million, according to the Government Accountability Office. Cleaning the Brentwood postal facility in Washington cost $130 million and took 26 months. Since then, newer and less costly methods have been developed.[94]

Cleanup of anthrax-contaminated areas on ranches and in the wild is much more problematic. Carcasses may be burned,[95] though often 3 days are needed to burn a large carcass and this is not feasible in areas with little wood. Carcasses may also be buried, though the burying of large animals deeply enough to prevent resurfacing of spores requires much manpower and expensive tools. Carcasses have been soaked in formaldehyde to kill spores, though this has environmental contamination issues. Block burning of vegetation in large areas enclosing an anthrax outbreak has been tried; this, while environmentally destructive, causes healthy animals to move away from an area with carcasses in search of fresh grass. Some wildlife workers have experimented with covering fresh anthrax carcasses with shadecloth and heavy objects. This prevents some scavengers from opening the carcasses, thus allowing the putrefactive bacteria within the carcass to kill the vegetative B. anthracis cells and preventing sporulation. This method also has drawbacks, as scavengers such as hyenas are capable of infiltrating almost any exclosure.

The experimental site at Gruinard Island is said to have been decontaminated with a mixture of formaldehyde and seawater by the Ministry of Defence.[96] It is not clear whether similar treatments had been applied to US test sites.

Biological warfare

Colin Powell giving a presentation to the United Nations Security Council, holding a model vial of anthrax
Colin Powell giving a presentation to the United Nations Security Council, holding a model vial of anthrax

Anthrax spores have been used as a biological warfare weapon. Its first modern incidence occurred when Nordic rebels, supplied by the German General Staff, used anthrax with unknown results against the Imperial Russian Army in Finland in 1916.[97] Anthrax was first tested as a biological warfare agent by Unit 731 of the Japanese Kwantung Army in Manchuria during the 1930s; some of this testing involved intentional infection of prisoners of war, thousands of whom died. Anthrax, designated at the time as Agent N, was also investigated by the Allies in the 1940s.

A long history of practical bioweapons research exists in this area. For example, in 1942, British bioweapons trials severely contaminated Gruinard Island in Scotland with anthrax spores of the Vollum-14578 strain, rendering it uninhabitable and named as a hazardous area by the Ministry of Supply until it was decontaminated in 1990.[98][99] The Gruinard trials involved testing the effectiveness of a submunition of an "N-bomb" – a biological weapon containing dried anthrax spores. Additionally, five million "cattle cakes" (animal feed pellets impregnated with anthrax spores) were prepared and stored at Porton Down for "Operation Vegetarian" – anti livestock attacks against Germany to be made by the Royal Air Force.[100] The plan was for anthrax-based biological weapons to be dropped on Germany in 1944. However, the edible cattle cakes and the bomb were not used; the cattle cakes were incinerated in late 1945.

Weaponized anthrax was part of the US stockpile prior to 1972, when the United States signed the Biological Weapons Convention.[101] President Nixon ordered the dismantling of US biowarfare programs in 1969 and the destruction of all existing stockpiles of bioweapons. In 1978–79, the Rhodesian government used anthrax against cattle and humans during its campaign against rebels.[102] The Soviet Union created and stored 100 to 200 tons of anthrax spores at Kantubek on Vozrozhdeniya Island; they were abandoned in 1992 and destroyed in 2002.[103]

American military and British Army personnel are no longer routinely vaccinated against anthrax prior to active service in places where biological attacks are considered a threat.[54]

Sverdlovsk incident (2 April 1979)

Despite signing the 1972 agreement to end bioweapon production, the government of the Soviet Union had an active bioweapons program that included the production of hundreds of tons of anthrax after this period. On 2 April 1979, some of the over one million people living in Sverdlovsk (now called Ekaterinburg, Russia), about 1,370 kilometres (850 mi) east of Moscow, were exposed to an accidental release of anthrax from a biological weapons complex located near there. At least 94 people were infected, of whom at least 68 died. One victim died four days after the release, 10 over an eight-day period at the peak of the deaths, and the last six weeks later. Extensive cleanup, vaccinations, and medical interventions managed to save about 30 of the victims.[104] Extensive cover-ups and destruction of records by the KGB continued from 1979 until Russian President Boris Yeltsin admitted this anthrax accident in 1992. Jeanne Guillemin reported in 1999 that a combined Russian and United States team investigated the accident in 1992.[104][105][106]

Nearly all of the night-shift workers of a ceramics plant directly across the street from the biological facility (compound 19) became infected, and most died. Since most were men, some NATO governments suspected the Soviet Union had developed a sex-specific weapon.[107] The government blamed the outbreak on the consumption of anthrax-tainted meat, and ordered the confiscation of all uninspected meat that entered the city. They also ordered all stray dogs to be shot and people not have contact with sick animals. Also, a voluntary evacuation and anthrax vaccination program was established for people from 18 to 55.[108]

To support the cover-up story, Soviet medical and legal journals published articles about an outbreak in livestock that caused gastrointestinal anthrax in people having consumed infected meat, and cutaneous anthrax in people having come into contact with the animals. All medical and public health records were confiscated by the KGB.[108] In addition to the medical problems the outbreak caused, it also prompted Western countries to be more suspicious of a covert Soviet bioweapons program and to increase their surveillance of suspected sites. In 1986, the US government was allowed to investigate the incident, and concluded the exposure was from aerosol anthrax from a military weapons facility.[109] In 1992, President Yeltsin admitted he was "absolutely certain" that "rumors" about the Soviet Union violating the 1972 Bioweapons Treaty were true. The Soviet Union, like the US and UK, had agreed to submit information to the UN about their bioweapons programs, but omitted known facilities and never acknowledged their weapons program.[107]

Anthrax bioterrorism

In theory, anthrax spores can be cultivated with minimal special equipment and a first-year collegiate microbiological education.[110] To make large amounts of an aerosol form of anthrax suitable for biological warfare requires extensive practical knowledge, training, and highly advanced equipment.[111]

Concentrated anthrax spores were used for bioterrorism in the 2001 anthrax attacks in the United States, delivered by mailing postal letters containing the spores.[112] The letters were sent to several news media offices and two Democratic senators: Tom Daschle of South Dakota and Patrick Leahy of Vermont. As a result, 22 were infected and five died.[33] Only a few grams of material were used in these attacks and in August 2008, the US Department of Justice announced they believed that Bruce Ivins, a senior biodefense researcher employed by the United States government, was responsible.[113] These events also spawned many anthrax hoaxes.

Due to these events, the US Postal Service installed biohazard detection systems at its major distribution centers to actively scan for anthrax being transported through the mail.[114] As of 2020, no positive alerts by these systems have occurred.[115]

Decontaminating mail

In response to the postal anthrax attacks and hoaxes, the United States Postal Service sterilized some mail using gamma irradiation and treatment with a proprietary enzyme formula supplied by Sipco Industries.[116]

A scientific experiment performed by a high school student, later published in the Journal of Medical Toxicology, suggested a domestic electric iron at its hottest setting (at least 400 °F (204 °C)) used for at least 5 minutes should destroy all anthrax spores in a common postal envelope.[117]

Popular culture

  • In Aldous Huxley's 1932 dystopian novel Brave New World, anthrax bombs are mentioned as the primary weapon by means of which original modern society is terrorized and in large part eradicated, to be replaced by a dystopian society.
  • The climax of the 1947 British film The Loves of Joanna Godden involves the death of a key character by anthrax. Composer Ralph Vaughan Williams provided the affecting mood music for the scene.
  • The episode "Diagnosis: Danger" (1963) from the series Alfred Hitchcock Presents concerns Health Department officials working to contain an anthrax outbreak.
  • Anthrax attacks have featured in the storylines of various television episodes and films. A Criminal Minds episode follows the attempt to identify an attacker who released anthrax spores in a public park.[118]
  • The American thrash metal band Anthrax gets its name from the disease.
  • BBC drama Silent Witness follows criminal cases from the perspective of forensic pathologists and forensic scientists. Series 16 episodes 3 and 4 expose a case of genetically modified anthrax.[119]
  • The 2013 book Russian Roulette by Anthony Horowitz contains a young protagonist who is described to have escaped from an anthrax outbreak.[120]
  • In the 2021 film The Power of the Dog, directed by Jane Campion and based on the novel by Thomas Savage, a key character dies from sepsis caused by anthrax.

Discover more about Society and culture related topics

Ethylene oxide

Ethylene oxide

Ethylene oxide is an organic compound with the formula C2H4O. It is a cyclic ether and the simplest epoxide: a three-membered ring consisting of one oxygen atom and two carbon atoms. Ethylene oxide is a colorless and flammable gas with a faintly sweet odor. Because it is a strained ring, ethylene oxide easily participates in a number of addition reactions that result in ring-opening. Ethylene oxide is isomeric with acetaldehyde and with vinyl alcohol. Ethylene oxide is industrially produced by oxidation of ethylene in the presence of silver catalyst.

Hart Senate Office Building

Hart Senate Office Building

The Philip A. Hart Senate Office Building is the third U.S. Senate office building, and is located on 2nd Street NE between Constitution Avenue NE and C Street NE in Washington, D.C., in the United States. Construction began in January 1975, and it was first occupied in November 1982. Rapidly rising construction costs plagued the building, creating several scandals. The structure is named for Philip Hart, who served 18 years as a senator from Michigan. Accessed via a spur of the United States Capitol Subway System, the building features a nine-story atrium dominated by massive artwork, and a large Central Hearing Facility which provides television facilities as well as extensive seating.

Chlorine dioxide

Chlorine dioxide

Chlorine dioxide is a chemical compound with the formula ClO2 that exists as yellowish-green gas above 11 °C, a reddish-brown liquid between 11 °C and −59 °C, and as bright orange crystals below −59 °C. It is usually handled as an aqueous solution. It is also commonly used as a bleach. More recent developments have extended its applications in food processing and as a disinfectant.

In situ

In situ

In situ is a Latin phrase that translates literally to "on site" or "in position." It can mean "locally", "on site", "on the premises", or "in place" to describe where an event takes place and is used in many different contexts. For example, in fields such as physics, geology, chemistry, or biology, in situ may describe the way a measurement is taken, that is, in the same place the phenomenon is occurring without isolating it from other systems or altering the original conditions of the test. The opposite of in situ is ex situ.

Ligand

Ligand

In coordination chemistry, a ligand is an ion or molecule that binds to a central metal atom to form a coordination complex. The bonding with the metal generally involves formal donation of one or more of the ligand's electron pairs, often through Lewis bases. The nature of metal–ligand bonding can range from covalent to ionic. Furthermore, the metal–ligand bond order can range from one to three. Ligands are viewed as Lewis bases, although rare cases are known to involve Lewis acidic "ligands".

Bicarbonate

Bicarbonate

In inorganic chemistry, bicarbonate is an intermediate form in the deprotonation of carbonic acid. It is a polyatomic anion with the chemical formula HCO−3.

Gruinard Island

Gruinard Island

Gruinard Island is a small, oval-shaped Scottish island approximately 2 kilometres long by 1 km wide, located in Gruinard Bay, about halfway between Gairloch and Ullapool. At its closest point to the mainland, it is about 1 km offshore. The island was dangerous for all mammals after experiments with the anthrax bacterium in 1942, until it was decontaminated in the late 20th century.

Anthrax weaponization

Anthrax weaponization

Anthrax weaponization is the development and deployment of the bacterium Bacillus anthracis or, more commonly, its spore, as a biological weapon. As a biological weapon, anthrax has been used in biowarfare and bioterrorism since 1914. However, in 1975 the Biological Weapons Convention prohibited the "development, production and stockpiling" of biological weapons. It has since been used in bioterrorism.

Colin Powell

Colin Powell

Colin Luther Powell was an American politician, statesman, diplomat, and United States Army officer who served as the 65th United States Secretary of State from 2001 to 2005. He was the first African-American Secretary of State. He served as the 15th United States National Security Advisor from 1987 to 1989 and as the 12th Chairman of the Joint Chiefs of Staff from 1989 to 1993.

Biological warfare

Biological warfare

Biological warfare, also known as germ warfare, is the use of biological toxins or infectious agents such as bacteria, viruses, insects, and fungi with the intent to kill, harm or incapacitate humans, animals or plants as an act of war. Biological weapons are living organisms or replicating entities. Entomological (insect) warfare is a subtype of biological warfare.

German General Staff

German General Staff

The German General Staff, originally the Prussian General Staff and officially the Great General Staff, was a full-time body at the head of the Prussian Army and later, the German Army, responsible for the continuous study of all aspects of war, and for drawing up and reviewing plans for mobilization or campaign. It existed unofficially from 1806, and was formally established by law in 1814, the first general staff in existence. It was distinguished by the formal selection of its officers by intelligence and proven merit rather than patronage or wealth, and by the exhaustive and rigorously structured training which its staff officers undertook. Its rise and development gave the German armed forces a major strategic advantage over their adversaries for nearly a century and a half.

Imperial Russian Army

Imperial Russian Army

The Imperial Russian Army was the armed land force of the Russian Empire, active from around 1721 to the Russian Revolution of 1917. In the early 1850s, the Russian Army consisted of more than 900,000 regular soldiers and nearly 250,000 irregulars.

Other animals

Anthrax is especially rare in dogs and cats, as is evidenced by a single reported case in the United States in 2001.[121] Anthrax outbreaks occur in some wild animal populations with some regularity.[122]

Russian researchers estimate arctic permafrost contains around 1.5 million anthrax-infected reindeer carcasses, and the spores may survive in the permafrost for 105 years.[123] A risk exists that global warming in the Arctic can thaw the permafrost, releasing anthrax spores in the carcasses. In 2016, an anthrax outbreak in reindeer was linked to a 75-year-old carcass that defrosted during a heat wave.[124][125]

Source: "Anthrax", Wikipedia, Wikimedia Foundation, (2023, January 30th), https://en.wikipedia.org/wiki/Anthrax.

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