Anthrax - From Russia with Love

Medical Author: Michael C. Fishbein, MD
Previous Medical Editor: Leslie J. Schoenfield, MD, PhD
Medical Editor: Melissa Conrad Stöppler, MD

This article recounts the chilling, yet fascinating story of the deadliest outbreak of anthrax in recorded history. Anthrax is a bacterium (germ) that can cause a serious, sometimes fatal infection. Anthrax can be used as a weapon. In 2001, anthrax was spread through the mail in a powder. Twenty-two people were infected. The events that occurred in Sverdlovsk, Russia, in 1979 demonstrate what can happen when anthrax is released into the air.

The Outbreak

This was the ninth day of the mysterious, fatal epidemicthat struck Sverdlovsk in early April of 1979. Autopsies already had been performed on 37 victims who died of an unknown disease. Yet neither the clinicians nor the pathologists had identified the cause of the epidemic. Moreover, as you can imagine, the members of the pathologydepartment were frustrated and overburdened with work. So, on this day, Dr. Faina Abramova, who had been chief of pathology at hospital #40, returned from retirement to help perform the autopsies.

The first autopsyDr. Abramova performed was number 38 of the 42 ultimately performed by the local pathologists. The patient was a 43-year-old man who had had weakness and feverfor two days. He was admitted to the hospital where he died four days later.

At the autopsy table, Dr. Abramova was struck by the crimson color of the membranes (meninges) covering the man's brain. In her description, she referred to this covering as the "cardinal's cap" because of its color and location. Astonishingly, she recognized this finding as characteristic of anthrax infection. (Few doctors have ever seen the disease anthrax.) In fact, her diagnosis was based on her recollection of a brain specimen from a patient with anthrax on display in a museum at her medical school.