Anthrax, Then and Now

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Medical Author: Michael C. Fishbein, MD
Previous Medical Editor: Leslie J. Schoenfield, MD, PhD
Revising Medical Editor: Jay W. Marks, MD

Introduction

Experts have said that it is a matter of when, not if, a large scale act of bioterrorism is carried out in the U.S. Why "bio" terrorism? Biologic weapons are cheaper and more devastating than chemical weapons and maybe even nuclear weapons. Deadly quantities of infectious agents are easy to hide, transport, and spread throughout the population. Indeed, the U.S. already experienced a bioterrorism attack. In 2001, powder containing the bacterium called anthrax was distributed through the U.S. mail. All together, 22 people became infected with anthrax. These people lived in South Florida, New York City, New Jersey, Maryland, Connecticut, Pennsylvania, Virginia, and Washington, DC. Eleven people seem to have inhaled the anthrax, and 11 others were infected through the skin. The FBI and CDC (Center for Disease Control) are still investigating this outbreak.

Because of this outbreak, most Americans are now aware of the infectious disease called anthrax. Most are also aware that it is usually a disease of animals and that it is a rare cause of disease or death in humans. Prior to the outbreak in 2001, the last case of fatal anthrax in the United States was in 1976. Moreover, no fatal cases occurred in the preceding 10 years. What may not be as widely known, however, is that the 1976 case occurred in California. This was not a case of bioterrorism. The patient did die of the infection, and the autopsy was performed at UCLA Medical Center. The details of this case have been described in a medical journal called Human Pathology (Volume 9, pages 594-597, September, 1978).

The California case--1976

The patient was a 32-year-old artistic weaver who worked at home. He purchased his yarns from commercial suppliers. Investigations later revealed that the source of his infection was imported wool from Pakistan. The patient had been well until he developed a fever and sore throat, six days before his death. The illness progressed to include chest pain, headache, nausea, and loss of appetite. During the illness, his major difficulties were trouble breathing, mental problems such as an inability to carry out simple commands, and involuntary eye and limb movements.

A spinal tap (removal of some spinal fluid for analysis) revealed spinal fluid bacteria that looked very much like anthrax. All of these findings indicated involvement of the lungs and central nervous system (spinal cord and brain). The bacterial organism was eventually confirmed at the CDC to be anthrax. In spite of antibiotic therapy, the patient died. In this case, the antibiotics were begun late in the course of the disease, after the anthrax had spread throughout the body.

Several medical examiner's offices and university hospitals in California declined to do the autopsy, presumably for fear of contracting or spreading the anthrax infection. When the UCLA Department of Pathology was asked to perform the autopsy, the faculty agreed for several reasons:

• As part of a teaching and research institution, they felt obligated to society to do the autopsy.
• They had the appropriate facilities, namely, an isolation room to limit exposure.
• They had experts in the pathology of infectious diseases and neuropathology on the faculty.
• For forewarned and prepared pathologists, the risk of getting infected during the autopsy was actually quite small.