Bugged!
Anthrax, plague, botulinum, brucellosis, cholera, and smallpox: a small cadre of bacteria, viruses, and toxins that could spell big trouble, though excessive fear of contagion might be as unfounded and unwarranted as a child’s disproportionate mental “knee-jerk” to imaginary Halloween gargoyles, ghosts, goblins, or the boogie-man. Let’s debunk, or “debug,” some of the more common misconceptions associated with infectious disease, transmissible human pathogens and their vectors, biological weapons, and the microbes themselves by taking aim at anthrax.
Historical perspective on the “measles experience” in the United States from 1912 to 1963 gives us a point of departure. The incidence of measles during that period never dropped below 100,000 cases per year, and epidemics were quite common. After the introduction of the first vaccine in 1963, the number of cases fell to very low levels. We are now faced, however, with an entirely new scenario that risks taking us back to square one.
Obtaining pathogens, culturing them in vast quantities, and “weaponizing” them, or turning them into a form that remains virulent, has not appeared to pose a problem to those who seek to undermine our democracy. Anthrax is a relatively common veterinary disease. Collect a little blood from a cow that has died of anthrax (or even get spores from the soil or a carcass), put it in a petri dish, and, “abracadabra,” you have anthrax.
To date, more than 70 bacteria, viruses, parasites, and fungi are serious human pathogens. The anthrax bacillus, for example, can infect skin (20% fatal), lungs (90% fatal), or gastrointestinal (GI) tract (25% to 60% fatal). Anthrax spores can enter the skin through minor cuts, and then grow into toxin-producing bacteria. Skin rash follows, with toxins striking surrounding tissue and immune cells carrying microbes from the skin to the lymph nodes and the rest of the body. Exposure to airborne spores, on the other hand, can result in their deposit in the alveoli of the lungs. After germination of those spores, which in some cases may take up to 60 days, flulike symptoms begin, followed by bacterial multiplication, toxin release, and further deterioration of lung tissue. Immune cells, the “taxicabs” of the body, then ferry the microbes from the lungs to lymph nodes and other sites in the body.
What can we do to prevent this public health nightmare? If you think you’ve been exposed to anthrax, telephone your doctor or your local health department, who will set up immediate lab testing which can quickly diagnose anthrax in blood or nasal secretions. Should you test positive for anthrax, immediate drug therapy will, and should be, initiated.
All forms of anthrax are highly treatable if detected within the first few days of exposure. Drugs are useless, however, once a person develops symptoms. Ciprofloxacin (Cipro), a potent, broad-spectrum antibiotic, is currently being used to treat suspected cases of inhaled anthrax. It should be pointed out, however, that the vast majority of anthrax infections can also be managed with penicillin or tetracycline (Doxycycline). The standard course of treatment is 60 days, or 30 days of antibiotic and a series of three vaccine shots. A preventive vaccine is available to military personnel and scientists, but has not been approved for general use or tested in the general public at large.
There are downsides, however. Ciprofloxacin should not be prescribed to pregnant women or to anyone under 18 years of age, except in known cases of anthrax exposure.
Although clearer heads, comfort levels, government reassurance, and enactment of adequate public health measures will go a long way to curtail panic, we must resign ourselves to the fact that anthrax and other “little fellas” will be around to “bug” us for quite some time. After all, they were here first. Cool heads and rational use of the medical weapons at our disposal, however, will ensure that we are the only ones left standing.
Historical perspective on the “measles experience” in the United States from 1912 to 1963 gives us a point of departure. The incidence of measles during that period never dropped below 100,000 cases per year, and epidemics were quite common. After the introduction of the first vaccine in 1963, the number of cases fell to very low levels. We are now faced, however, with an entirely new scenario that risks taking us back to square one.
Obtaining pathogens, culturing them in vast quantities, and “weaponizing” them, or turning them into a form that remains virulent, has not appeared to pose a problem to those who seek to undermine our democracy. Anthrax is a relatively common veterinary disease. Collect a little blood from a cow that has died of anthrax (or even get spores from the soil or a carcass), put it in a petri dish, and, “abracadabra,” you have anthrax.
To date, more than 70 bacteria, viruses, parasites, and fungi are serious human pathogens. The anthrax bacillus, for example, can infect skin (20% fatal), lungs (90% fatal), or gastrointestinal (GI) tract (25% to 60% fatal). Anthrax spores can enter the skin through minor cuts, and then grow into toxin-producing bacteria. Skin rash follows, with toxins striking surrounding tissue and immune cells carrying microbes from the skin to the lymph nodes and the rest of the body. Exposure to airborne spores, on the other hand, can result in their deposit in the alveoli of the lungs. After germination of those spores, which in some cases may take up to 60 days, flulike symptoms begin, followed by bacterial multiplication, toxin release, and further deterioration of lung tissue. Immune cells, the “taxicabs” of the body, then ferry the microbes from the lungs to lymph nodes and other sites in the body.
What can we do to prevent this public health nightmare? If you think you’ve been exposed to anthrax, telephone your doctor or your local health department, who will set up immediate lab testing which can quickly diagnose anthrax in blood or nasal secretions. Should you test positive for anthrax, immediate drug therapy will, and should be, initiated.
All forms of anthrax are highly treatable if detected within the first few days of exposure. Drugs are useless, however, once a person develops symptoms. Ciprofloxacin (Cipro), a potent, broad-spectrum antibiotic, is currently being used to treat suspected cases of inhaled anthrax. It should be pointed out, however, that the vast majority of anthrax infections can also be managed with penicillin or tetracycline (Doxycycline). The standard course of treatment is 60 days, or 30 days of antibiotic and a series of three vaccine shots. A preventive vaccine is available to military personnel and scientists, but has not been approved for general use or tested in the general public at large.
There are downsides, however. Ciprofloxacin should not be prescribed to pregnant women or to anyone under 18 years of age, except in known cases of anthrax exposure.
Although clearer heads, comfort levels, government reassurance, and enactment of adequate public health measures will go a long way to curtail panic, we must resign ourselves to the fact that anthrax and other “little fellas” will be around to “bug” us for quite some time. After all, they were here first. Cool heads and rational use of the medical weapons at our disposal, however, will ensure that we are the only ones left standing.
Copyright 2004, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
7/10/2006 12:47:00 PM
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