Robert Rennie Anthrax presentation 2017

7.  So! A couple of pearls:
◦ Micro-organisms have been here for about 3 billion
years. We only showed up 100 million years ago so
they’ve been here 30 times longer than we have been
around.
◦ When truth, science, fear, threats, and common sense
collide, fear and threats often win – at least for a time!

8. 2 – 3 μM

9.  Two principal virulence factors are responsible
for the lethality of anthrax:
◦ poly-D-glutamic acid capsule protects the
bacterium from phagocytosis by host neutrophils
◦ anthrax toxin a tripartite protein toxin that is a
mixture of three protein components:
 (i) protective antigen (PA)
 (ii) edema factor (EF)
 (iii) lethal factorr (LF).
 PA plus LF produces lethal toxin, and PA plus EF produces edema
toxin. These toxins cause death and tissue swelling (edema),
respectively.

10.  Non-industrial: - incidental exposure to
infected carcasses or ingestion of infected
meat.
◦ E.g.farmers, veterinarians, hunters.
 Industrial - direct exposure to tissue, wool,
hides, bone and animal products.
◦ E.g. tanners, woollen workers, abattoir workers

11.  Inhalation of spores by “accidental
release” from a Russian military
microbiological establishment.
 Spores spread by wind at the time of the
accident
 Over 50 human deaths directly
attributable to inhalation of spores; many
animals in the zone also died.

12. 04/04/79: - faintness, dizzinees trouble
breathing
08/04/79: - complete collapse on. Five hours to
bring up her blood pressure, then transported to
a local hospital (No. 20).
09/04/79: - Deceased
- Family given tetracycline pills
- Buried in a special cemetery (Sector 13).
- Son received vaccine in late April
01/05/79. Buildings hosed down and asphalt
road built in the area.

13.  Dr. Nikolay Babich: - “people died in streetcars and in
the lobbies of buildings. There was no time for an
ambulance”.
 Dr. D.N. Ponomaryev: - “a man and woman had died as
if by lightning”.
 Dr. Faina Abramova (pathologist):
- “massive thoracic and gastrointestinal
bleeding – there was a distinctive
pattern of bleeding in the brain -
(a ‘Cardinal’s cap’ of red
haemorrhagic tissue”).

15.  Pathology observations (1994) on 42
necropsies:
◦ hemorrhagic necrosis of thoracic lymph nodes
◦ hemorrhagic mediastinitis
◦ primary focal hemorrhagic necrotizing
pneumonia (11 cases)
◦ mesenteric lymphadenitis (9 cases)
◦ edema adjacent to sites of extensive
infection/pleural effusion
◦ hemorrhagic meningitis (21 cases)
◦ gastrointestinal submucosal hemorrhage (39
cases)

16.  63 yr. male in Florida - newspaper photo-editor
 Sept 27 - malaise, fever, fatigue, chills, anorexia,
sweats.
 Oct 2 - nausea, vomiting, confusion. T;39.2C
◦ -normal WBC, low platelets, mild hyponatremia, elevated
total bilirubin.
◦ Chest Xray- Prominent superior mediastinum, left pleural
effusion

17.  CSF
◦ WBC (4750 - 80% PMNs), RBC(1375), glucose (3.2),
protein (6.6)
◦ Gram smear - many Gram-positive bacilli
 Bacillus anthracis
◦ CSF (after 7 hr)
◦ Blood cultures (after 24 hr)

18.  October 2:
◦ Antibiotics - ceftazidime, gentamicin, metronidazole,
doxycycline, ampicllin, TMP-SMX.
 October 4: penicillin G, levofloxacin,
clindamycin
 October 5: Deceased
 Autopsy: hemorrhagic mediastinal
lymphadenitis, disseminated B.anthracis in
many organs

19.  Fever, chills
 Sweats
 Fatigue, malaise, lethargy, myalgia
 Cough, mimimal
 Nausea, vomiting
 Dyspnea, pleuritic pain
 Headache, confusion
 Abdominal pain
 Sore throat, rhinorrhea

20.  The Mirage Man (David Willman): Bruce Ivins, the anthrax
attacks and America’s rush to war. (Bantam Books).
◦ The powdered letters – five deaths, 17 additional infections.
Senators Daschle and Leahy, Tom Brokaw.
◦ Bruce Ivins- eccentric microbiologist at Fort Detrick, MD, with
unlimited access to B. anthracis. Eventually commits suicide?
◦ Enormous discussion on what is required to create a lethal
spore (a lot of fiction and not much fact!)
◦ FBI, faulty investigation, op-ed witch hunts.
◦ Struggles for control, overzealous press, disregard for
scientific data to justify the means to an end – war in the Gulf
and the war on terrorism.

21.  Since 1931 there have been 30 recorded
cases of anthrax in humans in Canada
 Last reported cases: 1991 and 2006
◦ Central Alberta: Farmer handling infected
carcasses
◦ Saskatchewan: Person assisting a farmer friend
with calving
 All cases primary cutaneous infection
 No deaths directly attributable to infection

26. “The animals, head lowered, gaunt and
drawn,
feeding voraciously at times were
depressed
and inordinately indifferent ---.
Most walked with difficulty, staggering at
times and exhibited a stiff-legged gait
when running. A swelling of the preputial
and umbilical regions was noted in many
animals”

27. Anthrax – the Natural Aftermath

37.  According to my former graduate student – the
vaccine “hurts like hell!”
◦ It is given to all military personnel and those personnel
working in higher threat areas.
◦ Is it safe? Most likely except for reactions – fever,
selling at injection sites, sometimes serum sickness,
flu-like illness.
◦ Does it protect? Primate data suggests that two
immunizations given over 2 weeks is effective for at
least a year. In one study 1/8 monkeys died when
aerosol challenged 2 years later.

38.  Stockpiling antibiotics is like building a bomb
shelter – a human response to a perceived threat!
 When the powder scares occurred in the United
States – the immediate response was to stockpile
ciprofloxacin
 The problem – a sudden realization that no one
knew how susceptible strains of B. anthracis were
to this agent.

39.  So the federal government requested
USAMRID and the antibiotic subcommittee
of CLSI to conduct a study. Three labs in the
U.S. (CDC, USAMRID, and Mayo Clinic).
 Our lab could not participate directly
because of the “Select Agent Rule”.
 We used the same protocol and tested
about 50 strains isolated from animals
isolated since 1962 – a larger collection
than those tested in the U.S.
 Results were the same as those in the U.S. –
there was good susceptibility (at least in
vitro) to ciprofloxacin and several other agents.

40.  The outcome (from scientists):
◦“We can’t combine the Canadian data since their strains
are not ‘HUMANIZED’
Then someone reminded them that the vaccine strain and
the strain they were using as a quality control isolate all
arose from animals!!
The strain used in the letter powders also was derived
from a naturally occurring animal isolate.

41.  The perception of a threat is often in the eye of the
beholder.
◦ Anthrax is not a great pathogen on it’s own. Conditions
and circumstances have to be right for dissemination.
◦ In the natural environment the spore has to be in the
right condition – at the surface, wet in the spring to float
and concentrate at the surface, dry in the late summer to
be ingested or inhaled.
◦ In the “action” environment, the spore itself has to be the
right size. It must therefore be “weaponized”.

42. Humans may actually support the
democratization of evil by poor science,
ignorance and panic, or other motives.