Inhalational Anthrax Due to Bioterrorism: Would Current Centers for Disease Control and Prevention Guidelines Have Identified the 11 Patients with Inhalational Anthrax from October through November 2001?

Mayer, Thom; Morrison, Allan J.; Bersoff‐Matcha, Susan; Druckenbrod, Glenn; Murphy, Cecele; Howell, John M.; Hanfling, Dan; Cates, Robert A.; Pauze, Denis R.; Earls, James P.

doi:10.1086/374843

Cited by 17 publications

(7 citation statements)

References 12 publications

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“…However, there is typically little evidence of significant bacterial growth within the alveolar space, as is characteristic of classical pneumonia. Today it remains difficult to diagnose inhalational anthrax; many of the 2001 victims of the mailing of anthrax spores in the United States were initially diagnosed with bronchitis or pneumonia (55). Thus, it is not surprising that early research focused on the lungs and trachea.…”

Section: Reforming the Trojan Horse Model In Light Of New Datamentioning

confidence: 99%

Updating Perspectives on the Initiation of Bacillus anthracis Growth and Dissemination through Its Host

Weiner

Glomski

2012

Infect Immun

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ABSTRACTSince 1957, it has been proposed that the dissemination of inhalational anthrax required spores to be transported from the lumena of the lungs into the lymphatic system. In 2002, this idea was expanded to state that alveolar macrophages act as a “Trojan horse” capable of transporting spores across the lung epithelium into draining mediastinal lymph nodes. Since then, the Trojan horse model of dissemination has become the most widely cited model of inhalational infection as well as the focus of the majority of studies aiming to understand events initiating inhalational anthrax infections. However, recent observations derived from animal models ofBacillus anthracisinfection are inconsistent with aspects of the Trojan horse model and imply that bacterial dissemination patterns during inhalational infection may be more similar to the cutaneous and gastrointestinal forms than previously thought. In light of these studies, it is of significant importance to reassess the mechanisms of inhalational anthrax dissemination, since it is this form of anthrax that is most lethal and of greatest concern whenB. anthracisis weaponized. Here we propose a new “jailbreak” model ofB. anthracisdissemination which applies to the dissemination of all common manifestations of the disease anthrax. The proposed model impacts the field by deemphasizing the role of host cells as conduits for dissemination and increasing the role of phagocytes as central players in innate defenses, while moving the focus toward interactions betweenB. anthracisand lymphoid and epithelial tissues.

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Section: Reforming the Trojan Horse Model In Light Of New Datamentioning

confidence: 99%

Updating Perspectives on the Initiation of Bacillus anthracis Growth and Dissemination through Its Host

Weiner

Glomski

2012

Infect Immun

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“…Other features more common in anthrax were: nausea, vomiting, pallor, cyanosis, diaphoresis, altered level of consciousness, and increased hematocrit level. Two groups 54,55 have developed screening criteria to help diagnose anthrax after a known bioterrorism incident. However, a costeffectiveness analysis showed that although both criteria would have identified cases Christian Abbreviations: CT, computed tomography scan; CXR, chest radiograph; MRI, magnetic resonance imaging.…”

Section: Bacterial Agentsmentioning

confidence: 99%

Biowarfare and Bioterrorism

Christian

2013

Critical Care Clinics

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Bioterrorism is not only a reality of the times in which we live but bioweapons have been used for centuries. Critical care physicians play a major role in the recognition of and response to a bioterrorism attack. Critical care clinicians must be familiar with the diagnosis and management of the most likely bioterrorism agents, and also be adequately prepared to manage a mass casualty situation. This article reviews the epidemiology, diagnosis, and treatment of the most likely agents of biowarfare and bioterrorism.

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“…On the other hand, Mayer et al proposed to modify the CDC-issued interim guidelines for clinical evaluation of persons with possible IA (41) on the basis of the epidemiological, clinical, laboratory, and radiologic findings of the 11 patients with bioterrorism-related IA during their first visit to a physician. Whereas the CDC guidelines would not have identified 10/11 of these patients, the proposed extensions of the guidelines retrospectively identified 8/11 of the patients with IA (42). In a recent article, Howell et al compared the two methods proposed to screen for IA, applying them to the emergency department charts of patients who presented with possible signs or symptoms of IA at a hospital.…”

Section: Initial Management Of Hospitalized Casesmentioning

confidence: 99%

The Initial Hospital Response to an Epidemic

Petrosillo

Puro

et al. 2005

Archives of Medical Research

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The last decades have been characterized by the appearance of a substantial number of newly recognized or novel infectious agents and by the re-emergence of infectious diseases with a global impact. The objective of this article is to briefly describe the model of hospital response for early diagnosis and prompt management of patients with highly contagious infectious diseases. We reviewed the main components of hospital preparedness in response to clustering of highly contagious diseases. A model for the initial hospital response to an epidemic in our referral Institute is discussed. Prompt recognition and identification is the initial and indispensable step in facing any communicable diseases, regardless of whether it is a prevalent, a newly emerging one or deliberately released. The importance of developing and implementing nontraditional methods of public health surveillance and a system that allows a wide and immediate dissemination of information and exchange of views on risk assessment and risk management are highlighted. Case identification and laboratory capabilities and isolation procedures are the essential components for an initial hospital response. The recent bioterrorist events and the worldwide outbreaks of highly contagious infectious diseases have evidenced the need for institutional preparedness at each hospital and for identification of referral centers for patient isolation and of laboratories with adequate capabilities. Moreover, hospitals should develop a plan for coordinating all hospital components to respond to critical situations deriving from the admission of patients with highly contagious infectious diseases.

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Inhalational Anthrax Due to Bioterrorism: Would Current Centers for Disease Control and Prevention Guidelines Have Identified the 11 Patients with Inhalational Anthrax from October through November 2001?

Cited by 17 publications

References 12 publications

Updating Perspectives on the Initiation of Bacillus anthracis Growth and Dissemination through Its Host

Updating Perspectives on the Initiation of Bacillus anthracis Growth and Dissemination through Its Host

Biowarfare and Bioterrorism

The Initial Hospital Response to an Epidemic

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