Inhalation anthrax in a home craftsman.

Inhalation anthrax with complicating subarachnoid hemorrhage due to simultaneous infection with two capsular biotypes of Bacillus anthracis of different virulence for the mouse is reported. The patient, a home craftsman, acquired his infection from imported animal-origin yarn.

Outbreak of leptospirosis associated with swimming.

Between July 7 and 18, 1991, five boys from a small town in rural Illinois experienced the onset of an acute febrile illness subsequently confirmed as leptospirosis by serologic tests. A cohort study found that swimming in a small swimming hole, Steel Tunnel Pond, was associated with disease (P < 0.01), the attack rate being 28%. Leptospira interrogans serovar grippotyphosa was isolated from urine cultures from two of the case patients and from a culture of Steel Tunnel Pond water. A high seroprevalence for grippotyphosa was found in animals near the pond. Drought conditions had been present in the month before the outbreak, creating an environment in the pond which probably facilitated transmission of the organism from area animals to humans. Although leptospirosis is infrequently reported in humans in the United States, it is endemic in animals and the potential for outbreaks exists, especially when environmental conditions are favorable.

Airborne spread of brucellosis.

review of epidemic and endemic brucellosis at six abattoirs demonstrates a correlation between case distribution and flow of air from the kill department (stage II) to other areas within an abattoir. Air from the kill department disseminated to nearby departments led to abnormally high brucellosis attack rates for persons who worked in these areas at two abattoirs. Complete physical separation or maintaining negative air pressure in the kill department was associated with reduced risk for workers in other areas at four abattoirs. Cases in persons who had exposure to kill department air but no contact with animal tissues provide strong evidence for airborne transmission of infection. Brucellosis is also contracted through skin contact with infectious animal tissues, but this route of transmission appears less important than formerly believed.

Leptospirosis in zoo workers associated with bears.

Leptospirosis due to Leptospira interrogans serovar icterohaemorrhagiae was diagnosed in two zoo animal keepers. The implicated source of infection was bear cubs that had microscopic agglutination antibody titers to leptospires of the Icterohaemorrhagiae serogroup.

Legionella pneumophila: identification in tissue sections by a new immunoenzymatic procedure.

A modified glucose oxidase immunoenzyme technique was shown to be highly sensitive and specific for detection of serogroup 1 Legionella pneumophila in 4% formaldehyde solution-fixed, paraffin-embedded tissue sections. There was complete concordance between infection with L pneumophila and detection of the organisms in tissue sections by glucose oxidase immunoenzyme staining. The L pneumophila organisms stained blue-black and were found within phagocytic cells as well as in the extracellular space. A cloud of blue-black pigment, probably representing diffusable antigen, was present in the extracellular spaces in the area of L pneumophila localization. No false-positive or false-negative reactions were found. This technique requires no specialized equipment, may be applicable to retrospective diagnostic problems, and can be adapted to routine diagnostic practice.

Melioidosis in imported non-human primates.

In 1969, five cases of melioidosis in three separate outbreaks were diagnosed in nonhuman primates in the United States. In the first outbreak, two stump-tailed macaque monkeys (Macaca arctoides) developed signs of the disease approximately 6 months after purchase. A third animal, a chimpanzee (Pan troglodytes), probably acquired its infection from one of these monkeys. Two other unrelated cases involving a pig-tailed monkey (Macaca nemestrina) and a rhesus monkey (Macaca mulatta) were diagnosed. These monkeys had been imported 3 years and 6 months, respectively, prior to the recognized onset of their disease. These cases represent the first known occurrences of spontaneous melioidosis in nonhuman primates in the United States.

Borreliosis in dogs from southern Connecticut.

Blood samples were obtained from dogs in tick-infested regions of southern Connecticut to assess canine exposure to Borrelia burgdorferi, the etiologic agent of Lyme disease in human beings. An indirect fluorescent antibody test detected immunoglobulin (Ig)M antibodies at titers of 1:64 to 1:512 in 22 of 84 serum samples previously shown to be positive with a polyvalent rabbit anti-dog total Ig conjugate. Analyses of paired serum samples from 20 seropositive dogs revealed temporal differences in titers; changes occurred during brief (1 month) or extended (greater than 4 years) sampling periods. Clinical records for 52 seropositive dogs indicated a history of intermittent lameness in 19 of these. Limb/joint disorders typically developed in dogs without IgM antibodies, suggesting manifestation during later phases of illness. A microscopic-agglutination test was used to assess cross reactivity between B burgdorferi and 20 serovars of Leptospira interrogans and biflexa. Analyses of 63 dog serum specimens with antibodies to B burgdorferi and a series of reference rabbit sera revealed minor antigenic relatedness. There was geographic clustering of dogs with antibodies to B burgdorferi in areas of south-central and southeastern Connecticut, where human Lyme disease also occurs.

An epizootiologic study of anthrax in Falls County, Texas.

In June and July, 1974, an anthrax epizootic in Falls County, Texas, resulted in the death of 236 animals (228 cattle, 5 horses, 2 mules, and 1 pig) on 48 premises. Death rates were highest for horses (18.2%) and bulls (16.8%). The epizootic was apparently precipitated by drought, and infection appeared to be the result of ingesting intrinsically contaminated soil and grass. Human illness was not associated with the epizootic.

Principles for emergency response to bioterrorism.

The recent occurrence of a series of anthrax-related hoaxes illustrates the need to educate emergency services personnel about how to best ensure patient and worker safety in the case of suspected exposure to biological threat agents. There are very few data to support the methods being used or the variation in current care. Emergency physicians, first responders, and hazardous materials response teams need a standardized approach to the management of patients who may have been exposed to biological threat agents. Currently recommended hospital infection control procedures seem appropriate for the level of risk involved with aerosolized biological threat agents. Such recommendations include standard and transmission-based precautions. These groups need a working knowledge of the isolation and infection control measures recommended for the treatment of patients exposed to those biological threat agents at outlined in the Centers for Disease Control and Prevention Guideline for Isolation Precautions in Hospitals.

Determination by enzyme-linked immunosorbent assay of immunoglobulin G (IgG), IgM, and IgA to Brucella melitensis major outer membrane proteins and whole-cell heat-killed antigens in sera of patients with brucellosis.

An enzyme-linked immunosorbent assay was used to compare Brucella melitensis major outer membrane proteins (MOMP) and whole-cell heat-killed antigens (HK) in measuring antibrucella immunoglobulin G (IgG), IgM, and IgA in sera of brucellosis patients and controls. Antibodies to MOMP were generally similar to those against HK, and the correlation coefficients between the two antigens and IgG, IgM, and IgA in patients varied between 0.73 and 0.94. Both antigens are comparably suitable in detecting antibrucella immunoglobulin isotypes for the serologic diagnosis of patients with brucellosis, with high (greater than or equal to 95%) sensitivity and specificity.

Psittacosis outbreak in employees of a turkey-processing plant.

In June 1976, 28 employees of a Nebraska poultry processing plant had clinical onset of an illness compatible with psittacosis. The diagnosis was serologically confirmed in 22 patients by fourfold or greater changes in their complement fixation antibody titers, using a Chlamydia group antigen. Lack of serologic response in the remaining patients could not be readily explained by therapy differences, timing of serologic evaluation, or severity of clinical illness. The comparable attack rates in the various processing departments were consistent with an airborne infection. However, results of the investigation also suggested that workers having both frequent contact with turkey tissues and skin injuries were more likely to be infected than other processing workers. The cost of the outbreak for reimbursed medical costs, workmen's compensation, and lost wages was $19,000. A single turkey flock was implicated as the source of infection. This flock had been screened on a voluntary basis for evidence of infection prior to slaughter, using criteria developed by the United States Department of Agriculture. Although the preslaughter screening failed to detect psittacosis infection, two turkeys from the same flock which inadvertently had not been sent to slaught were subsequently found to be infected.

Evaluation of the card test for diagnosis of human brucellosis.

The relative efficacy of the card test in the diagnosis of human brucellosis was evaluated by comparison with four other tests: the standard tube agglutination test, centrifugation agglutination test, 2-mercaptoethanol degradation technique, and 2-mercaptoethanol centrifugation agglutination test. A total of 1,701 serum specimens from persons with various degrees of potential exposure to brucella organisms or cross-reactive antigens were used in this study. In comparison with standard tube agglutination results, the card test had a sensitivity of 95.3% and a specificity of 84.1%. The card-test antigen was nonreactive with serum specimens from tularemia patients and cholera vaccinees. Our data indicated that this test measures both immunoglobulin G and immunoglobulin M agglutinins. The value of the card test in the presumptive serological diagnosis of clinical brucellosis in humans appears to be low; however, the card test may be of value in serological surveys to delineate high-risk populations.

The economic impact of a bioterrorist attack: are prevention and postattack intervention programs justifiable?

Understanding and quantifying the impact of a bioterrorist attack are essential in developing public health preparedness for such an attack. We constructed a model that compares the impact of three classic agents of biologic warfare (Bacillus anthracis, Brucella melitensis, and Francisella tularensis) when released as aerosols in the suburb of a major city. The model shows that the economic impact of a bioterrorist attack can range from an estimated $477.7 million per 100,000 persons exposed (brucellosis scenario) to $26.2 billion per 100,000 persons exposed (anthrax scenario). Rapid implementation of a postattack prophylaxis program is the single most important means of reducing these losses. By using an insurance analogy, our model provides economic justification for preparedness measures.