Death due to bioterrorism-related inhalational anthrax: report of 2 patients.

On October 9, 2001, a letter containing anthrax spores was mailed from New Jersey to Washington, DC. The letter was processed at a major postal facility in Washington, DC, and opened in the Senate's Hart Office Building on October 15. Between October 19 and October 26, there were 5 cases of inhalational anthrax among postal workers who were employed at that major facility or who handled bulk mail originating from that facility. The cases of 2 postal workers who died of inhalational anthrax are reported here. Both patients had nonspecific prodromal illnesses. One patient developed predominantly gastrointestinal symptoms, including nausea, vomiting, and abdominal pain. The other patient had a "flulike" illness associated with myalgias and malaise. Both patients ultimately developed dyspnea, retrosternal chest pressure, and respiratory failure requiring mechanical ventilation. Leukocytosis and hemoconcentration were noted in both cases prior to death. Both patients had evidence of mediastinitis and extensive pulmonary infiltrates late in their course of illness. The durations of illness were 7 days and 5 days from onset of symptoms to death; both patients died within 24 hours of hospitalization. Without a clinician's high index of suspicion, the diagnosis of inhalational anthrax is difficult during nonspecific prodromal illness. Clinicians have an urgent need for prompt communication of vital epidemiologic information that could focus their diagnostic evaluation. Rapid diagnostic assays to distinguish more common infectious processes from agents of bioterrorism also could improve management strategies.

Comparison of in vivo energy metabolism in the brain of rainbow trout, Salmo gairdneri and bullhead catfish, Ictalurus nebulosus during anoxia.

1. Rainbow trout and bullhead catfish (Ictalurus nebulosus) were exposed to anoxic water inside a plastic tube until death (12 min for trout; 62 min for catfish). Immediately upon death, the brain was removed and analyzed for metabolites, high energy phosphate compounds, and metabolic fuel while the blood was analyzed for metabolites. 2. Control bullhead brains had higher concentrations of glycogen, ATP, creatine phosphate (CrP), and glucose than control trout. 3. After anoxia bullheads showed a significant decrease in ATP, CrP, and glycogen while lactate more than doubled in concentration. 4. After anoxia trout showed a doubling in brain lactate and a decline in glycogen, but no decline in ATP or CrP. There were no changes in brain glucose, ketone bodies, or alternative anaerobic end-products in either species although an elevation in blood isobutyrate was noted. 5. Brain death in the catfish may be due to depletion of fuel for anaerobiosis and a subsequent loss of ATP. In the trout there may be other causes such as a greater permeability of its neuronal membranes and alterations in intracellular free calcium stores.

Lung tumor-associated antigens: thin layer immunoassay.

Six hundred eighty-four rapid, sensitive thin layer immunoassays (TLI) were performed using an adapted visualization of condensation on plastic surface (VCS) method, for testing squamous cell and adenocarcinoma monospecific (TAA) and monoclonal antibody derived lung tumor-associated antigens (TAA epitopes) against small amounts of coded human test sera. The TAA epitopes selected for VCS-TLI were more specific, but both forms of TAA gave positive tests in 94% of lung cancer test sera of the appropriate histological types. The four antigens (adeno TAA and TAA epitope, squamous TAA and TAA epitope) did not react in VCS-TLI with coded sera from preselected normal individuals with known medical histories. With both TAA epitopes, 5% of non-lung cancer test sera were positive. There were indications that such tests may be useful in aiding pathological evaluations and in detecting precancerous conditions in patients with asbestosis. Cross-reacting (with other non-lung cancers) and specific peptide sequences of TAA were indicated in the comparative tests with the corresponding TAA epitopes, suggesting the tests for probing and analyzing portions of the antigens. Of immediate use is VCS-TLI for monitoring patients on specific active TAA immunotherapy.