Abstract
In nature, Anthrax is a zoonotic disease caused by the gram-positive spore-forming bacterium Bacillus anthracis usually infecting grazing animals. Taking advantage of their stability and ability to survive harsh conditions for decades, this deadly bacterium was stockpiled during the twentieth century as a bio-weapon by the great nations. The 1972 convention that prohibited the development, production and stockpiling of bio-weapons reduced these nation-level productions but increased the probability that knowhow, and in some cases weapon grade spores, will become available for use by terror groups, thus creating a new threat—bio-terror. In modern history there were two documented bio-terror events as well as one accidental discharge from an army facility and other industrial exposures that resulted in human exposure to B. anthracis spores. These incidents demonstrate the power of B. anthracis spores as a bio-terror agent and the challenges that are associated with such release/use. In this chapter, we will use the published data regarding these events together with experimental data obtained from animal experiments, to discuss the challenges associated with the use of B. anthracis spores as a bio-terror agent and the ways to counteract them. We will go through the different challenges of patient diagnosis and treatment, discuss the challenges of monitoring the environment and decontamination. In addition we will describe the available forensic tools and discuss the challenges of identifying spore production prior to dissemination.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Hanna P. Anthrax pathogenesis and host response. Curr Top Microbiol Immunol. 1998;225:13–35.
Dixon TC, et al. Anthrax. N Engl J Med. 1999;341(11):815–26.
Sitali DC, et al. Awareness and attitudes towards anthrax and meat consumption practices among affected communities in Zambia: a mixed methods approach. PLoS Negl Trop Dis. 2017;11(5):e0005580.
Sirisanthana T, Brown AE. Anthrax of the gastrointestinal tract. Emerg Infect Dis. 2002;8(7):649–51.
Owen JL, Yang T, Mohamadzadeh M. New insights into gastrointestinal anthrax infection. Trends Mol Med. 2015;21(3):154–63.
Brachman PC. Inhalation anthrax. Ann N Y Acad Sci. 1980;353:11.
Spencer RC. Bacillus anthracis. J Clin Pathol. 2003;56(3):182–7.
Okinaka RT, Keim P. The Phylogeny of Bacillus cereus sensu lato. Microbiol Spectr. 2016;4(1):TBS-0012-2012.
Ganz HH, et al. Interactions between Bacillus anthracis and plants may promote anthrax transmission. PLoS Negl Trop Dis. 2014;8(6):e2903.
Liu S, Moayeri M, Leppla SH. Anthrax lethal and edema toxins in anthrax pathogenesis. Trends Microbiol. 2014;22(6):317–25.
Fouet A. The surface of Bacillus anthracis. Mol Asp Med. 2009;30(6):374–85.
Moayeri M, Leppla SH. Cellular and systemic effects of anthrax lethal toxin and edema toxin. Mol Asp Med. 2009;30(6):439–55.
Szablewski CM, et al. Anthrax cases associated with animal-hair shaving brushes. Emerg Infect Dis. 2017;23(5):806–8.
Dahlgren CM, et al. Bacillus anthracis aerosols in goat hair processing mills. Am J Hyg. 1960;72:24–31.
Kissling E, et al. B. anthracis in a wool-processing factory: seroprevalence and occupational risk. Epidemiol Infect. 2012;140(5):879–86.
Glassman HN. Discussion. Bacteriol Rev. 1966;30(3):657–9.
Druett HA, et al. Studies on respiratory infection: II. The influence of aerosol particle size on infection of the guinea-pig with Pasteurella pestis. J Hyg. 1956;54(1):37–48.
WHO. Anthrax in humans and animals. World Health Organization, 2008.
Schmitt K, Zacchia NA. Total decontamination cost of the anthrax letter attacks. Biosecur Bioterror. 2012;10(1):98–107.
Meselson M, et al. The Sverdlovsk anthrax outbreak of 1979. Science. 1994;266(5188):1202–8.
Consequences of alleged 1979 Sverdlovsk Anthrax outbreak explored, 1990.
Keim P, et al. Molecular investigation of the Aum Shinrikyo anthrax release in Kameido, Japan. J Clin Microbiol. 2001;39(12):4566–7.
Jernigan DB, et al. Investigation of bioterrorism-related anthrax, United States, 2001: epidemiologic findings. Emerg Infect Dis. 2002;8(10):1019–28.
Dull PM, et al. Bacillus anthracis aerosolization associated with a contaminated mail sorting machine. Emerg Infect Dis. 2002;8(10):1044–7.
Justice, T.U.S.D.o., Amerithrax investigative summary, T.U.S.D.o. Justice, Editor, 2010; p. 96.
Brookmeyer R, Blades N. Prevention of inhalational anthrax in the U.S. outbreak. Science. 2002;295(5561):1861.
Jernigan JA, et al. Bioterrorism-related inhalational anthrax: the first 10 cases reported in the United States. Emerg Infect Dis. 2001;7(6):933–44.
Heller MB, et al. Laboratory response to anthrax bioterrorism, New York City, 2001. Emerg Infect Dis. 2002;8(10):1096–102.
Council NR. Reopening public facilities after a biological attack: a decision making framework, vol. 224. Washington, DC: The National Academies Press; 2005.
CDC. Anthrax. Available from: https://www.cdc.gov/anthrax/index.html
Abramova FA, et al. Pathology of inhalational anthrax in 42 cases from the Sverdlovsk outbreak of 1979. Proc Natl Acad Sci USA. 1993;90(6):2291–4.
Goossens PL. Animal models of human anthrax: The Quest for the Holy Grail. Mol Asp Med. 2009;30(6):467–80.
Welkos S, et al. Animal models for the pathogenesis, treatment, and prevention of infection by Bacillus anthracis. Microbiol Spectr. 2015;3(1):TBS-0001-2012.
Beasley DWC, Brasel TL, Comer JE. First vaccine approval under the FDA animal rule. NPJ Vaccines. 2016;1:16013.
Kobiler D, et al. Protective antigen as a correlative marker for anthrax in animal models. Infect Immun. 2006;74(10):5871–6.
Twenhafel NA. Pathology of inhalational anthrax animal models. Vet Pathol. 2010;47(5):819–30.
Levy H, et al. The central nervous system as target of Bacillus anthracis toxin independent virulence in rabbits and guinea pigs. PLoS One. 2014;9(11):e112319.
Vasconcelos D, et al. Pathology of inhalation anthrax in cynomolgus monkeys (Macaca fascicularis). Lab Investig. 2003;83(8):1201–9.
Vietri NJ, et al. A short course of antibiotic treatment is effective in preventing death from experimental inhalational anthrax after discontinuing antibiotics. J Infect Dis. 2009;199(3):336–41.
Altboum Z, et al. Postexposure prophylaxis against anthrax: evaluation of various treatment regimens in intranasally infected guinea pigs. Infect Immun. 2002;70(11):6231–41.
Weiss S, et al. Efficacy of single and combined antibiotic treatments of anthrax in rabbits. Antimicrob Agents Chemother. 2015;59(12):7497–503.
Weiss S, et al. Antibiotics cure anthrax in animal models. Antimicrob Agents Chemother. 2011;55(4):1533–42.
Boyer AE, et al. Detection and quantification of anthrax lethal factor in serum by mass spectrometry. Anal Chem. 2007;79(22):8463–70.
Gates-Hollingsworth MA, et al. Immunoassay for capsular antigen of Bacillus anthracis enables rapid diagnosis in a rabbit model of inhalational anthrax. PLoS One. 2015;10(5):e0126304.
CDC, Anthrax (Bacillus anthracis) 2010 Case Definition 2010, CDC.
Quinn CP, et al. Specific, sensitive, and quantitative enzyme-linked immunosorbent assay for human immunoglobulin G antibodies to anthrax toxin protective antigen. Emerg Infect Dis. 2002;8(10):1103–10.
Hendricks KA, et al. Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis. 2014;20(2)
Turnbull PCB, et al. MICs of selected antibiotics for Bacillus anthracis, Bacillus cereus, Bacillus thuringiensis, and Bacillus mycoides from a range of clinical and environmental sources as determined by the etest. J Clin Microbiol. 2004;42(8):3626–34.
Heine HS, et al. Evaluation of combination drug therapy for treatment of antibiotic-resistant inhalation anthrax in a murine model. Antimicrob Agents Chemother. 2017;61(9)
EPA, multiple daily low-dose Bacillus anthracis Ames inhalation exposures in the rabbit, T.U.S.E.P. Agency, Editor. 2012.
Henning LN, et al. Development of an inhalational Bacillus anthracis exposure therapeutic model in cynomolgus macaques. Clin Vaccine Immunol. 2012;19(11):1765–75.
Friedlander AM, et al. Postexposure prophylaxis against experimental inhalation anthrax. J Infect Dis. 1993;167(5):1239–43.
Bresnitz EA. Lessons learned from the CDC’s post-exposure prophylaxis program following the anthrax attacks of 2001. Pharmacoepidemiol Drug Saf. 2005;14(6):389–91.
Knudson GB. Treatment of anthrax in man: historical and current concepts. U.S.A.M.R.I.o.I. Diseases, Editor. 1985.
Pillai SK, et al. Antimicrobial treatment for systemic anthrax: analysis of cases from 1945 to 2014 identified through a systematic literature review. Health Secur. 2015;13(6):355–64.
Riedel S. Anthrax: a continuing concern in the era of bioterrorism. Proc (Bayl Univ Med Cent). 2005;18(3):234–43.
Bower WA, et al. Clinical framework and medical countermeasure use during an anthrax mass-casualty incident. MMWR Recomm Rep. 2015;64(4):1–22.
Cunha AB. Anthrax treatment & management. Medscape, 2016.
Xu W, et al. A systematic review and meta-analysis of preclinical trials testing anti-toxin therapies for B. anthracis infection: a need for more robust study designs and results. PLoS One. 2017;12(8):e0182879.
Glinert I, et al. Revisiting the concept of targeting only Bacillus anthracis toxins as a treatment for anthrax. Antimicrob Agents Chemother. 2016;60(8):4878–85.
CDC. Update: investigation of bioterrorism-related anthrax and interim guidelines for clinical evaluation of persons with possible anthrax, in MMWR. Centers for disease control and prevention, 2001; p. 8.
Greene CM, et al. Epidemiologic investigations of bioterrorism-related anthrax, New Jersey, 2001. Emerg Infect Dis. 2002;8(10):1048–55.
CCR. Anthrax in America: a chronology and analysis of the fall 2001 attacks. Center for Counterproliferation Research; 2002.
Pile JC, et al. Anthrax as a potential biological warfare agent. Arch Intern Med. 1998;158(5):429–34.
CDC, Sentinel level clinical microbiology laboratory guidelines for suspected agents of bioterrorism and emerging infectious diseases – Bacillus anthracis 2010.
Ozanich RM, et al. Evaluation of PCR systems for field screening of Bacillus anthracis. Health Secur. 2017;15(1):70–80.
Bartholomew RA, et al. Evaluation of immunoassays and general biological indicator tests for field screening of Bacillus anthracis and Ricin. Health Secur. 2017;15(1):81–96.
Riojas MA, et al. Multiplex PCR for species-level identification of Bacillus anthracis and detection of pXO1, pXO2, and related plasmids. Health Secur. 2015;13(2):122–9.
Koczula KM, Gallotta A. Lateral flow assays. Essays Biochem. 2016;60(1):111–20.
Fisher M, et al. A combined immunomagnetic separation and lateral flow method for a sensitive on-site detection of Bacillus anthracis spores – assessment in water and dairy products. Lett Appl Microbiol. 2009;48(4):413–8.
Tetracore. BioThreat Alert® Reader. Available from: http://www.tetracore.com/bio-warfare/index.html
Weis CP, et al. Secondary aerosolization of viable Bacillus anthracis spores in a contaminated US Senate Office. JAMA. 2002;288(22):2853–8.
Ferrari N, et al. Bone marrow-derived, endothelial progenitor-like cells as angiogenesis-selective gene-targeting vectors. Gene Ther. 2003;10(8):647–56.
Council NR. Review of the scientific approaches used during the FBI’s investigation of the 2001 anthrax letters. Washington, DC: The National Academies Press, 2011; p. 232.
GAO. Capitol Hill Anthrax Incident, C.o.F. Report to the Chairman, U.S. Senate, Editor, 2003.
EPA. Federal on-scene coordinator’s report for the Capitol Hill Site Washington, DC, P. United States Environmental Protection Agency Region 3 Philadelphia, Editor, 2002.
Office, U.S.G.A., Capitol hill anthrax incident EPA’s cleanup was successful; opportunities exist to enhance contract oversight, C.o.F. Report to the Chairman, U.S. Senate, Editor, 2003.
Canter DA. Addressing residual risk issues at anthrax cleanups: how clean is safe? J Toxicol Environ Health A. 2005;68(11–12):1017–32.
Brief, E.t., review of Bacillus anthracis (anthrax) studies for dose-response modeling to estimate risk, U.S.E.P. Agency, Editor, 2012.
Brachman PS, et al. An epidemic of inhalation anthrax: The first in the twentieth century epidemiology. Am J Epidemiol. 1960;72(1):6–23.
Medicine, I.o., Prepositioning antibiotics for anthrax, ed. C. Stroud, et al. Washington, DC: The National Academies Press, 2012; p. 358.
PriMED, Anthrax – Russia (10): (Yamal-Nenets) Human, Reindeer Vaccinated, 2016.
illumina, An introduction to next-generation sequencing technology.
Rasko DA, et al. Bacillus anthracis comparative genome analysis in support of the Amerithrax investigation. Proc Natl Acad Sci USA. 2011;108(12):5027–32.
Sammon C, et al. A survey of use of the emergency department during a local public health crisis. Ann Emerg Med. 2002;40(2):1.
Keim P, et al. The genome and variation of Bacillus anthracis. Mol Asp Med. 2009;30(6):397–405.
ProMED, Anthrax – Kenya: foiled anthrax attack, suspected Islamic State, 2016.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Ethics declarations
The opinions, conclusions, and recommendations expressed or implied within are solely those of the authors and do not necessarily represent the views of the Israel Institute for Biological research, or any other Israeli Government agency.
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Levy, H. et al. (2019). Challenges Associated with Bacillus anthracis as a Bio-threat Agent. In: Singh, S., Kuhn, J. (eds) Defense Against Biological Attacks. Springer, Cham. https://doi.org/10.1007/978-3-030-03071-1_5
Download citation
DOI: https://doi.org/10.1007/978-3-030-03071-1_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-03070-4
Online ISBN: 978-3-030-03071-1
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)