Modified from N.Y. Dept. of Health Anthrax is Diagnosed: Day 10 Click for larger picture.

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Presentation transcript:

Modified from N.Y. Dept. of Health Anthrax is Diagnosed: Day 10 Click for larger picture

Anthrax as a Biological Weapon (JAMA. 1999; 281: ) Figure 4. Day of Onset of Inhalational Anthrax Following Sverdlovsk Accident Figure is based on data from Guillermin. 68

(JAMA. 1999; 281: ) This curve approximates that of the accumulated deaths more closely Anthrax is Diagnosed: Day 10 Click for larger picture

Lidia Tretyakova looks at the tombstone of her father, Lazar Karsayev, at a cemetery in Yekaterinburg, Russia, Thursday, Oct. 18, A mysterious outbreak of anthrax killed at least 68 people, including Karsayev, 22 years ago in the Russian industrial center of Sverdlovsk, today known as Yekaterinburg. At the time, neither the victims nor their families suspected they had been hit by a biological weapon.

Laboratory workers at the Sverdlovsk regional epedemiological service put on the special suits they wear when working with anthrax and other dangerous bacteria in Yekaterinburg, Russia, Wednesday, Oct. 17, 2001

A general view of the Stepnogorsk Scientific Experimental and Production Base (SEPB) in Stepnogorsk, 220 km (100 miles) northwest of Kazakstan's new capital of Astana, Monday, Oct. 22, The SEPB was the biggest anthrax-manufacturing plant in the world. (AP Photo)

Scientists work in an environmental monitoring laboratory of Stepnogorsk Scientific Experimental and Production Base (SEPB) in Stepnogorsk, 220 km ( 100 miles) northwest of Kazakstan's new capital of Astana, Monday, Oct. 22, The SEPB was the biggest anthrax-manufacturing plant in the world. (AP Photo)

J.A.M.A : Working Group on Civilian Biodefense Review of some Consensus guidelines

J.A.M.A : Working Group on Civilian Biodefense Click for larger picture

Ratified in MMWR : (Oct. 19, 2001) J.A.M.A : Working Group on Civilian Biodefense Click for larger picture

The recent Anthrax victims The victims of the recent terrorist use of anthrax bacilli started to appear in October On October 2 the spinal fluid of a patient in Miami showed large Gram positive bacilli, confirmed on October 4 as Bacillus anthracis

Ottilie Lundgren, 94 Inhaled Connecticut farm Died, Nov.21, 2001 List of recent bioterrorism- related Anthrax victims Inhalational Patients Recovered Died Norma Wallace, 56

More illustrations  Data mostly from Jernigan et al., Emerging Infectious Diseases, 7: , 2001 Patient No. 11 is not presented in the Jernigan series; the data appeared in the news. Click for larger picture

Timeline of 10 cases of inhalational anthrax in relation to onset of symptoms, October through November 2001 Jernigan et al., Emerging Infectious Diseases, 7: , 2001 Click for larger picture

Table 2, Jernigan et al., Emerging Infectious Diseases, 7:

Table 3, Jernigan et al., Emerging Infectious Diseases, 7: Click for larger picture

Initial chest X-ray, Case 1 – Prominent upper mediastinum

Gram stain, cerebrospinal fluid, Case 1  Clear diagnosis, Oct. 2, 2001

Chest X-ray, Case 2 – Diffuse consolidation, consistent with pneumonia of left lung No mediastinal widening

Computed tomography of chest, Case 2 Bilateral pulmonary consolidation and pleural effusioins

Chest X-ray, Case 7 – Mediastinal widening, left pleural effusion

Chest computed tomography, Case 7 – Mediastinal adenopathy, bilateral pleural effusions