著者: Tanja Popović, Mindy Glass
雑誌名: Croat Med J. 2003 Jun;44(3):336-41.
Abstract/Text
During the bioterrorism-associated anthrax investigation of 2001 in the United States, 11 patients were diagnosed with inhalational anthrax and 11 more with the cutaneous forms of the disease. Over 125,000 specimens were processed at laboratories of the Laboratory Response Network including those at the Centers for Disease Control and Prevention. Although the 2001 anthrax investigation initially began as a public health investigation, the forensic aspect quickly became a preeminent component of the investigation. Whereas a public health investigation aims primarily to identify the causative agent and its source, so that appropriate and timely control and preventative measures can be implemented, a forensic investigation goes further to associate the source of the causative agent with a specific individual or group. In addition to identification and molecular characterization of the causative agents, which are the crucial components of forensic microbiology, there are many other requirements and activities that need to be in place for investigators to successfully complete a forensic investigation. These activities include establishment of quality assurance/quality control criteria and regular proficiency testing for all laboratories where evidence is analyzed; additional and/or specialized training in handling and processing samples in accordance with forensic microbiology criteria, not only for first responders but also for laboratory and other public health scientists; and establishing and maintaining repositories and databases containing isolates of diverse temporal and geographic origins to provide a comparative and diverse background for investigators to identify and track the origin and source of such agents.
PMID
12808729 Croat Med J. 2003 Jun;44(3):336-41.
著者: Wan-Jun Chen, Sheng-Jie Lai, Yang Yang, Kun Liu, Xin-Lou Li, Hong-Wu Yao, Yu Li, Hang Zhou, Li-Ping Wang, Di Mu, Wen-Wu Yin, Li-Qun Fang, Hong-Jie Yu, Wu-Chun Cao
雑誌名: PLoS Negl Trop Dis. 2016 Apr;10(4):e0004637. doi: 10.1371/journal.pntd.0004637. Epub 2016 Apr 20.
Abstract/Text
BACKGROUND: Anthrax, a global re-emerging zoonotic disease in recent years is enzootic in mainland China. Despite its significance to the public health, spatiotemporal distributions of the disease in human and livestock and its potential driving factors remain poorly understood.
METHODOLOGY/PRINCIPAL FINDINGS: Using the national surveillance data of human and livestock anthrax from 2005 to 2013, we conducted a retrospective epidemiological study and risk assessment of anthrax in mainland China. The potential determinants for the temporal and spatial distributions of human anthrax were also explored. We found that the majority of human anthrax cases were located in six provinces in western and northeastern China, and five clustering areas with higher incidences were identified. The disease mostly peaked in July or August, and males aged 30-49 years had higher incidence than other subgroups. Monthly incidence of human anthrax was positively correlated with monthly average temperature, relative humidity and monthly accumulative rainfall with lags of 0-2 months. A boosted regression trees (BRT) model at the county level reveals that densities of cattle, sheep and human, coverage of meadow, coverage of typical grassland, elevation, coverage of topsoil with pH > 6.1, concentration of organic carbon in topsoil, and the meteorological factors have contributed substantially to the spatial distribution of the disease. The model-predicted probability of occurrence of human cases in mainland China was mapped at the county level.
CONCLUSIONS/SIGNIFICANCE: Anthrax in China was characterized by significant seasonality and spatial clustering. The spatial distribution of human anthrax was largely driven by livestock husbandry, human density, land cover, elevation, topsoil features and climate. Enhanced surveillance and intervention for livestock and human anthrax in the high-risk regions, particularly on the Qinghai-Tibetan Plateau, is the key to the prevention of human infections.
PMID
27097318 PLoS Negl Trop Dis. 2016 Apr;10(4):e0004637. doi: 10.13･･･
著者: M N Swartz
雑誌名: N Engl J Med. 2001 Nov 29;345(22):1621-6. doi: 10.1056/NEJMra012892. Epub 2001 Nov 6.
Abstract/Text
PMID
11704686 N Engl J Med. 2001 Nov 29;345(22):1621-6. doi: 10.1056/･･･
著者: Eric Jacob Stern, Kristin Broome Uhde, Sean Vincent Shadomy, Nancy Messonnier
雑誌名: Emerg Infect Dis. 2008 Apr;14(4). doi: 10.3201/eid1404.070969.
Abstract/Text
On March 13-14, 2006, a meeting on anthrax, sponsored by the Centers for Disease Control and Prevention (CDC) in collaboration with the Southeastern Center for Emerging Biologic Threats, was held at Emory University in Atlanta, Georgia, USA. The meeting's agenda included discussion of postexposure prophylaxis (PEP), screening and evaluation, and treatment of the various manifestations of human anthrax. The goal was to convene subject matter experts for a review of research developments and clinical experience with anthrax prophylaxis and treatment and to make consensus recommendations for updating guidelines for PEP, treatment, and clinical evaluation of patients with anthrax. A 2001 conference on guidelines for anthrax has previously been summarized in this journal. This article summarizes the meeting's presentations and discussion. Consensus recommendations are summarized in the Table. Updated CDC guidelines for treatment and prophylaxis of anthrax will be published in detail in other CDC publications and are available on CDC's website at http://www.bt.cdc.gov/agent/anthrax/index.asp.
PMID
18394267 Emerg Infect Dis. 2008 Apr;14(4). doi: 10.3201/eid1404.･･･
著者: Nicholas E Kman, Richard N Nelson
雑誌名: Emerg Med Clin North Am. 2008 May;26(2):517-47, x-xi. doi: 10.1016/j.emc.2008.01.006.
Abstract/Text
The terrorist attacks on the United States in 2001 and the anthrax release soon after brought the issue of bioterrorism to the forefront in the medical community. Bioterrorism is the use of a biologic weapon to create terror and panic. Biologic weapons, or bioweapons, can be bacteria, fungi, viruses, or biologic toxins. Because the emergency department represents the front line of defense for the recognition of agents of bioterrorism, it is essential that emergency physicians have the ability to quickly diagnose victims of bioterrorism. This review examines the most deadly and virulent category A agents of bioterrorism, that is, anthrax, smallpox, plague, botulism, hemorrhagic fever viruses, and tularemia. The focus is on epidemiology, transmission, clinical manifestations, diagnosis, and treatment.
PMID
18406986 Emerg Med Clin North Am. 2008 May;26(2):517-47, x-xi. d･･･
著者: Charles E Binkley, Sandro Cinti, Diane M Simeone, Lisa M Colletti
雑誌名: Ann Surg. 2002 Jul;236(1):9-16.
Abstract/Text
OBJECTIVE: To familiarize surgeons with the specific complications of cutaneous, gastrointestinal, inhalation, and systemic infection with Bacillus Anthracis, which may require surgical treatment.
SUMMARY BACKGROUND DATA: The recent cases of intentional exposure to Bacillus Anthracis in the United States make familiarity with the basic microbiology, clinical manifestations, diagnosis, treatment, and control of this disease essential if mortality and morbidity is to be minimized, particularly following mass exposure. Although the treatment of Bacillus Anthracis infection is primarily medical, there are specific surgical complications with which the surgeon should be familiar.
METHODS: A review of the literature was undertaken, utilizing electronic databases on infection with Bacillus Anthracis, as well as consultation with experts in this field. Emphasis was placed on the diagnosis and treatment of complications of infection that might require surgical intervention.
RESULTS: Cutaneous anthrax infection results in eschar formation and massive soft tissue edema. When involving the extremities, increased compartment pressure requiring fasciotomy may result. Primary infection of the gastrointestinal tract may result in oropharyngeal edema and respiratory compromise requiring a surgical airway. Direct involvement of the lower gastrointestinal tract can result in intestinal ulceration, necrosis, bleeding, and perforation, which would require surgical exploration and resection of affected segments. Systemic sepsis, most often associated with inhalation anthrax, can cause massive ascites, electrolyte derangements, and profound shock requiring aggressive fluid resuscitation and careful hemodynamic monitoring and respiratory support. Systemic anthrax infection can also lead to gastrointestinal involvement by hematogenous dissemination, resulting in complications and requiring surgical management similar to direct gastrointestinal infection.
CONCLUSIONS: Cutaneous, gastrointestinal, inhalation and systemic infection with Bacillus Anthracis can result in complications which would require familiarity with the pathogenesis and manifestations of this disease in order to recognize and treat promptly and successfully by surgical intervention.
PMID
12131080 Ann Surg. 2002 Jul;236(1):9-16.
著者: Caitlin W Hicks, Daniel A Sweeney, Xizhong Cui, Yan Li, Peter Q Eichacker
雑誌名: Intensive Care Med. 2012 Jul;38(7):1092-104. doi: 10.1007/s00134-012-2541-0. Epub 2012 Apr 24.
Abstract/Text
PURPOSE: Bacillus anthracis infection (anthrax) can be highly lethal. Two recent outbreaks related to contaminated mail in the USA and heroin in the UK and Europe and its potential as a bioterrorist weapon have greatly increased concerns over anthrax in the developed world.
METHODS: This review summarizes the microbiology, pathogenesis, diagnosis, and management of anthrax.
RESULTS AND CONCLUSIONS: Anthrax, a gram-positive bacterium, has typically been associated with three forms of infection: cutaneous, gastrointestinal, and inhalational. However, the anthrax outbreak among injection drug users has emphasized the importance of what is now considered a fourth disease form (i.e., injectional anthrax) that is characterized by severe soft tissue infection. While cutaneous anthrax is most common, its early stages are distinct and prompt appropriate treatment commonly produces a good outcome. However, early symptoms with the other three disease forms can be nonspecific and mistaken for less lethal conditions. As a result, patients with gastrointestinal, inhalational, or injectional anthrax may have advanced infection at presentation that can be highly lethal. Once anthrax is suspected, the diagnosis can usually be made with gram stain and culture from blood or tissue followed by confirmatory testing (e.g., PCR). While antibiotics are the mainstay of anthrax treatment, use of adjunctive therapies such as anthrax toxin antagonists are a consideration. Prompt surgical therapy appears to be important for successful management of injectional anthrax.
PMID
22527064 Intensive Care Med. 2012 Jul;38(7):1092-104. doi: 10.10･･･
