Systemic anthrax

Suggested Alternatives for Differential Diagnosis Anthrax, tetanus, rabies, meningitis, encephalitis, cerebral trypanosomiasis, piroplasmosis, theileriosis, listeriosis, parasitism poisoning by strychnine, lead, organophosphates, arsenic, and various plants that affect the central nervous system. 

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Anthrax Attacks — Soon after September 11, 2001, terrorists began sending envelopes containing anthrax spores through the U.S. mail system. The envelopes were mailed to NBC and CBS television stations, The New York Post, Senator Tom Daschle s office, the State Department, and other locations. As of November 21, 2001, 37 individuals had been exposed to anthrax 13 were infected and 5 eventually died. The FBI is still trying to determine who was responsible for these attacks. 

Depending on the route of exposure to this biological agent, the exposed person may experience inhalation anthrax, cutaneous anthrax, or gastrointestinal anthrax. Any one of these forms can be complicated by meningitis occurring in about 5% of cases when anthrax bacilli enter the central nervous system via the bloodstream and eventually reach the blood-brain barrier. 

Actually, before the Oklahoma City bombing, the anthrax attacks, and 9/11, OSHA and USEPA had already taken the initial steps to ensure safety and security in chemical production facilities and in other facilities that use, produce, or store listed chemicals. These steps were listed in OSHA s Process Safety Management (PSM) Standard and USEPA s Risk Management Program (RMP). Based on personal experience, having conducted VAs and modified VAs (wastewater) on both water and wastewater systems and having implemented RMP in a major U.S. wastewater system, we have to concur that these initial safety/security steps were quite effective. 

The LF is the most disruptive to cellular functions and disables intracellular signaling molecules. It prevents macrophages from releasing tumor necrosis factor (TNF) and interleukin cytokines, although the production of TNF and cytokines in the macrophages is not impeded. The host s immune system is compromised and is unable to eliminate the anthrax bacillus. 

Third, as the anthrax vaccine experience reveals, both DoD acquisition personnel and the contractors hired by DoD have not always possessed the technical and managerial expertise for working with FDA. Interactions with FDA, especially in licensing-related efforts, involve a complicated three-way relationship among DoD, the private contractor, and FDA. This relationship is quite unlike either the two-way relationship between DoD and defense contractors involved in the procurement of weapon systems or the two-way interaction between FDA and a private drug firm. The policy and operational issues about how to manage these three-way relationships have yet to be worked out. 

Sloat, B. R., and Zhengrong, C. (2006), Strong mucosal and systemic immunities induced by nasal immunization with anthrax protective antigen protein incorporated in lipo-some-protamine-DNA particles, Pharm. Res., 23,262-269. 

The events of 9/11 and subsequent anthrax attacks underscored the need for U.S. health care organizations and public health agencies to be prepared to respond to acts of bioterrorism and other public health emergencies. Many states and health care organizations and systems have developed preparedness plans that include enhancing surge capacity to respond to such events. 

In 2001, 11 people in the United States were diagnosed with confirmed or probable cases of cutaneous anthrax (Inglesby et al., 2002). One of these victims was a 7-month-old infant, who probably contracted the spores at his mother s workplace (Freedman et al., 2002). The previously healthy infant experienced severe systemic illness, despite early antibiotic therapy and hospitalization that included microangiopathic hemolytic anemia with renal involvement, coagulopathy, and hyponatremia (Freedman et al., 2002). The patient was hospitalized for 17 days, and his symptoms resolved 30 days after admission (Freedman et al., 2002). Fortunately, the infant survived. 

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