Inhalation anthrax is so rare that very few doctors have ever seen it.
Anthrax is caused by a bacterium, Bacillus anthracis, and is transmitted by spores that can enter the body in three ways: it can be inhaled, ingested or can enter the skin through a scratch or cut.
Inhalational anthrax is extremely rare in nature and by far is the most deadly form of the disease. This is the form that
infected the man who died in Florida. Only 18 cases were reported in the United States in the 20th century. So, for most of the healthcare professionals are not familiar as to how to treat the outbreak caused by the current terrorist attack with biological weapons.
Much of what is known about how the disease progresses was learned from a single outbreak, in the Soviet Union in 1979. An accidental release of anthrax spores that were being grown in a germ warfare laboratory on a military base in Sverdlovsk, Russia infected 79 people at once. Sixty-eight of them died. Autopsies were performed on 42.
The disease starts when a person inhales spores into the lung. Once there, the spores travel to lymph nodes in the mediastinum, in the middle of the chest. This journey can take just a few hours. There, in the lymph nodes, in a process that can take anywhere from days to weeks, the spores in the lymph nodes turn into anthrax bacteria, which begin producing deadly toxins that attack body tissues. Because the timing of this germination process can vary, it is hard to know until about 60 days have passed if a person who inhales the spores has the disease. However, as we know from the case of the postal worker who died a short time after inhaling the anthrax spore mailed to Sen, Dashle, the terrorists can manipulate the packaging of the bacteria in such a way that it can attack faster and can lead to death in a shorter period of time.
Once the spores germinate, it does not take long for symptoms to appear. They are caused by the toxins, which kill cells and cause fluids to accumulate in tissues.
The first symptoms are fever, cough, headache, vomiting and chills. These resemble the symptoms of flu. But within hours to a few days, the disease enters a second phase. The victims have trouble breathing because their lungs are compressed by fluid in the mediastinum. They sweat profusely and go into shock because their blood vessels leak and their blood pressure drops. About half the patients have blood-filled fluid in the tissue covering their brains, which compresses the brain, causing coma and delirium. Once the second phase begins, death can occur within hours.
According to doctors who have examined the autopsy records of the Russian victims, the disease is very distinctive and leave its own hallmark on the victim. Beneath a victim's skull, the lining of the brain is filled with blood. Some pathologists call this, "the cardinal's cap."
The blood-filled fluid in the mediastinum, the tissue in the middle of the chest, shows that the victim has met death from anthrax.
Because there are so few cases of human anthrax, little is known about treating people who are exposed to it. But experiments with animals have provided some clues.
A wide variety of antibiotics, like penicillin and doxycycline as well as ciprofloxacin and other antibiotics in its class — the fluoroquinolones — can kill anthrax bacteria.
But like any bacteria, Bacillus anthracis may develop immunity to some antibiotics and hence the scientists need to culture the bacteria and then test which antibiotic work best on the strain presented. The anthrax sent to the media outlets in New York responded well to penicillin; however, the one sent to Sen. Dashle in
Washington was a more refined and deadly kind.
Ciprofloxacin is the only drug identified by the Food and Drug Administration as an anthrax treatment. It is a preferred antibiotic as it acts more broadly than penicillin; however, it also has more severe side reactions. In general, the doctors like to treat you with the lowest possible antibiotic in the chain so that the strain won't develop immunity to the best antibiotic. However, when they work against time, as in the case of deadly inhalation anthrax, the tendency is to go for the most effective
Whatever antibiotic is used, it is important that they are given before symptoms appear. By the time a person is ill, the bacteria have already released large quantities of their deadly toxins into the body. Experts have recommended treating people with symptoms of anthrax who may have been exposed to anthrax for 60 days.
See Also: There
May Not Be "A Safe Dose for Anthrax Exposure"