What is anthrax?
In medical microbiology jargon, Bacillus anthracis is a "large, nonmotile, encapsulated, chain-forming, aerobic, gram-positive rod that forms oval spores" . Large is of course a relative term and in this case it means that the boxcar-shaped bacteria is 1 to 1.5 microns by 4 to 10 microns in size. The bacteria requires oxygen to make spores but not for the spores to grow once they have seeded. The spores can survive in dirt for years, but are destroyed after boiling in water for ten minutes, or after treating with an oxidizing agent, such as hydrogen peroxide. The Gram stain is a way for microbiologists to classify bacteria. Gram-positive simply means that under a microscope, the bacterium appears blue after the Gram stain has been applied.
Anthrax can be found worldwide among domestic and wild herbivores, most notably cattle, sheep, horses, and goats. In humans there are three ways in which anthrax can present. It can be acquired through the skin via cuts, abrasions, or biting flies that have contacted an infected animal, or from direct handling of the animal or its carcass. This is known as cutaneous anthrax. Gastrointestinal anthrax, which is very rare, is from eating b. anthracis contaminated meat. Inhalation anthrax, also known as woolsorter's disease, is associated with industrial exposure to hides, goat's hair, wool, or bones. Inhalation anthrax has been implicated in the Florida attacks, and it is the feared mode of delivery in terrorist attacks.
Anthrax kills via the anthrax toxin that it makes. This toxin is made up of three proteins, The first protein is known as protective antigen (PA), which is cleaved into two by a cellular protease. The larger fragment of PA binds to the cell membranes of the target cell that the bacterium is trying to damage. This fragment then acts as a receptor for the other two toxin proteins, edema factor (EF) and lethal factor (LF), to enter the cell. Edema factor is responsible for the skin lesions of cutaneous anthrax and also turns off polymorphonuclear leukocytes, inhibiting the immune response. Lethal factor kills the unfortunate target cell by an unknown mechanism.
Oh My God, Do I Have Anthrax?
Inhalation anthrax is very difficult to distinguish from any severe viral respiratory illness, such as the flu (cause by the influenza virus). A person may have a flu-like syndrome of fever, muscle pain, shortness of breath, and low blood pressure for one to six days flowing exposure. Then there is a brief period of improvement followed by extreme worsening of symptoms, which can include chest pain, severe shortness of breath, sweating, coughing up of blood, and cyanosis, which is the "blueing" of the lips and extremities from lack of oxygen. After the onset of respiratory distress, death usually comes within 24 hours. Mortality is from 80 to 100%.
The bacteria can be easily tested for at a hospital. An x-ray of the chest shows certain characteristics that can also help make the diagnosis. The strain in Florida is sensitive to penicillin and can be treated with a number of different antibiotics.
Anthrax is not readily contagious. The fact that two individuals working at the same place have tested positive for anthrax, and the fact that is was found on the computer of one individual indicates criminal activity.
Anthrax in biological warfare: Japan's Unit 731 and Sverdlovsk
Biological warfare has an extensive history. During WWII, both Germany and Japan were known to have had invested in biological warfare capabilities. Germany was thought to have "operated under very restrictive orders, formally forbidding all offensive research" .
Japan, blinded by fascism, participated in the utterly horrifying experiments at Unit 731, a Japanese military installation in China from 1937 to 1945. These experiments warrant their own article on kuro5hin. Studies were performed on thousands of Chinese individuals using anthrax, typhoid, cholera, the plague, and other pathogens. Estimates of the number killed are between 5,000 and 10,000. Victims were often dissected alive. The unit was ordered burned to the ground at the end of WWII, and logs of the experiments were destroyed. In a horrendous development following the close of World War II, "US military officials bartered the cancellation of all charges of war crimes against the administrators of the Japanese WWII BW [biological warfare] program in exchange for the tissue pathology data from Japanese experiments with BW agents on human subjects" . Much of this data later turned out to be academically useless. The existence of these experiments was not acknowledged by Japan until an August 1998 Supreme Court ruling, which stated that these experiments were well known in academic circles.
[As an aside, I did not know about Unit 731 until a briefing I had this morning. As an American, I want to express my shame and embarrassment at the actions of my government at that point in history.]
In 1979, 64 people died of an anthrax outbreak in Sverdlovsk (now called Ekaterinburg) in the former Soviet Union. Initially, Soviet officials claimed that it was caused by cutaneous and gastrointestinal anthrax from exposure to infected animals. In fact it was later found that most of the cases were inhalation anthrax from a nearby military installation. The majority of sources indicate that it was an explosion at the facility that set off a huge plume of anthrax over the neighboring area.
The effectiveness of anthrax as a biological weapon
One important conclusion can be drawn from Unit 731 and the Soviet anthrax gaff, which is that anthrax is very difficult to use as a biological weapon, and only with limited results. In both cases large amounts of anthrax were released on the population with a proportionally small number of deaths. The bacterium does not aerosolize readily, and even in the Soviet accident, where a huge amount of anthrax was released into the air, relatively few were killed. At Unit 731, the Japanese likely discovered what is commonly known in bioterrorism circles, that the bacterium is for the most part destroyed by the heat of a bomb explosion. Further frustrating efforts to use it in bioterrorism is the large titer needed to give somebody inhalation anthrax. Some thousands of spores have to be inhaled before a person becomes ill.
For the large part, the claims on some news sources that millions of people could die if it is released in Washington are simply not true. There is no known effective means of distributing enough bacteria to that many people.
The media sensationalism of this anthrax outbreak is feeding into the FUD of terrorism. Now don't get me wrong, the people immediately exposed, including anybody who went into that Boca Raton building, should receive their doses of ciprofloxacin and be tested for anthrax. Also, if a bag of anthrax were to be dropped at Grand Central Station, everybody who goes through it that day are at high-risk and should be treated. Also, if you are ill with flu-like symptoms and for some reason suspect somebody might have poisoned you with anthrax, don't just sit around in your circa-1980s Anthrax T-shirt and read k5, go to your ER. Flu season officially starts in November.
This being said, there is no reason to be stockpiling antibiotics or to be locking yourself in your house, as individuals in Boca Raton, Florida are doing. This is the exactly the equivalent of being one of the people who decided to go live in a cave and stockpile guns and canned beans for a few weeks during the whole Y2K scare. It is completely uncalled for and is playing into the hands of the terrorists, regardless of whether or not they are behind these attacks.
Anthrax is psychological warfare.
As I stated in the introductory paragraph, the most potentially devastating consequence of an anthrax attack is psychological and economic. If people begin to stay indoors at all times and stockpile antibiotics, the economy will suffer and there will be an antibiotic shortage. The natural flora of infectious diseases will change because of massive numbers of people taking antibiotics they don't need and building up resistance among more common diseases that we actually do have. People will begin suffering the relatively rare side effects of some of the stronger antibiotics, such as tendonitis, and there would end up being more sick people than with just an anthrax attack, not to mention a poorer economy to boot. This would be disastrous and far more damaging than the limited scale of an anthrax attack.
I hope the New York Post article is not true, and I anticipate an increase in this anthrax FUD if more victims are found, or if a bigger anthrax attack occurs. Please, help to diminish the dangers of mass hysteria by telling people about what you learned here in this article. A more worthy cause to worry about is the genetic engineering of biological weapons more powerful than anthrax.
Who am I?
I am an NYU medical student. Due to these recent events, this morning we were given a briefing by an individual I will not name, who is incredibly respected in the medical field and was involved in the government Committee on Research and Development Needs for Improving Civilian Medical Response to Chemical and Biological Terrorism Incidents Response. I have attempted to provide citations via web links where I could, but some important facts about anthrax in biological warfare are distorted and not well known on the internet, and instead come from the doctors who spoke to us at the meeting. I have been instructed to pass on this knowledge to patients and friends of mine, some of who live in Florida. I am also passing this on to kuro5hin readers. I am obviously not a doctor yet, so do not take any of this as medical advice.
 Fauci et al. Harrison's Principles of Internal Medicine. pp. 897-899. New York: McGraw-Hill 1998.
 FAS.org - see link within article
 FAS.org - see link within article