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Galante D, Gainer RS, Hugh-Jones ME. Environmental relationships and anthrax epidemiology: field experiences of host resistance as opposed to dose-dependent experiments. Acta Trop 2024; 252:107128. [PMID: 38309609 DOI: 10.1016/j.actatropica.2024.107128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/10/2024] [Accepted: 01/21/2024] [Indexed: 02/05/2024]
Abstract
Even though anthrax is a disease of antiquity that has been studied for centuries, serious concerns have been raised about our understanding of its epidemiology. Since the 1960s, we have based the epidemiology of anthrax on the results of dose-dependent experiments, especially those involving cattle at that time. In this species the experiments demonstrated that the severity of infection was dependent upon the numbers of Bacillus anthracis spores ingested. The opinion was that ingesting only a few spores would be insufficient to cause an apparent infection; any infection that resulted would be latent (i.e., unrecognized). Based on the results of these experiments, it was accepted that the ingestion of large numbers of spores was the source of infection for hundreds of anthrax outbreaks. However, many investigations of both human and animal anthrax outbreaks have failed to identify sources of large numbers of spores, suggesting that these outbreaks are only rarely a consequence of ingestion or inhalation of large quantities of spores. This opinion piece builds upon the indirect evidence previously presented in an article focused on the existence of latent infections. Much of the evidence for the existence of latent infections was predicated upon a reduction of host resistance, which revealed how latent infections could be a source of more severe forms of the infection. That is, a latent infection can be the source of a severe infection, but the cause of the severe infection is the reduced host resistance. That first article concentrated on the arguments for latent infections, while this article concentrates on the arguments for host resistance. Host resistance is virtually impossible to measure objectively in the field. To provide a subjective measure of host resistance during anthrax outbreaks, we suggest the use of the opinions of livestock owners and or their veterinary practitioners and or field workers during investigations of anthrax outbreaks. When veterinary personal work in the field they are much like field biologists. In some ways field biologists better appreciate environmental factors, population ecology and other perspectives that are of use to epidemiologists. The more diverse the information the better the epidemiology is understood. To this effect we present our personal anecdotal and theoretical ideas from our experiences as well as a collection of bibliographic observations from others'. Our conclusions are that a combination of latent infections and reduced host resistance based on the host's relationship with its environment would better explain the epidemiology of severe infections in anthrax outbreaks for which large quantities of spores have not been located. This applies especially if the area has a history of the disease and/or if necropsies have shown the presence of latent infections in otherwise normal animals in the area and/or if environmental conditions are considered stressful and include intense insect activity.
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Affiliation(s)
- Domenico Galante
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Anthrax Reference Institute of Italy, Via Manfredonia 20, 71121, Foggia, Italy.
| | | | - Martin E Hugh-Jones
- Department of Environmental Sciences, College of the Coast and Environment, Louisiana State University, Baton Rouge, LA 70803-5705, USA
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2
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Hughes D, Lawrence W, Peel J, Rosan DW, Ling L, Niiti N, Aaron P, Shukla R, MacGillavry H, Heine H, Martha H, Elbert W, Weingarth M, Lewis K. A Resistance-Evading Antibiotic for Treating Anthrax. Res Sq 2024:rs.3.rs-3991430. [PMID: 38585816 PMCID: PMC10996807 DOI: 10.21203/rs.3.rs-3991430/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
The antimicrobial resistance crisis (AMR) is associated with millions of deaths and undermines the franchise of medicine. Of particular concern is the threat of bioweapons, exemplified by anthrax. Introduction of novel antibiotics helps mitigate AMR, but does not address the threat of bioweapons with engineered resistance. We reasoned that teixobactin, an antibiotic with no detectable resistance, is uniquely suited to address the challenge of weaponized anthrax. Teixobactinbinds to immutable targets, precursors of cell wall polymers. Here we show that teixobactinis highly efficacious in a rabbit model of inhalation anthrax. Inhaling spores of Bacillus anthracis causes overwhelming morbidity and mortality. Treating rabbits with teixobactinafter the onset of disease rapidly eliminates the pathogen from blood and tissues, normalizes body temperature, and prevents tissue damage. Teixobactinassembles into an irreversible supramolecular structure of the surface of B. anthracis membrane, likely contributing to its unusually high potency against anthrax. Antibiotics evading resistance provide a rational solution to both AMR and engineered bioweapons.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Kim Lewis
- Antimicrobial Discovery Center, Department of Biology, Northeastern University
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3
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Beliveau M, Rubets I, Bojan D, Hall C, Toth D, Kodihalli S, Kammanadiminti S. Animal-to-Human Dose Translation of ANTHRASIL for Treatment of Inhalational Anthrax in Healthy Adults, Obese Adults, and Pediatric Subjects. Clin Pharmacol Ther 2024; 115:248-255. [PMID: 38082506 DOI: 10.1002/cpt.3097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/25/2023] [Indexed: 01/23/2024]
Abstract
Anthrax Immune Globulin Intravenous (AIGIV [ANTHRASIL]), was developed for the treatment of toxemia associated with inhalational anthrax. It is a plasma product collected from individuals vaccinated with anthrax vaccine and contains antitoxin IgG antibodies against Bacillus anthracis protective antigen. A pharmacokinetic (PK) and exposure-response model was constructed to assess the PKs of AIGIV in anthrax-free and anthrax-exposed rabbits, non-human primates and anthrax-free humans, as well as the relationship between AIGIV exposure and survival from anthrax, based on available preclinical/clinical studies. The potential effect of anthrax on the PKs of AIGIV was evaluated and estimates of survival odds following administration of AIGIV protective doses with and without antibiotic co-treatment were established. As the developed PK model can simulate exposure of AIGIV in any species for any dosing scenario, the relationship between the predicted area under the concentration curve of AIGIV in humans and the probability of survival observed in preclinical studies was explored. Based on the simulation results, the intravenous administration of 420 U (units of potency as measured by validated Toxin Neutralization Assay) of AIGIV is expected to result in a > 80% probability of survival in more than 90% of the human population. Additional simulations suggest that exposure levels were similar in healthy and obese humans, and exposure in pediatrics is expected to be up to approximately seven-fold higher than in healthy adults, allowing for doses in pediatric populations that ranged from one to seven vials. Overall, the optimal human dose was justified based on the PK/pharmacodynamic (PD) properties of AIGIV in animals and model-based translation of PK/PD to predict human exposure and efficacy.
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Affiliation(s)
- Martin Beliveau
- Integrated Drug Development, Certara, Montreal, Quebec, Canada
| | - Igor Rubets
- Integrated Drug Development, Certara, Montreal, Quebec, Canada
| | - Drobic Bojan
- Emergent BioSolutions Inc., Winnipeg, Manitoba, Canada
| | | | - Derek Toth
- Emergent BioSolutions Inc., Winnipeg, Manitoba, Canada
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4
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Blacksell SD, Dhawan S, Kusumoto M, Le KK, Summermatter K, O'Keefe J, Kozlovac JP, Almuhairi SS, Sendow I, Scheel CM, Ahumibe A, Masuku ZM, Bennett AM, Kojima K, Harper DR, Hamilton K. Laboratory-acquired infections and pathogen escapes worldwide between 2000 and 2021: a scoping review. Lancet Microbe 2024; 5:e194-e202. [PMID: 38101440 DOI: 10.1016/s2666-5247(23)00319-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 12/17/2023]
Abstract
Laboratory-acquired infections (LAIs) and accidental pathogen escape from laboratory settings (APELS) are major concerns for the community. A risk-based approach for pathogen research management within a standard biosafety management framework is recommended but is challenging due to reasons such as inconsistency in risk tolerance and perception. Here, we performed a scoping review using publicly available, peer-reviewed journal and media reports of LAIs and instances of APELS between 2000 and 2021. We identified LAIs in 309 individuals in 94 reports for 51 pathogens. Eight fatalities (2·6% of all LAIs) were caused by infection with Neisseria meningitidis (n=3, 37·5%), Yersinia pestis (n=2, 25%), Salmonella enterica serotype Typhimurium (S Typhimurium; n=1, 12·5%), or Ebola virus (n=1, 12·5%) or were due to bovine spongiform encephalopathy (n=1, 12·5%). The top five LAI pathogens were S Typhimurium (n=154, 49·8%), Salmonella enteritidis (n=21, 6·8%), vaccinia virus (n=13, 4·2%), Brucella spp (n=12, 3·9%), and Brucella melitensis (n=11, 3·6%). 16 APELS were reported, including those for Bacillus anthracis, SARS-CoV, and poliovirus (n=3 each, 18·8%); Brucella spp and foot and mouth disease virus (n=2 each, 12·5%); and variola virus, Burkholderia pseudomallei, and influenza virus H5N1 (n=1 each, 6·3%). Continual improvement in LAI and APELS management via their root cause analysis and thorough investigation of such incidents is essential to prevent future occurrences. The results are biased due to the reliance on publicly available information, which emphasises the need for formalised global LAIs and APELS reporting to better understand the frequency of and circumstances surrounding these incidents.
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Affiliation(s)
- Stuart D Blacksell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK.
| | - Sandhya Dhawan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Marina Kusumoto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Khanh K Le
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Joseph O'Keefe
- Ministry for Primary Industries, Wellington, New Zealand
| | - Joseph P Kozlovac
- US Department of Agriculture, Agricultural Research Service, Beltsville, MD, USA
| | - Salama S Almuhairi
- National Emergency Crisis and Disaster Management Authority, Abu Dhabi, United Arab Emirates
| | - Indrawati Sendow
- Research Center for Veterinary Science, National Research and Innovation Agency, Jakarta, Indonesia
| | - Christina M Scheel
- WHO Collaborating Center for Biosafety and Biosecurity, Office of the Associate Director for Laboratory Science, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA; Office of Science and Technology Assessment, Office of Occupational Safety and Health Administration, US Department of Labor, Washington, DC, USA
| | - Anthony Ahumibe
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Zibusiso M Masuku
- National Institute for Communicable Diseases a Division of the National Health Laboratory Services, Johannesburg, South Africa
| | | | - Kazunobu Kojima
- Department of Epidemic and Pandemic Preparedness and Prevention, WHO, Geneva, Switzerland
| | - David R Harper
- The Royal Institute of International Affairs, Chatham House, London, UK
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5
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Curran EH, Devine MD, Hartley CD, Huang Y, Conrady CD, Debiec MR, Justin GA, Thomas J, Yeh S. Ophthalmic implications of biological threat agents according to the chemical, biological, radiological, nuclear, and explosives framework. Front Med (Lausanne) 2024; 10:1349571. [PMID: 38293299 PMCID: PMC10824978 DOI: 10.3389/fmed.2023.1349571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
As technology continues to evolve, the possibility for a wide range of dangers to people, organizations, and countries escalate globally. The United States federal government classifies types of threats with the capability of inflicting mass casualties and societal disruption as Chemical, Biological, Radiological, Nuclear, and Energetics/Explosives (CBRNE). Such incidents encompass accidental and intentional events ranging from weapons of mass destruction and bioterrorism to fires or spills involving hazardous or radiologic material. All of these have the capacity to inflict death or severe physical, neurological, and/or sensorial disabilities if injuries are not diagnosed and treated in a timely manner. Ophthalmic injury can provide important insight into understanding and treating patients impacted by CBRNE agents; however, improper ophthalmic management can result in suboptimal patient outcomes. This review specifically addresses the biological agents the Center for Disease Control and Prevention (CDC) deems to have the greatest capacity for bioterrorism. CBRNE biological agents, encompassing pathogens and organic toxins, are further subdivided into categories A, B, and C according to their national security threat level. In our compendium of these biological agents, we address their respective CDC category, systemic and ophthalmic manifestations, route of transmission and personal protective equipment considerations as well as pertinent vaccination and treatment guidelines.
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Affiliation(s)
- Emma H. Curran
- Creighton University School of Medicine, Omaha, NE, United States
| | - Max D. Devine
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Caleb D. Hartley
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Ye Huang
- Department of Ophthalmology, University of Illinois-Chicago, Chicago, IL, United States
| | - Christopher D. Conrady
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Microbiology and Pathology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Matthew R. Debiec
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Grant A. Justin
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Joanne Thomas
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
| | - Steven Yeh
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, United States
- National Strategic Research Institute, University of Nebraska Medical Center, Omaha, NE, United States
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Bower WA, Yu Y, Person MK, Parker CM, Kennedy JL, Sue D, Hesse EM, Cook R, Bradley J, Bulitta JB, Karchmer AW, Ward RM, Cato SG, Stephens KC, Hendricks KA. CDC Guidelines for the Prevention and Treatment of Anthrax, 2023. MMWR Recomm Rep 2023; 72:1-47. [PMID: 37963097 PMCID: PMC10651316 DOI: 10.15585/mmwr.rr7206a1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
This report updates previous CDC guidelines and recommendations on preferred prevention and treatment regimens regarding naturally occurring anthrax. Also provided are a wide range of alternative regimens to first-line antimicrobial drugs for use if patients have contraindications or intolerances or after a wide-area aerosol release of Bacillus anthracis spores if resources become limited or a multidrug-resistant B. anthracis strain is used (Hendricks KA, Wright ME, Shadomy SV, et al.; Workgroup on Anthrax Clinical Guidelines. Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis 2014;20:e130687; Meaney-Delman D, Rasmussen SA, Beigi RH, et al. Prophylaxis and treatment of anthrax in pregnant women. Obstet Gynecol 2013;122:885-900; Bradley JS, Peacock G, Krug SE, et al. Pediatric anthrax clinical management. Pediatrics 2014;133:e1411-36). Specifically, this report updates antimicrobial drug and antitoxin use for both postexposure prophylaxis (PEP) and treatment from these previous guidelines best practices and is based on systematic reviews of the literature regarding 1) in vitro antimicrobial drug activity against B. anthracis; 2) in vivo antimicrobial drug efficacy for PEP and treatment; 3) in vivo and human antitoxin efficacy for PEP, treatment, or both; and 4) human survival after antimicrobial drug PEP and treatment of localized anthrax, systemic anthrax, and anthrax meningitis. Changes from previous CDC guidelines and recommendations include an expanded list of alternative antimicrobial drugs to use when first-line antimicrobial drugs are contraindicated or not tolerated or after a bioterrorism event when first-line antimicrobial drugs are depleted or ineffective against a genetically engineered resistant B. anthracis strain. In addition, these updated guidelines include new recommendations regarding special considerations for the diagnosis and treatment of anthrax meningitis, including comorbid, social, and clinical predictors of anthrax meningitis. The previously published CDC guidelines and recommendations described potentially beneficial critical care measures and clinical assessment tools and procedures for persons with anthrax, which have not changed and are not addressed in this update. In addition, no changes were made to the Advisory Committee on Immunization Practices recommendations for use of anthrax vaccine (Bower WA, Schiffer J, Atmar RL, et al. Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices, 2019. MMWR Recomm Rep 2019;68[No. RR-4]:1-14). The updated guidelines in this report can be used by health care providers to prevent and treat anthrax and guide emergency preparedness officials and planners as they develop and update plans for a wide-area aerosol release of B. anthracis.
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Fonseca BDP, Morel CM. Relevance of national, regional and global virome projects on pandemics prediction, prevention, and control: a social network analysis of GVP-citing articles. Mem Inst Oswaldo Cruz 2023; 118:e230116. [PMID: 37878831 PMCID: PMC10599233 DOI: 10.1590/0074-02760230116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/05/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The Global Virome Project (GVP) was proposed in 2018 as an evolution of the USAID PREDICT project and was presented as a "collaborative scientific initiative to discover zoonotic viral threats and stop future pandemics". The immediate response was mixed, with public health and scientific communities representatives showing skepticism, if not direct opposition. OBJECTIVES The economic, social, and health consequences of the coronavirus disease 2019 (COVID-19) pandemic demonstrated how unprepared the world was in the face of new pandemics. This paper analyses the impact of the GVP on the scientific and public health communities. METHODS Published scientific articles that cited the two 2018 seminal publications proposing the project were analysed using social network analysis methods. FINDINGS Encompassing the periods before and after the onset of the Covid-19 pandemic, the results indicate that (i) the concepts of the GVP have received more support than opposition in the scientific literature; (ii) its foundations should be updated to address the specific criticisms. MAIN CONCLUSIONS Shifting focus to national virome projects can provide tangible, regional benefits that can positively contribute towards a consensus on achieving a high level of preparedness for the ever-present possibility of the following global viral pandemic.
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Affiliation(s)
- Bruna de Paula Fonseca
- Fundação Oswaldo Cruz-Fiocruz, Centro de Desenvolvimento Tecnológico em Saúde, Rio de Janeiro, RJ, Brasil
- Fundação Oswaldo Cruz-Fiocruz, Centro de Desenvolvimento Tecnológico em Saúde, Instituto Nacional de Ciência e Tecnologia de Inovação em Doenças de Populações Negligenciadas, Rio de Janeiro, RJ, Brasil
| | - Carlos Medicis Morel
- Fundação Oswaldo Cruz-Fiocruz, Centro de Desenvolvimento Tecnológico em Saúde, Rio de Janeiro, RJ, Brasil
- Fundação Oswaldo Cruz-Fiocruz, Centro de Desenvolvimento Tecnológico em Saúde, Instituto Nacional de Ciência e Tecnologia de Inovação em Doenças de Populações Negligenciadas, Rio de Janeiro, RJ, Brasil
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Sabra DM, Krin A, Romeral AB, Frieß JL, Jeremias G. Anthrax revisited: how assessing the unpredictable can improve biosecurity. Front Bioeng Biotechnol 2023; 11:1215773. [PMID: 37795173 PMCID: PMC10546327 DOI: 10.3389/fbioe.2023.1215773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/24/2023] [Indexed: 10/06/2023] Open
Abstract
B. anthracis is one of the most often weaponized pathogens. States had it in their bioweapons programs and criminals and terrorists have used or attempted to use it. This study is motivated by the narrative that emerging and developing technologies today contribute to the amplification of danger through greater easiness, accessibility and affordability of steps in the making of an anthrax weapon. As states would have way better preconditions if they would decide for an offensive bioweapons program, we focus on bioterrorism. This paper analyzes and assesses the possible bioterrorism threat arising from advances in synthetic biology, genome editing, information availability, and other emerging, and converging sciences and enabling technologies. Methodologically we apply foresight methods to encourage the analysis of contemporary technological advances. We have developed a conceptual six-step foresight science framework approach. It represents a synthesis of various foresight methodologies including literature review, elements of horizon scanning, trend impact analysis, red team exercise, and free flow open-ended discussions. Our results show a significant shift in the threat landscape. Increasing affordability, widespread distribution, efficiency, as well as ease of use of DNA synthesis, and rapid advances in genome-editing and synthetic genomic technologies lead to an ever-growing number and types of actors who could potentially weaponize B. anthracis. Understanding the current and future capabilities of these technologies and their potential for misuse critically shapes the current and future threat landscape and underlines the necessary adaptation of biosecurity measures in the spheres of multi-level political decision making and in the science community.
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Affiliation(s)
- Dunja Manal Sabra
- Carl Friedrich von Weizsäcker-Centre for Science and Peace Research (ZNF), University of Hamburg, Bogenallee, Hamburg, Germany
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Oh SY, Château A, Tomatsidou A, Elli D, Gula H, Schneewind O, Missiakas D. Modeling gastrointestinal anthrax disease. Res Microbiol 2023; 174:104026. [PMID: 36646261 PMCID: PMC10338639 DOI: 10.1016/j.resmic.2023.104026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023]
Abstract
Bacillus anthracis is a spore-forming microbe that persists in soil and causes anthrax disease. The most natural route of infection is ingestion by grazing animals. Gastrointestinal (GI) anthrax also occurs in their monogastric predators, including humans. Exposure of carcasses to oxygen triggers sporulation and contamination of the surrounding soil completing the unusual life cycle of this microbe. The pathogenesis of GI anthrax is poorly characterized. Here, we use B. anthracis carrying the virulence plasmids pXO1 and pXO2, to model gastrointestinal disease in Guinea pigs and mice. We find that spores germinate in the GI tract and precipitate disease in a dose-dependent manner. Inoculation of vegetative bacilli also results in GI anthrax. Virulence is impacted severely by the loss of capsule (pXO2-encoded) but only moderately in absence of toxins (pXO1-encoded). Nonetheless, the lack of toxins leads to reduced bacterial replication in infected hosts. B. cereus Elc4, a strain isolated from a fatal case of inhalational anthrax-like disease, was also found to cause GI anthrax. Because transmission to new hosts depends on the release of large numbers of spores in the environment, we propose that the acquisition of pXO1- and pXO2-like plasmids may promote the successful expansion of members of the Bacillus cereus sensu lato group able to cause anthrax-like disease.
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Affiliation(s)
- So Young Oh
- The University of Chicago, Department of Microbiology, Howard Taylor Ricketts Laboratory, Lemont, IL, USA
| | - Alice Château
- The University of Chicago, Department of Microbiology, Howard Taylor Ricketts Laboratory, Lemont, IL, USA
| | - Anastasia Tomatsidou
- The University of Chicago, Department of Microbiology, Howard Taylor Ricketts Laboratory, Lemont, IL, USA
| | - Derek Elli
- The University of Chicago, Department of Microbiology, Howard Taylor Ricketts Laboratory, Lemont, IL, USA
| | - Haley Gula
- The University of Chicago, Department of Microbiology, Howard Taylor Ricketts Laboratory, Lemont, IL, USA
| | - Olaf Schneewind
- The University of Chicago, Department of Microbiology, Howard Taylor Ricketts Laboratory, Lemont, IL, USA
| | - Dominique Missiakas
- The University of Chicago, Department of Microbiology, Howard Taylor Ricketts Laboratory, Lemont, IL, USA.
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10
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Tyśkiewicz R, Fedorowicz M, Nakonieczna A, Zielińska P, Kwiatek M, Mizak L. Electrochemical, optical and mass-based immunosensors: A comprehensive review of Bacillus anthracis detection methods. Anal Biochem 2023; 675:115215. [PMID: 37343693 DOI: 10.1016/j.ab.2023.115215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
A biosensor is an analytical device whose main components include transducer and bioreceptor segments. The combination of biological recognition with the ligand is followed by transformation into physical or chemical signals. Many publications describe biological sensors as user-friendly, easy, portable, and less time-consuming than conventional methods. Among major categories of methods for the detection of Bacillus anthracis, such as culture-based microbiological method, polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA), microarray-based techniques sensors with bioreceptors have been highlighted which particular emphasis is placed on herein. There are several types of biosensors based on various chemical or physical transducers (e.g., electrochemical, optical, piezoelectric, thermal or magnetic electrodes) and the type of biological materials used (e.g., enzymes, nucleic acids, antibodies, cells, phages or tissues). In recent decades, antibody-based sensors have increasingly gained popularity due to their reliability, sensitivity and rapidness. The fundamental principle of antibody-based sensors is mainly based on the molecular recognition between antigens and antibodies. Therefore, immunosensors that detect B. anthracis surface antigens can provide a rapid tool for detecting anthrax bacilli and spores, especially in situ. This review provides a comprehensive summary of immunosensor-based methods using electrochemical, optical, and mass-based transducers to detect B. anthracis.
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Affiliation(s)
- Renata Tyśkiewicz
- Analytical Laboratory, Łukasiewicz Research Network - New Chemical Syntheses Institute, Aleja Tysiąclecia Państwa Polskiego 13a, 24-110, Puławy, Poland.
| | - Magdalena Fedorowicz
- Biological Threats Identification and Countermeasure Centre, Military Institute of Hygiene and Epidemiology, Lubelska 4, 24-100, Puławy, Poland
| | - Aleksandra Nakonieczna
- Biological Threats Identification and Countermeasure Centre, Military Institute of Hygiene and Epidemiology, Lubelska 4, 24-100, Puławy, Poland
| | - Paulina Zielińska
- Biological Threats Identification and Countermeasure Centre, Military Institute of Hygiene and Epidemiology, Lubelska 4, 24-100, Puławy, Poland
| | - Magdalena Kwiatek
- Biological Threats Identification and Countermeasure Centre, Military Institute of Hygiene and Epidemiology, Lubelska 4, 24-100, Puławy, Poland
| | - Lidia Mizak
- Biological Threats Identification and Countermeasure Centre, Military Institute of Hygiene and Epidemiology, Lubelska 4, 24-100, Puławy, Poland
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11
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Kozytska T, Bassiouny M, Chechet O, Ordynska D, Galante D, Neubauer H, Wareth G. Retrospective Analysis of Official Data on Anthrax in Europe with a Special Reference to Ukraine. Microorganisms 2023; 11:1294. [PMID: 37317268 DOI: 10.3390/microorganisms11051294] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 06/16/2023] Open
Abstract
Anthrax is an acute infectious zoonotic disease caused by Bacillus anthracis that mostly affects grazing livestock and wildlife. Furthermore, B. anthracis is considered one of the most important biological agents of bioterrorism that could also be potentially misused in biological weapons. The distribution of anthrax in domestic animals and wildlife in Europe with a particular focus on Ukraine as a country of war was analyzed. Between 2005 and 2022, 267 anthrax cases were registered at the World Organization of Animal Health (WOAH) in animals in Europe, including 251 cases in domestic animals and 16 in wildlife. The highest numbers of cases were recorded in 2005 and 2016 followed by 2008, and the highest numbers of registered cases were reported from Albania, Russia, and Italy. In Ukraine, anthrax is currently a sporadic infection. Since 2007, 28 notifications were registered, with isolates mainly from soil samples. The highest number of confirmed anthrax cases was registered in 2018, and Odesa, which is close to Moldova, had the highest number of cases, followed by the Cherkasy region. The presence of thousands of biothermal pits and burial grounds of fallen cattle nationwide favors the re-emergence of new foci. Most confirmed cases were in cattle; however, single cases were confirmed in dogs, horses, and pigs. Further investigation of the disease in wildlife and in environmental samples is needed. The genetic analysis of isolates, investigation of susceptibility to antimicrobial compounds, and determination of virulence and pathogenicity factors are required in this volatile region of the world for awareness raising and preparedness.
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Affiliation(s)
- Tamara Kozytska
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 96a, 07743 Jena, Germany
- State Research Institute for Laboratory Diagnostics and Veterinary and Sanitary Expertise, State Service of Ukraine for Food Safety and Consumer Protection, 30, Donetska St., 03151 Kyiv, Ukraine
| | - Marwa Bassiouny
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 96a, 07743 Jena, Germany
| | - Olha Chechet
- State Research Institute for Laboratory Diagnostics and Veterinary and Sanitary Expertise, State Service of Ukraine for Food Safety and Consumer Protection, 30, Donetska St., 03151 Kyiv, Ukraine
| | - Diana Ordynska
- State Research Institute for Laboratory Diagnostics and Veterinary and Sanitary Expertise, State Service of Ukraine for Food Safety and Consumer Protection, 30, Donetska St., 03151 Kyiv, Ukraine
| | - Domenico Galante
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Anthrax Reference Institute of Italy, Via Manfredonia 20, 71121 Foggia, Italy
| | - Heinrich Neubauer
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 96a, 07743 Jena, Germany
| | - Gamal Wareth
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 96a, 07743 Jena, Germany
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
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12
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Nikolakakis I, Michaleas SN, Panayiotakopoulos G, Papaioannou TG, Karamanou M. The History of Anthrax Weaponization in the Soviet Union. Cureus 2023; 15:e36800. [PMID: 37123719 PMCID: PMC10134958 DOI: 10.7759/cureus.36800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2023] [Indexed: 03/30/2023] Open
Abstract
In this paper, we reveal the anthrax weaponization in the Soviet Union and its impact on biowarfare research, technology, and public health that resulted in the development of the first Soviet Anthrax vaccine and the subsequent vaccination of animals and humans en masse. We assume that there are cases that a biowarfare technology was incorporated into the civilian industry and benefited public health. However, the legacy of bioweapons today still poses an asymmetric threat to public health and safety.
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13
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McCurdy S, Halasohoris SA, Babyak AL, Lembirik S, Hoover R, Hickman M, Scarff J, Klimko CP, Cote CK, Meinig JM. Efficacy of delafloxacin against the biothreat pathogen Bacillus anthracis. J Antimicrob Chemother 2023; 78:810-816. [PMID: 36738250 DOI: 10.1093/jac/dkad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/29/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To evaluate the in vitro activity and in vivo efficacy of delafloxacin against Bacillus anthracis, the causative agent of anthrax. METHODS MICs were obtained according to CLSI guidelines for 30 virulent isolates and 14 attenuated antibiotic-resistant strains. For the in vivo efficacy study, mice were administered delafloxacin (30-62.5 mg/kg) subcutaneously, or ciprofloxacin (30 mg/kg) intraperitoneally beginning at either 24 or 48 ± 1 h post-challenge (post-exposure prophylaxis) and continued every 12 h for 14 days with study termination on day 30. The mean inhaled dose in the study was approximately 103 × LD50 equivalents, and the range was 87-120 × LD50. RESULTS Delafloxacin (MIC90 = 0.004 mg/L) was 16-fold more potent than ciprofloxacin (MIC90 = 0.06 mg/L) against a 30-strain set of virulent B. anthracis. Against a panel of attenuated antibiotic-resistant strains, delafloxacin demonstrated potency ≥128-fold over that observed with ciprofloxacin. When evaluated in vivo, mice treated with all delafloxacin doses tested at 24 h post-challenge demonstrated equivalent survival compared with mice treated with the positive control ciprofloxacin. Because of the high challenge dose of spores, mice treated at 48 h showed rapid and high mortality in all groups including the positive control. Surviving animals in all delafloxacin- and ciprofloxacin-treated groups (24 and 48 h) showed complete splenic clearance of infection and <2.2 × 103 cfu/g lung tissue. CONCLUSIONS Given the high bar set by the 100 × LD50 challenge dose in this study, the results from delafloxacin treatment are promising for the treatment of inhaled anthrax.
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Affiliation(s)
- Sandra McCurdy
- Melinta Therapeutics, 44 Whippany Rd, Morristown, NJ, USA
| | - Stephanie A Halasohoris
- Bacteriology Division, US Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter St., Fort Detrick, MD, USA
| | - Ashley L Babyak
- Bacteriology Division, US Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter St., Fort Detrick, MD, USA
| | - Sanae Lembirik
- Bacteriology Division, US Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter St., Fort Detrick, MD, USA
| | - Randall Hoover
- Pharmacology Consultant for Melinta Therapeutics, 15 Plane Tree Ln, Dix Hills, NY 11746, USA
| | - Mark Hickman
- Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense (JPEO-CBRND), CBRN Medical, 110 Thomas Johnson Dr., Suite 300, Frederick, MD, USA
| | - Jennifer Scarff
- Bacteriology Division, US Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter St., Fort Detrick, MD, USA
| | - Christopher P Klimko
- Bacteriology Division, US Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter St., Fort Detrick, MD, USA
| | - Christopher K Cote
- Bacteriology Division, US Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter St., Fort Detrick, MD, USA
| | - J Matthew Meinig
- Bacteriology Division, US Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter St., Fort Detrick, MD, USA
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14
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Wang H, Bishop AE, Koralewski TE, Grant WE. In Search of Proximate Triggers of Anthrax Outbreaks in Wildlife: A Hypothetical Individual-Based Model of Plasmid Transfer within Bacillus Communities. Diversity 2023; 15:347. [DOI: 10.3390/d15030347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Bacillus anthracis, the causative agent of anthrax in humans, livestock, and wildlife, exists in a community with hundreds of other species of bacteria in the environment. Work on the genetics of these communities has shown that B. anthracis shares a high percentage of chromosomal genes with both B. thuringiensis and B. cereus, and that phenotypic differences among these bacteria can result from extra-chromosomal DNA in the form of plasmids. We developed a simple hypothetical individual-based model to simulate the likelihood of detecting plasmids with genes encoding anthrax toxins within bacterial communities composed of B. anthracis, B. thuringiensis, and B. cereus, and the surrounding matrix of extra-cellular polymeric substances. Simulation results suggest the horizontal transfer of plasmids with genes encoding anthrax toxins among Bacillus species persisting outside the host could function as a proximate factor triggering anthrax outbreaks.
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15
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Fontes B, Scavone D, Bridges W, Landgraf T, Fortgang N. Biorisk Management Features of a Temporary COVID-19 Hospital. Appl Biosaf 2023; 28:32-42. [PMID: 36895579 PMCID: PMC9991446 DOI: 10.1089/apb.2022.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Introduction Yale University designed and constructed a temporary field hospital for 100 COVID-19 symptomatic patients. Conservative biocontainment decisions were made in design and operational practices. Objectives of the field hospital included the safe flow of patients, staff, equipment and supplies, and obtaining approval by the Connecticut Department of Public Health (CT DPH) for opening as a field hospital. Methods The CT DPH regulations for mobile hospitals were used as primary guidance for the design, equipment, and protocols. References for BSL-3 and ABSL-3 design from the National Institutes of Health (NIH) and Tuberculosis isolation rooms from the United States Centers for Disease Control and Prevention (CDC) were also utilized. The final design involved an array of experts throughout the university. Results and Conclusion Vendors tested and certified all High Efficiency Particulate Air (HEPA) filters and balanced the airflows inside the field hospital. Yale Facilities designed and constructed positive pressure access and exit tents within the field hospital, established appropriate pressure relationships between zones, and added Minimum Efficiency Reporting Value 16 exhaust filters. The BioQuell ProteQ Hydrogen Peroxide decontamination unit was validated with biological spores in the rear sealed section of the biowaste tent. A ClorDiSys Flashbox UV-C Disinfection Chamber was also validated. Visual indicators were placed the doors of the pressurized tents and spaced throughout the facility to verify airflows. The plans created to design, construct and operate the field hospital provide a blueprint for recreating and reopening a field hospital in the future if ever needed at Yale University.
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Affiliation(s)
- Benjamin Fontes
- Yale Health, Environmental Health and Safety, Yale Center for Clinical Investigation, Yale University, New Haven, Connecticut, USA
| | - Danielle Scavone
- Yale Health, Environmental Health and Safety, Yale Center for Clinical Investigation, Yale University, New Haven, Connecticut, USA
| | - Wesley Bridges
- Yale Health, Environmental Health and Safety, Yale Center for Clinical Investigation, Yale University, New Haven, Connecticut, USA
| | - Tessa Landgraf
- Yale Health, Environmental Health and Safety, Yale Center for Clinical Investigation, Yale University, New Haven, Connecticut, USA
| | - Nanci Fortgang
- Yale Health, Environmental Health and Safety, Yale Center for Clinical Investigation, Yale University, New Haven, Connecticut, USA
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16
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Kammanadiminti S, Comer J, Meister G, Carnelley T, Toth D, Kodihalli S. Efficacy of ANTHRASIL (Anthrax Immune Globulin Intravenous (Human)) in rabbit and nonhuman primate models of inhalational anthrax: Data supporting approval under animal rule. PLoS One 2023; 18:e0283164. [PMID: 36930692 PMCID: PMC10022752 DOI: 10.1371/journal.pone.0283164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/21/2023] [Indexed: 03/18/2023] Open
Abstract
To meet the requirements of the Animal Rule, the efficacy of monotherapy with ANTHRASIL® (Anthrax Immune Globulin Intravenous (Human)) for inhalational anthrax was evaluated in blinded studies using rabbit and nonhuman primate models. Animals in both studies were randomized to treatment groups exposed to ~ 200 LD50 Bacillus anthracis (Ames strain) spores by the aerosol route to induce inhalational anthrax. Rabbits (N = 50/group) were treated with either 15 U/kg ANTHRASIL or a volume-matching dose of IGIV after disease onset as determined by the detection of bacterial toxin in the blood. At the end of the study, survival rates were 2% (1 of 48) in the IGIV control group, and 26% (13 of 50) in the ANTHRASIL-treated group (p = 0.0009). Similarly, ANTHRASIL was effective in cynomolgus monkeys (N = 16/group) when administered therapeutically after the onset of toxemia, with 6% survival in the IGIV control and a dose-related increase in survival of 36%, 43%, and 70% with 7.5, 15 or 30 U/kg doses of ANTHRASIL, respectively. These studies formed the basis for approval of ANTHRASIL by FDA under the Animal Rule.
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Affiliation(s)
| | - Jason Comer
- Battelle Biomedical Research Center, Columbus, Ohio, United States of America
| | - Gabriel Meister
- Battelle Biomedical Research Center, Columbus, Ohio, United States of America
| | - Trevor Carnelley
- Emergent BioSolutions Canada (Previously Cangene Corporation), Winnipeg, MB, Canada
| | - Derek Toth
- Emergent BioSolutions Canada (Previously Cangene Corporation), Winnipeg, MB, Canada
| | - Shantha Kodihalli
- Emergent BioSolutions Canada (Previously Cangene Corporation), Winnipeg, MB, Canada
- * E-mail:
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17
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Costantino V, Bahl P, Doolan C, de Silva C, Heslop D, Chen X, Lim S, MacIntyre CR. Modeling on the Effects of Deliberate Release of Aerosolized Inhalational Bacillus anthracis (Anthrax) on an Australian Population. Health Secur 2023; 21:61-69. [PMID: 36695665 DOI: 10.1089/hs.2022.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
This study aimed to determine optimal mitigation strategies in the event of an aerosolized attack with Bacillus anthracis, a category A bioterrorism agent with a case fatality rate of nearly 100% if inhaled and untreated. To simulate the effect of an anthrax attack, we used a plume dispersion model for Sydney, Australia, accounting for weather conditions. We determined the radius of exposure in different sizes of attack scenarios by spore quantity released per second. Estimations of different spore concentrations were then used to calculate the exposed population to inform a Susceptible-Exposed-Infected-Recovered (SEIR) deterministic mathematical model. Results are shown as estimates of the total number of exposed and infected people, along with the burden of disease, to quantify the amount of vaccination and antibiotics doses needed for stockpiles. For the worst-case scenario, over 500,000 people could be exposed and over 300,000 infected. The number of deaths depends closely on timing to start postexposure prophylaxis. Vaccination used as a postexposure prophylaxis in conjunction with antibiotics is the most effective mitigation strategy to reduce deaths after an aerosolized attack and is more effective when the response starts early (2 days after release) and has high adherence, while it makes only a small difference when started late (after 10 days).
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Affiliation(s)
- Valentina Costantino
- Valentina Costantino, PhD, is a Postdoctoral Research Associate; in the Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Prateek Bahl
- Prateek Bahl, PhD, is a Postdoctoral Research Associate; at the School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, Australia
| | - Con Doolan
- Con Doolan, PhD, is a Professor and Associate Dean (Academic Programs); at the School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, Australia
| | - Charitha de Silva
- Charitha de Silva, PhD, is a Lecturer; at the School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, Australia
| | - David Heslop
- David Heslop, PhD, MPH, is an Associate Professor, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Xin Chen
- Xin Chen, PhD, is a Postdoctoral Research Associate; in the Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Samsung Lim
- Samsung Lim, MA, PhD, is an Associate Professor, School of Civil and Environmental Engineering, University of New South Wales, Sydney, Australia
| | - Chandini Raina MacIntyre
- Chandini Raina MacIntyre, MBBS, MAE, PhD, is a Professor and Head; in the Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia.,Chandini Raina MacIntyre is also a Professor, College of Health Solutions and College of Public Service and Community Solutions, Arizona State University, Tempe, AZ
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18
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Boyer AE, Gallegos-Candela M, Lins RC, Solano MI, Woolfitt AR, Lee JS, Sanford DC, Knostman KAB, Quinn CP, Hoffmaster AR, Pirkle JL, Barr JR. Comprehensive characterization of toxins during progression of inhalation anthrax in a non-human primate model. PLoS Pathog 2022; 18:e1010735. [PMID: 36534695 PMCID: PMC9810172 DOI: 10.1371/journal.ppat.1010735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/03/2023] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Inhalation anthrax has three clinical stages: early-prodromal, intermediate-progressive, and late-fulminant. We report the comprehensive characterization of anthrax toxins, including total protective antigen (PA), total lethal factor (LF), total edema factor (EF), and their toxin complexes, lethal toxin and edema toxin in plasma, during the course of inhalation anthrax in 23 cynomolgus macaques. The toxin kinetics were predominantly triphasic with an early rise (phase-1), a plateau/decline (phase-2), and a final rapid rise (phase-3). Eleven animals had shorter survival times, mean±standard deviation of 58.7±7.6 hours (fast progression), 11 animals had longer survival times, 113±34.4 hours (slow progression), and one animal survived. Median (lower-upper quartile) LF levels at the end-of-phase-1 were significantly higher in animals with fast progression [138 (54.9-326) ng/mL], than in those with slow progression [23.8 (15.6-26.3) ng/mL] (p = 0.0002), and the survivor (11.1 ng/mL). The differences were also observed for other toxins and bacteremia. Animals with slow progression had an extended phase-2 plateau, with low variability of LF levels across all time points and animals. Characterization of phase-2 toxin levels defined upper thresholds; critical levels for exiting phase-2 and entering the critical phase-3, 342 ng/mL (PA), 35.8 ng/mL (LF), and 1.10 ng/mL (EF). The thresholds were exceeded earlier in animals with fast progression (38.5±7.4 hours) and later in animals with slow progression (78.7±15.2 hours). Once the threshold was passed, toxin levels rose rapidly in both groups to the terminal stage. The time from threshold to terminal was rapid and similar; 20.8±7.4 hours for fast and 19.9±7.5 hours for slow progression. The three toxemic phases were aligned with the three clinical stages of anthrax for fast and slow progression which showed that anthrax progression is toxin- rather than time-dependent. This first comprehensive evaluation of anthrax toxins provides new insights into disease progression.
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Affiliation(s)
- Anne E. Boyer
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | | | - Renato C. Lins
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Battelle Atlanta Analytical Services, Atlanta, Georgia, United States of America
| | - Maria I. Solano
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Adrian R. Woolfitt
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John S. Lee
- Biomedical Advanced Research and Development Authority, Washington, DC, United States of America
| | - Daniel C. Sanford
- Battelle Biomedical Research Center, West Jefferson, Ohio, United States of America
| | | | - Conrad P. Quinn
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alex R. Hoffmaster
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - James L. Pirkle
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John R. Barr
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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19
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Joseph J, Baby HM, Zhao S, Li X, Cheung K, Swain K, Agus E, Ranganathan S, Gao J, Luo JN, Joshi N. Role of bioaerosol in virus transmission and material-based countermeasures. Exploration (Beijing) 2022; 2:20210038. [PMID: 37324804 PMCID: PMC10190935 DOI: 10.1002/exp.20210038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/15/2022] [Indexed: 06/17/2023]
Abstract
Respiratory pathogens transmit primarily through particles such as droplets and aerosols. Although often overlooked, the resuspension of settled droplets is also a key facilitator of disease transmission. In this review, we discuss the three main mechanisms of aerosol generation: direct generation such as coughing and sneezing, indirect generation such as medical procedures, and resuspension of settled droplets and aerosols. The size of particles and environmental factors influence their airborne lifetime and ability to cause infection. Specifically, humidity and temperature are key factors controlling the evaporation of suspended droplets, consequently affecting the duration in which particles remain airborne. We also suggest material-based approaches for effective prevention of disease transmission. These approaches include electrostatically charged virucidal agents and surface coatings, which have been shown to be highly effective in deactivating and reducing resuspension of pathogen-laden aerosols.
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Affiliation(s)
- John Joseph
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Helna Mary Baby
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Spencer Zhao
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Xiang‐Ling Li
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Krisco‐Cheuk Cheung
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Kabir Swain
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Eli Agus
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Sruthi Ranganathan
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Jingjing Gao
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - James N Luo
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
| | - Nitin Joshi
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
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20
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Pappas G. The Lanzhou Brucella Leak: The Largest Laboratory Accident in the History of Infectious Diseases? Clin Infect Dis 2022; 75:1845-1847. [PMID: 35675697 DOI: 10.1093/cid/ciac463] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
An inadequacy in sanitizing processes in a biopharmaceutical plant in Lanzhou, China, during July and August 2019, led to the aerosolization of Brucella that was subsequently spread through wind to nearby settlements and academic institutes, resulting in >10 000 human brucellosis cases, as of November 2020. The leak, possibly the largest laboratory accident in the history of infectious diseases, underlines the particular characteristics of Brucella that have made the pathogen a historical entity in biodefense research and a major cause of laboratory-associated infections. It further underlines the need for enhanced vigilance and strict regulatory interventions in similar facilities.
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Affiliation(s)
- Georgios Pappas
- Institute of Continuing Medical Education of Ioannina, Ioannina, Greece
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21
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Hendricks K, Martines RB, Bielamowicz H, Boyer AE, Long S, Byers P, Stoddard RA, Taylor K, Kolton CB, Gallegos-Candela M, Roberts C, DeLeon-Carnes M, Salzer J, Dawson P, Brown D, Templeton-LeBouf L, Maves RC, Gulvik C, Lonsway D, Barr JR, Bower WA, Hoffmaster A. Welder's Anthrax: A Tale of 2 Cases. Clin Infect Dis 2022; 75:S354-S363. [PMID: 36251561 PMCID: PMC9649440 DOI: 10.1093/cid/ciac535] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bacillus anthracis has traditionally been considered the etiologic agent of anthrax. However, anthrax-like illness has been documented in welders and other metal workers infected with Bacillus cereus group spp. harboring pXO1 virulence genes that produce anthrax toxins. We present 2 recent cases of severe pneumonia in welders with B. cereus group infections and discuss potential risk factors for infection and treatment options, including antitoxin.
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Affiliation(s)
- Katherine Hendricks
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Roosecelis Brasil Martines
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hannah Bielamowicz
- Pathology Department, Fort Bend County Medical Examiner Office, Rosenberg, Texas, USA
| | - Anne E Boyer
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen Long
- Houston Laboratory Response Network, Houston Health Department, Houston, Texas, USA
| | - Paul Byers
- Office of Communicable Diseases, Mississippi State Department of Health, Jackson, Mississippi, USA
| | - Robyn A Stoddard
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn Taylor
- Office of Communicable Diseases, Mississippi State Department of Health, Jackson, Mississippi, USA
| | - Cari Beesley Kolton
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maribel Gallegos-Candela
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christine Roberts
- Office of Communicable Diseases, Mississippi State Department of Health, Jackson, Mississippi, USA
| | - Marlene DeLeon-Carnes
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Johanna Salzer
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patrick Dawson
- Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dannette Brown
- King Daughters Medical Center, Brookhaven, Mississippi, USA
| | | | - Ryan C Maves
- Departments of Infectious Diseases and Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Chris Gulvik
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David Lonsway
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John R Barr
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William A Bower
- Correspondence: W. A. Bower, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS H24-12, Atlanta, GA 30329 ()
| | - Alex Hoffmaster
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Thompson JM, Cook R, Person MK, Negrón ME, Traxler RM, Bower WA, Hendricks K. Risk Factors for Death or Meningitis in Adults Hospitalized for Cutaneous Anthrax, 1950-2018: A Systematic Review. Clin Infect Dis 2022; 75:S459-S467. [PMID: 36251551 PMCID: PMC9649426 DOI: 10.1093/cid/ciac533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Cutaneous anthrax accounts for approximately 95% of anthrax cases worldwide. About 24% of untreated patients die, and many cases are complicated by meningitis. Here, we explore clinical features of cutaneous disease associated with poor outcomes. METHODS A systematic review identified 303 full-text articles published from 1950 through 2018 that met predefined inclusion criteria. Cases were abstracted, and descriptive analyses and univariate logistic regression were conducted to identify prognostic indicators for cutaneous anthrax. RESULTS Of 182 included patients, 47 (25.8%) died. Previously reported independent predictors for death or meningitis that we confirmed included fever or chills; nausea or vomiting; headache; severe headache; nonheadache, nonmeningeal signs; leukocytosis; and bacteremia. Newly identified predictors included anxiety, abdominal pain, diastolic hypotension, skin trauma, thoracic edema, malignant pustule edema, lymphadenopathy, and evidence of coagulopathy (all with P < .05). CONCLUSIONS We identified patient presentations not previously associated with poor outcomes.
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Affiliation(s)
- Julie M Thompson
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112, USA
| | - Rachel Cook
- Oak Ridge Institute for Science and Education, CDC Fellowship Program, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
| | - Marissa K Person
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
| | - María E Negrón
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
| | - Rita M Traxler
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
| | - William A Bower
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
| | - Katherine Hendricks
- Correspondence: K. Hendricks, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 1600 Clifton Road, H24-12, Atlanta, GA 30329-4027 ()
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Binney S, Person MK, Traxler RM, Cook R, Bower WA, Hendricks K. Algorithms for the Identification of Anthrax Meningitis During a Mass Casualty Event Based on a Systematic Review of Systemic Anthrax From 1880 Through 2018. Clin Infect Dis 2022; 75:S468-S477. [PMID: 36251554 PMCID: PMC9649431 DOI: 10.1093/cid/ciac546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND During an anthrax mass casualty event, prompt identification of patients with anthrax meningitis is important. Previous research has suggested use of a screening tool based on neurological symptoms and signs. METHODS Using historical anthrax patient data from 1880 through 2018, we analyzed risk factors for meningitis. We developed lists of symptoms and signs (ie, algorithms) for predicting meningitis with high sensitivity and specificity. We evaluated both single and paired algorithms as screening tools. RESULTS A single algorithm with 1 or more neurological symptoms or signs identifying patients with likely meningitis achieved high sensitivity (86%; 95% confidence interval [CI], 71%-100%) and specificity (90%; 95% CI, 82%-98%). Pairing algorithms with the same symptoms and signs (severe headache, altered mental status, meningeal signs, and "other neurological deficits") improved specificity (99%; 95% CI, 97%-100%) but left 17.3% of patients in a middle "indeterminate" meningitis category and in need of additional diagnostic testing to determine likely meningitis status. Pairing algorithms with differing symptoms and signs also improved specificity over the single algorithm (92%; 95% CI, 85%-99%) but categorized just 2.5% of patients as indeterminate. CONCLUSIONS Our study confirms prior research suggesting quick and reliable assessment of patients for anthrax meningitis is possible based on the presence or absence of certain symptoms and signs. A single algorithm was adequate; however, if we assumed low-resource diagnostic testing was feasible for some patients, pairing algorithms improved specificity. Pairing algorithms with differing symptoms and signs minimized the proportion of patients requiring additional diagnostics.
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Affiliation(s)
- Sophie Binney
- Correspondence: S. Binney, School of Public Health, Georgia State University, 1083 Seville Dr, Clarkston, GA, 30021 ()
| | - Marissa K Person
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rita M Traxler
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel Cook
- Oak Ridge Institute for Science and Education, CDC Fellowship Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William A Bower
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine Hendricks
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kennedy JL, Bulitta JB, Chatham-Stephens K, Person MK, Cook R, Mongkolrattanothai T, Shin E, Yu P, Negron ME, Bower WA, Hendricks K. Postexposure Prophylaxis and Treatment of Bacillus anthracis Infections: A Systematic Review and Meta-analyses of Animal Models, 1947-2019. Clin Infect Dis 2022; 75:S379-S391. [PMID: 36251546 PMCID: PMC9649436 DOI: 10.1093/cid/ciac591] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Anthrax is endemic to many countries, including the United States. The causative agent, Bacillus anthracis, poses a global bioterrorism threat. Without effective antimicrobial postexposure prophylaxis (PEPAbx) and treatment, the mortality of systemic anthrax is high. To inform clinical guidelines for PEPAbx and treatment of B. anthracis infections in humans, we systematically evaluated animal anthrax treatment model studies. METHODS We searched for survival outcome data in 9 scientific search engines for articles describing antimicrobial PEPAbx or treatment of anthrax in animals in any language through February 2019. We performed meta-analyses of efficacy of antimicrobial PEPAbx and treatment for each drug or drug combination using random-effects models. Pharmacokinetic/pharmacodynamic relationships were developed for 5 antimicrobials with available pharmacokinetic data. Monte Carlo simulations were used to predict unbound drug exposures in humans. RESULTS We synthesized data from 34 peer-reviewed studies with 3262 animals. For PEPAbx and treatment of infection by susceptible B. anthracis, effective monotherapy can be accomplished with fluoroquinolones, tetracyclines, β-lactams (including penicillin, amoxicillin-clavulanate, and imipenem-cilastatin), and lipopeptides or glycopeptides. For naturally occurring strains, unbound drug exposures in humans were predicted to adequately cover the minimal inhibitory concentrations (MICs; those required to inhibit the growth of 50% or 90% of organisms [MIC50 or MIC90]) for ciprofloxacin, levofloxacin, and doxycycline for both the PEPAbx and treatment targets. Dalbavancin covered its MIC50 for PEPAbx. CONCLUSIONS These animal studies show many reviewed antimicrobials are good choices for PEPAbx or treatment of susceptible B. anthracis strains, and some are also promising options for combating resistant strains. Monte Carlo simulations suggest that oral ciprofloxacin, levofloxacin, and doxycycline are particularly robust choices for PEPAbx or treatment.
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Affiliation(s)
- Jordan L Kennedy
- Correspondence: J. L. Kennedy, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 1600 Clifton Rd, H24-12, Atlanta, GA 30329-4027 ()
| | - Jürgen B Bulitta
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Orlando, Florida, USA
| | - Kevin Chatham-Stephens
- Division of Human Development and Disability, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marissa K Person
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel Cook
- Oak Ridge Institute for Science and Education, CDC Fellowship Program, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thitipong Mongkolrattanothai
- Oak Ridge Institute for Science and Education, CDC Fellowship Program, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eunjeong Shin
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Orlando, Florida, USA
| | - Patricia Yu
- Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria E Negron
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William A Bower
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine Hendricks
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Honein MA, Hoffmaster AR. Responding to the Threat Posed by Anthrax: Updated Evidence to Improve Preparedness. Clin Infect Dis 2022; 75:S339-S340. [PMID: 36251547 PMCID: PMC9649413 DOI: 10.1093/cid/ciac567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Margaret A Honein
- Correspondence: M. A. Honein, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H24-11, Atlanta, GA 30329 ()
| | - Alex R Hoffmaster
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Hendricks K, Person MK, Bradley JS, Mongkolrattanothai T, Hupert N, Eichacker P, Friedlander AM, Bower WA. Clinical Features of Patients Hospitalized for All Routes of Anthrax, 1880-2018: A Systematic Review. Clin Infect Dis 2022; 75:S341-S353. [PMID: 36251560 PMCID: PMC9649428 DOI: 10.1093/cid/ciac534] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Anthrax is a toxin-mediated zoonotic disease caused by Bacillus anthracis, with a worldwide distribution recognized for millennia. Bacillus anthracis is considered a potential biowarfare agent. METHODS We completed a systematic review for clinical and demographic characteristics of adults and children hospitalized with anthrax (cutaneous, inhalation, ingestion, injection [from contaminated heroin], primary meningitis) abstracted from published case reports, case series, and line lists in English from 1880 through 2018, assessing treatment impact by type and severity of disease. We analyzed geographic distribution, route of infection, exposure to anthrax, and incubation period. RESULTS Data on 764 adults and 167 children were reviewed. Most cases reported for 1880 through 1915 were from Europe; those for 1916 through 1950 were from North America; and from 1951 on, cases were from Asia. Cutaneous was the most common form of anthrax for all populations. Since 1960, adult anthrax mortality has ranged from 31% for cutaneous to 90% for primary meningitis. Median incubation periods ranged from 1 day (interquartile range [IQR], 0-4) for injection to 7 days (IQR, 4-9) for inhalation anthrax. Most patients with inhalation anthrax developed pleural effusions and more than half with ingestion anthrax developed ascites. Treatment and critical care advances have improved survival for those with systemic symptoms, from approximately 30% in those untreated to approximately 70% in those receiving antimicrobials or antiserum/antitoxin. CONCLUSIONS This review provides an improved evidence base for both clinical care of individual anthrax patients and public health planning for wide-area aerosol releases of B. anthracis spores.
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Affiliation(s)
- Katherine Hendricks
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marissa K Person
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John S Bradley
- Division of Infectious Diseases, Rady Children’s Hospital San Diego and the University of California San Diego School of Medicine, San Diego, California, USA
| | - Thitipong Mongkolrattanothai
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Oak Ridge Institute for Science and Education, CDC Fellowship Program, Oak Ridge, Tennessee, USA
| | - Nathaniel Hupert
- Departments of Population Health Sciences and of Medicine, Weill Cornell Medicine, Cornell University, and New York-Presbyterian Hospital, New York, New York, USA
| | - Peter Eichacker
- Department of Critical Care Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Arthur M Friedlander
- US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland, USA,Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - William A Bower
- Correspondence: W. A. Bower, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS H24-12, Atlanta, GA 30329, USA ()
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27
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Person MK, Cook R, Bradley JS, Hupert N, Bower WA, Hendricks K. Systematic Review of Hospital Treatment Outcomes for Naturally Acquired and Bioterrorism-Related Anthrax, 1880-2018. Clin Infect Dis 2022; 75:S392-S401. [PMID: 36251553 PMCID: PMC9649424 DOI: 10.1093/cid/ciac536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Bacillus anthracis can cause anthrax and is a potential bioterrorism agent. The 2014 Centers for Disease Control and Prevention recommendations for medical countermeasures against anthrax were based on in vitro data and expert opinion. However, a century of previously uncompiled observational human data that often includes treatment and outcomes is available in the literature for analysis. METHODS We reviewed treatment outcomes for patients hospitalized with anthrax. We stratified patients by meningitis status, route of infection, and systemic criteria, then analyzed survival by treatment type, including antimicrobials, antitoxin/antiserum, and steroids. Using logistic regression, we calculated odds ratios and 95% confidence intervals to compare survival between treatments. We also calculated hospital length of stay. Finally, we evaluated antimicrobial postexposure prophylaxis (PEPAbx) using data from a 1970 Russian-language article. RESULTS We identified 965 anthrax patients reported from 1880 through 2018. After exclusions, 605 remained: 430 adults, 145 children, and 30 missing age. Survival was low for untreated patients and meningitis patients, regardless of treatment. Most patients with localized cutaneous or nonmeningitis systemic anthrax survived with 1 or more antimicrobials; patients with inhalation anthrax without meningitis fared better with at least 2. Bactericidal antimicrobials were effective for systemic anthrax; addition of a protein synthesis inhibitor(s) (PSI) to a bactericidal antimicrobial(s) did not improve survival. Likewise, addition of antitoxin/antiserum to antimicrobials did not improve survival. Mannitol improved survival for meningitis patients, but steroids did not. PEPAbx reduced risk of anthrax following exposure to B. anthracis. CONCLUSIONS Combination therapy appeared to be superior to monotherapy for inhalation anthrax without meningitis. For anthrax meningitis, neither monotherapy nor combination therapy were particularly effective; however, numbers were small. For localized cutaneous anthrax, monotherapy was sufficient. For B. anthracis exposures, PEPAbx was effective.
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Affiliation(s)
- Marissa K Person
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel Cook
- Oak Ridge Institute for Science and Education, CDC Fellowship Program, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, USA
| | - John S Bradley
- Division of Infectious Diseases, Rady Children’s Hospital San Diego and the University of California San Diego School of Medicine, San Diego, California, USA
| | - Nathaniel Hupert
- Departments of Population Health Sciences and of Medicine, Weill Cornell Medicine (Cornell University) and New York-Presbyterian Hospital, New York, New York, USA
| | - William A Bower
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine Hendricks
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Mondange L, Tessier É, Tournier JN. Pathogenic Bacilli as an Emerging Biothreat? Pathogens 2022; 11:pathogens11101186. [PMID: 36297243 PMCID: PMC9609551 DOI: 10.3390/pathogens11101186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Bacillus anthracis, present as a very durable endospore in soil, causes zoonotic illness which is mainly associated with herbivores and domestic animals. Human cases are scarce and often involve populations close to infected livestock. If anthrax is no longer of public health concern in developed countries, B. anthracis is one of the top-tier biological weapon agents. It is classified by the CDC as a category A agent. Since 1994, emerging strains of Bacillus cereus have been associated with anthrax-like disease in mammals. Some clinical strains of B. cereus harbor anthrax-like plasmid genes (pXO1 and pXO2) associated with non-human primate and human infections, with the same clinical presentation of inhalation anthrax and mortality rates. Although currently restricted to certain limited areas of circulation, the emergence of these new strains of B. cereus extends the list of potential agents possibly usable for bioterrorism or as a biological weapon. It is therefore important to improve our knowledge of the phylogeny within the B. cereus sensu lato group to better understand the origin of these strains. We can then more efficiently monitor the emergence of new strains to better control the risk of infection and limit potentially malicious uses.
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Affiliation(s)
- Lou Mondange
- Bacteriology Unit, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France
- Yersinia Unit, Institut Pasteur, 75015 Paris, France
- Correspondence: (L.M.); (J.-N.T.)
| | - Émilie Tessier
- Immunopathology Unit, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France
| | - Jean-Nicolas Tournier
- CNR-LE Charbon, Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France
- Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France
- École du Val-de-Grâce, 75015 Paris, France
- Correspondence: (L.M.); (J.-N.T.)
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Bower WA, Hendricks KA, Vieira AR, Traxler RM, Weiner Z, Lynfield R, Hoffmaster A. What Is Anthrax? Pathogens 2022; 11:690. [PMID: 35745544 DOI: 10.3390/pathogens11060690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
Anthrax has been feared for its high mortality in animals and humans for centuries. The etiologic agent is considered a potentially devastating bioweapon, and since 1876―when Robert Koch demonstrated that Bacillus anthracis caused anthrax―it has been considered the sole cause of the disease. Anthrax is, however, a toxin-mediated disease. The toxins edema toxin and lethal toxin are formed from protein components encoded for by the pXO1 virulence plasmid present in pathogenic B. anthracis strains. However, other members of the Bacillus cereus group, to which B. anthracis belongs, have recently been shown to harbor the pXO1 plasmid and produce anthrax toxins. Infection with these Bacillus cereus group organisms produces a disease clinically similar to anthrax. This suggests that anthrax should be defined by the exotoxins encoded for by the pXO1 plasmid rather than the bacterial species it has historically been associated with, and that the definition of anthrax should be expanded to include disease caused by any member of the B. cereus group containing the toxin-producing pXO1 plasmid or anthrax toxin genes specifically.
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30
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Affiliation(s)
- Zhenjun Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China
| | - Jiafu Jiang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China
| | - Yigang Tong
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, PR China
| | - Xiangdong Ruan
- Academy of Forest Inventory and Planning, State Forestry and Grassland Administration, Beijing 100714, PR China
| | - Jianguo Xu
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China
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31
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de Perio MA, Hendricks KA, Dowell CH, Bower WA, Burton NC, Dawson P, Schrodt CA, Salzer JS, Marston CK, Feldmann K, Hoffmaster AR, Antonini JM. Welder’s Anthrax: A Review of an Occupational Disease. Pathogens 2022; 11:pathogens11040402. [PMID: 35456077 PMCID: PMC9029013 DOI: 10.3390/pathogens11040402] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 02/04/2023] Open
Abstract
Since 1997, nine cases of severe pneumonia, caused by species within the B. cereus group and with a presentation similar to that of inhalation anthrax, were reported in seemingly immunocompetent metalworkers, with most being welders. In seven of the cases, isolates were found to harbor a plasmid similar to the B. anthracis pXO1 that encodes anthrax toxins. In this paper, we review the literature on the B. cereus group spp. pneumonia among welders and other metalworkers, which we term welder’s anthrax. We describe the epidemiology, including more information on two cases of welder’s anthrax in 2020. We also describe the health risks associated with welding, potential mechanisms of infection and pathological damage, prevention measures according to the hierarchy of controls, and clinical and public health considerations. Considering occupational risk factors and controlling exposure to welding fumes and gases among workers, according to the hierarchy of controls, should help prevent disease transmission in the workplace.
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Affiliation(s)
- Marie A. de Perio
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226, USA
- Correspondence: or ; Tel.: +1-513-841-4116
| | - Katherine A. Hendricks
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (K.A.H.); (W.A.B.); (C.K.M.); (A.R.H.)
| | - Chad H. Dowell
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226, USA
| | - William A. Bower
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (K.A.H.); (W.A.B.); (C.K.M.); (A.R.H.)
| | - Nancy C. Burton
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA;
| | - Patrick Dawson
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226, USA; (N.C.B.); (K.F.)
| | - Caroline A. Schrodt
- Office of Science, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA;
| | - Johanna S. Salzer
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA;
| | - Chung K. Marston
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (K.A.H.); (W.A.B.); (C.K.M.); (A.R.H.)
| | - Karl Feldmann
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA;
| | - Alex R. Hoffmaster
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (K.A.H.); (W.A.B.); (C.K.M.); (A.R.H.)
| | - James M. Antonini
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA;
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Achtman M, Van den Broeck F, Cooper KK, Lemey P, Parker CT, Zhou Z; ATCC14028s Study Group. Genomic population structure associated with repeated escape of Salmonella enterica ATCC14028s from the laboratory into nature. PLoS Genet 2021; 17:e1009820. [PMID: 34570761 DOI: 10.1371/journal.pgen.1009820] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 10/07/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
Salmonella enterica serovar Typhimurium strain ATCC14028s is commercially available from multiple national type culture collections, and has been widely used since 1960 for quality control of growth media and experiments on fitness (“laboratory evolution”). ATCC14028s has been implicated in multiple cross-contaminations in the laboratory, and has also caused multiple laboratory infections and one known attempt at bioterrorism. According to hierarchical clustering of 3002 core gene sequences, ATCC14028s belongs to HierCC cluster HC20_373 in which most internal branch lengths are only one to three SNPs long. Many natural Typhimurium isolates from humans, domesticated animals and the environment also belong to HC20_373, and their core genomes are almost indistinguishable from those of laboratory strains. These natural isolates have infected humans in Ireland and Taiwan for decades, and are common in the British Isles as well as the Americas. The isolation history of some of the natural isolates confirms the conclusion that they do not represent recent contamination by the laboratory strain, and 10% carry plasmids or bacteriophages which have been acquired in nature by HGT from unrelated bacteria. We propose that ATCC14028s has repeatedly escaped from the laboratory environment into nature via laboratory accidents or infections, but the escaped micro-lineages have only a limited life span. As a result, there is a genetic gap separating HC20_373 from its closest natural relatives due to a divergence between them in the late 19th century followed by repeated extinction events of escaped HC20_373. Clades of closely related bacteria exist in nature. Individual isolates from such clades are often distinguishable by genomic sequencing because genomic sequence differences can be acquired over a few years due to neutral drift and natural selection. The evolution of laboratory strains is often largely frozen, physically due to storage conditions and genetically due to long periods of storage. Thus, laboratory strains can normally be readily distinguished from natural isolates because they show much less diversity. However, laboratory strain ATCC14028s shows modest levels of sequence diversity because it has been shipped around the world to multiple laboratories and is routinely used for analyses of laboratory evolution. Closely related natural isolates also exist, but their genetic diversity is not dramatically greater at the core genome level. Indeed, many scientists doubt that such isolates are natural, and interpret them as undetected contamination by the laboratory strain. We present data indicating that ATCC14028s has repeatedly escaped from the laboratory through inadvertent contamination of the environment, infection of technical staff and deliberate bioterrorism. The escapees survive in nature long enough that some acquire mobile genomic elements by horizontal gene transfer, but eventually they go extinct. As a result, even extensive global databases of natural isolates lack closely related isolates whose ancestors diverged from ATCC14028s within the last 100 years.
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Affiliation(s)
- Dacre Knight
- From the Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida
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Abstract
This commentary encourages the regular archiving of nucleic-acid-stabilized serial samples of wastewaters and/or sewage. Stabilized samples would facilitate retrospective reconstitution of built environments’ biological fluids. Biological time capsules would allow retrospective searches for nucleic acids from viruses such as SARS-CoV-2. Current resources for testing need not be diverted if samples are saved in case they become important in the future. Systematic storage would facilitate investigation into the origin and prevalence of viruses and other agents. Comparison of prevalence data from individual and clinical samplings with community wastewater would allow valuable comparison, contrast and correlation among different testing modalities. Current interest is focused on SARS-CoV-2, but archived samples could become valuable in many contexts including surveys for other infectious and chemical agents whose identity is not currently known. Archived time series of wastewater will take their place alongside other biological repositories and records including those from medical facilities, museums, eDNA, living cell and tissue collections. Together these will prove invaluable records of the evolving Anthropocene.
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Affiliation(s)
- David S Thaler
- Biozentrum, University of Basel, CH-4056, Basel, Switzerland. .,Program for the Human Environment, Rockefeller University, New York, NY, USA. .,Laboratory of Chemical Biology and Signal Transduction, Rockefeller University, New York, NY, USA.
| | - Thomas P Sakmar
- Laboratory of Chemical Biology and Signal Transduction, Rockefeller University, New York, NY, USA
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Adeniran JA, Mohammed IA, Muniru OI, Oloyede T, Sonibare OO, Yusuf MNO, Abdulraheem KA, Odediran ET, Yusuf RO, Sonibare JA. Indoor transmission dynamics of expired SARS-CoV-2 virus in a model African hospital ward. J Environ Health Sci Eng 2021; 19:331-341. [PMID: 33500782 PMCID: PMC7821173 DOI: 10.1007/s40201-020-00606-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/15/2020] [Indexed: 05/05/2023]
Abstract
Cough and sneeze droplets' interactions with indoor air of a typical hospital clinic that could be majorly found in developing African countries were studied to investigate the effectiveness of existing guidelines/protocols being adopted in the control of the widespread coronavirus disease (COVID-19) transmission. The influences of indoor air velocity, the type, size distribution, residence time in air, and trajectory of the droplets, were all considered while interrogating the effectiveness of physical distancing measures, the use of face covers, cautionary activities of the general public, and the plausibility of community spread of the SARS-CoV-2 virus through airborne transmission. Series of 3-D, coupled, discrete phase models (DPM) were implemented in the numerical studies. Based on DPM concentration maps as function of particle positions and particle residence times that were observed under different droplets release conditions, the virus-laden droplets could travel several meters away from the source of release (index patient), with smaller-sized particles staying longer in the air. The behavior of indoor air was also found to indicate complex dynamics as particle transports showed no linear dependence on air velocity. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40201-020-00606-5.
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Affiliation(s)
- Jamiu Adetayo Adeniran
- Environmental Engineering Research Laboratory, Department of Chemical Engineering, University of Ilorin, Ilorin, Nigeria
- Laboratory for Climate and Ocean-Atmosphere Studies, Department of Atmospheric and Oceanic Sciences, School of Physics, Peking University, Beijing, 100871 China
| | - Ishaq Alhassan Mohammed
- Environmental Engineering Research Laboratory, Department of Chemical Engineering, University of Ilorin, Ilorin, Nigeria
| | | | - Taofeek Oloyede
- Department of Internal Medicine, Federal Medical Centre, Katsina, Katsina State Nigeria
| | - Omowonuola Olubukola Sonibare
- Department of Family Medicine, General Out Patient Department, Obafemi Awolowo Teaching Hospital Complex (OAUTHC), Ile-Ife, Osun State Nigeria
| | - Muhammad-Najeeb O. Yusuf
- Environmental Engineering Research Laboratory, Department of Chemical Engineering, University of Ilorin, Ilorin, Nigeria
| | | | - Emmanuel Tolulope Odediran
- Environmental Engineering Research Laboratory, Department of Chemical Engineering, University of Ilorin, Ilorin, Nigeria
| | - Rafiu Olasunkanmi Yusuf
- Environmental Engineering Research Laboratory, Department of Chemical Engineering, University of Ilorin, Ilorin, Nigeria
| | - Jacob Ademola Sonibare
- Environmental Engineering Research Laboratory, Department of Chemical Engineering, Obafemi Awolowo University, Ile-Ife, Nigeria
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Oosterholt SP, Della Pasqua O. Population pharmacokinetics of raxibacumab in healthy adult subjects. Br J Clin Pharmacol 2021; 87:4718-4725. [PMID: 33973655 DOI: 10.1111/bcp.14894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/29/2021] [Accepted: 04/20/2021] [Indexed: 01/24/2023] Open
Abstract
AIMS Raxibacumab is a fully humanized monoclonal antibody that blocks the interaction of Bacillus anthracis toxins, thereby protecting target cells from its effects. Raxibacumab is approved in the USA for the treatment of adults and children with inhalational anthrax in combination with antibiotics, and for prophylaxis of inhalational anthrax. The aim of this investigation was to characterise the population pharmacokinetics and assess the effect of baseline demographic covariates on the disposition of raxibacumab. METHODS The data used for this analysis were obtained from 3 clinical trials and include 2229 blood samples from 322 healthy subjects who were randomised to receive a 40 mg/kg intravenous dose of raxibacumab over a period of 2.25 hours. Population pharmacokinetic modelling was performed using a nonlinear mixed effects approach. Secondary parameters of interest were the area under the curve, maximum concentration and the time of serum raxibacumab concentrations greater than or equimolar to the highest serum protective antigen concentrations observed for at least 28 days in any monkey challenged with B. anthracis that died. RESULTS Raxibacumab exposure in healthy subjects was described by a 2-compartment model. Interindividual variability was estimated for all model parameters, whilst residual variability was described by a proportional and additive error model. Weight was the only influential covariate with significant effect on disposition parameters. CONCLUSIONS A dose of 40 mg/kg provided comparable exposure across the overall healthy subject population. Interindividual variability in raxibacumab vs. time profiles could partially be accounted for by differences in body weight.
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Affiliation(s)
- Sean P Oosterholt
- Clinical Pharmacology & Therapeutics Group, University College London, London, UK
| | - Oscar Della Pasqua
- Clinical Pharmacology & Therapeutics Group, University College London, London, UK.,Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Brentford, UK
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Smith-Keiling BL. Real-World Ethical Dilemmas in Laboratory Safety for Microbiology Under-Resourced and Outreach Teaching. Front Microbiol 2021; 12:589569. [PMID: 33897625 PMCID: PMC8060768 DOI: 10.3389/fmicb.2021.589569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 02/12/2021] [Indexed: 11/13/2022] Open
Abstract
With modernization of safety standards for microbiology outreach teaching laboratories, ethical challenges arise in teaching microbiology for the public good without short-changing students in under-resourced situations, or when institutional support is subpar. Still, educators want students to engage using applied skills for inquiry, research-based microbial learning activities – safely. Following several United States microbial outbreaks, federal investigation traced sources back to teaching laboratories. Policy discussions ensued. The American Society for Microbiology (ASM) Task Force provides recommended but not mandated guidelines; however, guidelines are not amenable by all. Here, a real-world, ethical scenario of a university-level outreach microbiology laboratory course hosted at several locations provides context for under-resourced challenges in safety compliance. In this example of biomedical and public health ethical considerations, upper administration puts the onus on instructors to assure safe labs for their students and the general public. Temporarily hired instructors without curriculum or sufficient institutional support are put in precarious positions with often egregious practices to get the job done. This scenario is examined with different public health ethical frameworks and principles: non-maleficence, beneficence, health maximization, efficiency of policy regulations, respect for institutional and instructor autonomy, justice, and proportionality balancing stakeholder concerns. Sample curricular strategies are employed to mitigate these challenges. Taking a utilitarianism framework of the greatest good for the most benefit, this paper advocates for social justice supporting access to education as a moral duty. Administrations should ensure instructors are supported sufficiently to provide safe, authentic learning experiences. Solutions for under-resourced outreach teaching are needed for public trust.
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Affiliation(s)
- Beverly L Smith-Keiling
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota Medical School and College of Biological Sciences, Minneapolis, MN, United States.,Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States
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Pratt A, Bennett E, Gillard J, Leach S, Hall I. Dose-Response Modeling: Extrapolating From Experimental Data to Real-World Populations. Risk Anal 2021; 41:67-78. [PMID: 32966638 DOI: 10.1111/risa.13597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dose-response modeling of biological agents has traditionally focused on describing laboratory-derived experimental data. Limited consideration has been given to understanding those factors that are controlled in a laboratory, but are likely to occur in real-world scenarios. In this study, a probabilistic framework is developed that extends Brookmeyer's competing-risks dose-response model to allow for variation in factors such as dose-dispersion, dose-deposition, and other within-host parameters. With data sets drawn from dose-response experiments of inhalational anthrax, plague, and tularemia, we illustrate how for certain cases, there is the potential for overestimation of infection numbers arising from models that consider only the experimental data in isolation.
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Affiliation(s)
- Adrian Pratt
- Emergency Response Department, Public Health England, Porton Down, UK
| | - Emma Bennett
- Emergency Response Department, Public Health England, Porton Down, UK
| | - Joseph Gillard
- Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - Steve Leach
- Emergency Response Department, Public Health England, Porton Down, UK
| | - Ian Hall
- Emergency Response Department, Public Health England, Porton Down, UK
- Department of Mathematics, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Papp S, Kimmerl K, Gatz J, Laue M, Grunow R, Kaspari O. Evaluation of Sporicidal Disinfectants for the Disinfection of Personal Protective Equipment During Biological Hazards. Health Secur 2020; 18:36-48. [PMID: 32078425 PMCID: PMC7047094 DOI: 10.1089/hs.2019.0128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A fast, effective, and safe disinfection of personal protective equipment (PPE) is vitally important for emergency forces involved in biological hazards. This study aimed to investigate a broad range of disinfectants to improve the established disinfection procedure. We analyzed the efficacy of chlorine-, peracetic acid–, and oxygen-based disinfectants against Bacillus spores on PPE. Therefore, spores of different Bacillus species were exposed to disinfectants on PPE material by using a standardized procedure covering the dried spores with disinfectants and applying mechanical distribution. Efficacy of disinfectants was quantified by determining the reduction factor (log10 levels) and number of viable spores left afterward. The chlorine-based granulate Hypochlorit CA G (2% chlorine) sufficiently inactivated Bacillus spores of risk groups 1 and 2, even with temperatures ranging from −20 to 35°C. Wofasteril® SC super (1.75% peracetic acid) achieved a reliable reduction of risk groups 1 and 2 and even fully virulent Bacillus spores by ≥5 log10 levels on PPE. With this, Hypochlorit-CA G and Wofasteril® SC super proved to be promising alternatives to the previously proven and widely used peracetic acid compound Wofasteril® (2% peracetic acid) for the disinfection of PPE when bacterial spores are known to be the contaminating agent. These results will help to improve the disinfection of PPE during biological hazards by providing new data on promising alternative compounds. A fast, effective, and safe disinfection of personal protective equipment (PPE) is vitally important for emergency forces involved in biological hazards. This study aimed to investigate a broad range of disinfectants to improve the established disinfection procedure. The authors analyzed the efficacy of chlorine-, peracetic acid-, and oxygen-based disinfectants against Bacillus spores on PPE.
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Affiliation(s)
- Stefanie Papp
- Dr. Stefanie Papp, Katharina Kimmerl, Jacob Gatz, Prof. Dr. Roland Grunow, and Dr. Oliver Kaspari are with the Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2); Dr. Michael Laue is with the Centre for Biological Threats and Special Pathogens, Advanced Light and Electron Microscopy (ZBS 4); all are with the Robert Koch Institute, Berlin, Germany
| | - Katharina Kimmerl
- Dr. Stefanie Papp, Katharina Kimmerl, Jacob Gatz, Prof. Dr. Roland Grunow, and Dr. Oliver Kaspari are with the Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2); Dr. Michael Laue is with the Centre for Biological Threats and Special Pathogens, Advanced Light and Electron Microscopy (ZBS 4); all are with the Robert Koch Institute, Berlin, Germany
| | - Jacob Gatz
- Dr. Stefanie Papp, Katharina Kimmerl, Jacob Gatz, Prof. Dr. Roland Grunow, and Dr. Oliver Kaspari are with the Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2); Dr. Michael Laue is with the Centre for Biological Threats and Special Pathogens, Advanced Light and Electron Microscopy (ZBS 4); all are with the Robert Koch Institute, Berlin, Germany
| | - Michael Laue
- Dr. Stefanie Papp, Katharina Kimmerl, Jacob Gatz, Prof. Dr. Roland Grunow, and Dr. Oliver Kaspari are with the Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2); Dr. Michael Laue is with the Centre for Biological Threats and Special Pathogens, Advanced Light and Electron Microscopy (ZBS 4); all are with the Robert Koch Institute, Berlin, Germany
| | - Roland Grunow
- Dr. Stefanie Papp, Katharina Kimmerl, Jacob Gatz, Prof. Dr. Roland Grunow, and Dr. Oliver Kaspari are with the Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2); Dr. Michael Laue is with the Centre for Biological Threats and Special Pathogens, Advanced Light and Electron Microscopy (ZBS 4); all are with the Robert Koch Institute, Berlin, Germany
| | - Oliver Kaspari
- Dr. Stefanie Papp, Katharina Kimmerl, Jacob Gatz, Prof. Dr. Roland Grunow, and Dr. Oliver Kaspari are with the Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2); Dr. Michael Laue is with the Centre for Biological Threats and Special Pathogens, Advanced Light and Electron Microscopy (ZBS 4); all are with the Robert Koch Institute, Berlin, Germany
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Mikelonis AM, Ratliff K, Youn S. Laboratory results and mathematical modeling of spore surface interactions in stormwater runoff. J Contam Hydrol 2020; 235:103707. [PMID: 32916588 PMCID: PMC7704712 DOI: 10.1016/j.jconhyd.2020.103707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
Development of numerical models to predict stormwater-mediated transport of pathogenic spores in the environment depends on an understanding of adhesion forces that dictate detachment after rain events. Zeta potential values were measured in the laboratory for Bacillus globigii and Bacillus thuringiensis kurstaki, two common surrogates used to represent Bacillus anthracis, in synthetic baseline ultrapure water and laboratory prepared stormwater. Zeta potential curves were also determined for materials representative of urban infrastructure (concrete and asphalt). These data were used to predict the interaction energy between the spores and urban materials using Derjaguin-Landau-Verwey-Overbeek (DLVO) modeling. B. globigii and B. thuringiensis kurstaki sourced from Yakibou Inc., were found to have similar zeta potential curves, whereas spores sourced from the U.S. military's Dugway laboratory were found to diverge. In the ultrapure water, the modeling results use the laboratory data to demonstrate that the energy barriers between the spores and the urban materials were tunable through compression of the electrical double layer of the spores via changes of ionic strength and pH of the water. In the runoff water, charge neutralization dominated surface processes. The cations, metals, and natural organic matter (NOM) in the runoff water contributed to equalizing the zeta potential values for Dugway B. globigii and B. thuringiensis kurstaki, and drastically modified the surface of the concrete and asphalt. All DLVO energy curves using the runoff water were repulsive. The highest energy barrier predicted in this study was for Dugway B. globigii spores interacting with a concrete surface in runoff water, suggesting that this would be the most challenging combination to detach through water-based decontamination.
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Affiliation(s)
- Anne M Mikelonis
- Office of Research and Development, Center for Environmental Solutions and Emergency Response, Homeland Security and Materials Management Division, U.S. Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA.
| | - Katherine Ratliff
- Office of Research and Development, Center for Environmental Solutions and Emergency Response, Homeland Security and Materials Management Division, U.S. Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Sungmin Youn
- Marshall University, Department of Civil Engineering, College of Engineering and Computer Sciences, 1 John Marshall Drive, Huntington, WV 25755, United States
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Abstract
Infectious diseases prevalent in humans and animals are caused by pathogens that once emerged from other animal hosts. In addition to these established infections, new infectious diseases periodically emerge. In extreme cases they may cause pandemics such as COVID-19; in other cases, dead-end infections or smaller epidemics result. Established diseases may also re-emerge, for example by extending geographically or by becoming more transmissible or more pathogenic. Disease emergence reflects dynamic balances and imbalances, within complex globally distributed ecosystems comprising humans, animals, pathogens, and the environment. Understanding these variables is a necessary step in controlling future devastating disease emergences.
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Affiliation(s)
- David M Morens
- Office of the Director, National Institute of Allergy & Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
| | - Anthony S Fauci
- Office of the Director, National Institute of Allergy & Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Manish M, Verma S, Kandari D, Kulshreshtha P, Singh S, Bhatnagar R. Anthrax prevention through vaccine and post-exposure therapy. Expert Opin Biol Ther 2020; 20:1405-1425. [DOI: 10.1080/14712598.2020.1801626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Manish Manish
- Laboratory of Molecular Biology and Genetic Engineering, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Shashikala Verma
- Centre of Experimental Medicine & Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Divya Kandari
- Laboratory of Molecular Biology and Genetic Engineering, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Parul Kulshreshtha
- Department of Zoology, Shivaji College, University of Delhi, Delhi, India
| | - Samer Singh
- Centre of Experimental Medicine & Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
- Department of Microbial Biotechnology, Panjab University, Chandigarh, India
| | - Rakesh Bhatnagar
- Laboratory of Molecular Biology and Genetic Engineering, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
- Centre of Experimental Medicine & Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Patel VI, Booth JL, Dozmorov M, Brown BR, Metcalf JP. Anthrax Edema and Lethal Toxins Differentially Target Human Lung and Blood Phagocytes. Toxins (Basel) 2020; 12:toxins12070464. [PMID: 32698436 PMCID: PMC7405021 DOI: 10.3390/toxins12070464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/26/2022] Open
Abstract
Bacillus anthracis, the causative agent of inhalation anthrax, is a serious concern as a bioterrorism weapon. The vegetative form produces two exotoxins: Lethal toxin (LT) and edema toxin (ET). We recently characterized and compared six human airway and alveolar-resident phagocyte (AARP) subsets at the transcriptional and functional levels. In this study, we examined the effects of LT and ET on these subsets and human leukocytes. AARPs and leukocytes do not express high levels of the toxin receptors, tumor endothelium marker-8 (TEM8) and capillary morphogenesis protein-2 (CMG2). Less than 20% expressed surface TEM8, while less than 15% expressed CMG2. All cell types bound or internalized protective antigen, the common component of the two toxins, in a dose-dependent manner. Most protective antigen was likely internalized via macropinocytosis. Cells were not sensitive to LT-induced apoptosis or necrosis at concentrations up to 1000 ng/mL. However, toxin exposure inhibited B. anthracis spore internalization. This inhibition was driven primarily by ET in AARPs and LT in leukocytes. These results support a model of inhalation anthrax in which spores germinate and produce toxins. ET inhibits pathogen phagocytosis by AARPs, allowing alveolar escape. In late-stage disease, LT inhibits phagocytosis by leukocytes, allowing bacterial replication in the bloodstream.
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Affiliation(s)
- Vineet I. Patel
- Department of Medicine, Pulmonary, Critical Care & Sleep Medicine, the University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (V.I.P.); (J.L.B.); (B.R.B.)
| | - J. Leland Booth
- Department of Medicine, Pulmonary, Critical Care & Sleep Medicine, the University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (V.I.P.); (J.L.B.); (B.R.B.)
| | - Mikhail Dozmorov
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - Brent R. Brown
- Department of Medicine, Pulmonary, Critical Care & Sleep Medicine, the University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (V.I.P.); (J.L.B.); (B.R.B.)
| | - Jordan P. Metcalf
- Department of Medicine, Pulmonary, Critical Care & Sleep Medicine, the University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (V.I.P.); (J.L.B.); (B.R.B.)
- Department of Microbiology and Immunology, the University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Veterans Affairs Medical Center, Oklahoma City, OK 73104, USA
- Correspondence:
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Popescu NI, Keshari RS, Cochran J, Coggeshall KM, Lupu F. C3 Opsonization of Anthrax Bacterium and Peptidoglycan Supports Recognition and Activation of Neutrophils. Microorganisms 2020; 8:E1039. [PMID: 32668703 PMCID: PMC7409185 DOI: 10.3390/microorganisms8071039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/08/2020] [Accepted: 07/11/2020] [Indexed: 12/01/2022] Open
Abstract
Neutrophils are the most abundant innate cell population and a key immune player against invading pathogens. Neutrophils can kill both bacterium and spores of Bacillus anthracis, the causative anthrax pathogen. Unlike interactions with professional phagocytes, the molecular recognition of anthrax by neutrophils is largely unknown. In this study, we investigated the role of complement C3 deposition on anthrax particles for neutrophil recognition of bacterium and/or its cell wall peptidoglycan, an abundant pathogen-associated molecular pattern that supports anthrax sepsis. C3 opsonization and recognition by complement receptors accounted for 70-80% of the affinity interactions between neutrophils and anthrax particles at subphysiologic temperatures. In contrast, C3 supported up to 50% of the anthrax particle ingestion under thermophysiologic conditions. Opsonin-dependent low affinity interactions and, to a lower extent, opsonin-independent mechanisms, provide alternative entry routes. Similarly, C3 supported 58% of peptidoglycan-induced degranulation and, to a lower extent, 23% of bacterium-induced degranulation. Interestingly, an opsonin independent mechanism mediated by complement C5, likely through C5a anaphylatoxin, primes azurophilic granules in response to anthrax particles. Overall, we show that C3 deposition supports anthrax recognition by neutrophils but is dispensable for pathogen ingestion and neutrophil degranulation, highlighting immune recognition redundancies that minimize the risk of pathogen evasion.
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Affiliation(s)
- Narcis I. Popescu
- Department of Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA; (J.C.); (K.M.C.)
| | - Ravi S. Keshari
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA;
| | - Jackie Cochran
- Department of Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA; (J.C.); (K.M.C.)
| | - K. Mark Coggeshall
- Department of Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA; (J.C.); (K.M.C.)
| | - Florea Lupu
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA;
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Taft SC, Nichols TL, Hines SA, Barnewall RE, Stark GV, Comer JE. Physiological Responses to a Single Low-Dose of Bacillus anthracis Spores in the Rabbit Model of Inhalational Anthrax. Pathogens 2020; 9:E461. [PMID: 32545184 DOI: 10.3390/pathogens9060461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 11/25/2022] Open
Abstract
Credible dose–response relationships are needed to more accurately assess the risk posed by exposure to low-level Bacillus anthracis contamination during or following a release. To begin to fill this knowledge gap, New Zealand White rabbits were implanted with D70-PCT telemetry transmitters and subsequently aerosol challenged with average inhaled doses of 2.86 × 102 to 2.75 × 105 colony forming units (CFU) of B. anthracis spores. Rabbits exposed to a single inhaled dose at or above 2.54 × 104 CFU succumbed with dose-dependent time to death. Death was associated with increases above baseline in heart rate, respiration rate, and body temperature and all rabbits that died exhibited bacteremia at some point prior to death. Rabbits that inhaled doses of 2.06 × 103 CFU or lower survived to the end of the study and showed no or minimal adverse changes in the measured physiological responses in response to the challenge. Moreover, no bacteremia nor toxemia were observed in rabbits that survived to the end of the study. Overall, the data indicate that challenge doses of B. anthracis below the level sufficient to establish systemic infection do not produce observable physiological responses; however, doses that triggered a response resulted in death.
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FINKE ERNSTJÜRGEN, BEYER WOLFGANG, LODERSTÄDT ULRIKE, FRICKMANN HAGEN. Review: The risk of contracting anthrax from spore-contaminated soil - A military medical perspective. Eur J Microbiol Immunol (Bp) 2020; 10:29-63. [PMID: 32590343 PMCID: PMC7391381 DOI: 10.1556/1886.2020.00008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/10/2020] [Indexed: 12/31/2022] Open
Abstract
Anthrax is an infectious disease of relevance for military forces. Although spores of Bacillus anthracis obiquitously occur in soil, reports on soil-borne transmission to humans are scarce. In this narrative review, the potential of soil-borne transmission of anthrax to humans is discussed based on pathogen-specific characteristics and reports on anthrax in the course of several centuries of warfare. In theory, anthrax foci can pose a potential risk of infection to animals and humans if sufficient amounts of virulent spores are present in the soil even after an extended period of time. In praxis, however, transmissions are usually due to contacts with animal products and reported events of soil-based transmissions are scarce. In the history of warfare, even in the trenches of World War I, reported anthrax cases due to soil-contaminated wounds are virtually absent. Both the perspectives and the experience of the Western hemisphere and of former Soviet Republics are presented. Based on the accessible data as provided in the review, the transmission risk of anthrax by infections of wounds due to spore-contaminated soil is considered as very low under the most circumstance. Active historic anthrax foci may, however, still pose a risk to the health of deployed soldiers.
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Affiliation(s)
| | - WOLFGANG BEYER
- Department of Infectiology and Animal Hygiene, University of Hohenheim, Institute of Animal Science, Stuttgart, Germany
| | - ULRIKE LODERSTÄDT
- Diagnostic Department, Bernhard-Nocht-Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - HAGEN FRICKMANN
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
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Chen X, Bahl P, de Silva C, Heslop D, Doolan C, Lim S, MacIntyre CR. Systematic Review and Evaluation of Mathematical Attack Models of Human Inhalational Anthrax for Supporting Public Health Decision Making and Response. Prehosp Disaster Med 2020; 35:412-9. [PMID: 32495728 DOI: 10.1017/S1049023X20000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Anthrax is a potential biological weapon and can be used in an air-borne or mail attack, such as in the attack in the United States in 2001. Planning for such an event requires the best available science. Since large-scale experiments are not feasible, mathematical modelling is a crucial tool to inform planning. The aim of this study is to systematically review and evaluate the approaches to mathematical modelling of inhalational anthrax attack to support public health decision making and response. METHODS A systematic review of inhalational anthrax attack models was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The models were reviewed based on a set of defined criteria, including the inclusion of atmospheric dispersion component and capacity for real-time decision support. RESULTS Of 13 mathematical modelling studies of human inhalational anthrax attacks, there were six studies that took atmospheric dispersion of anthrax spores into account. Further, only two modelling studies had potential utility for real-time decision support, and only one model was validated using real data. CONCLUSION The limited modelling studies available use widely varying methods, assumptions, and data. Estimation of attack size using different models may be quite different, and is likely to be under-estimated by models which do not consider weather conditions. Validation with available data is crucial and may improve models. Further, there is a need for both complex models that can provide accurate atmospheric dispersion modelling, as well as for simpler modelling tools that provide real-time decision support for epidemic response.
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Gainer RS, Vergnaud G, Hugh-Jones ME. A Review of Arguments for the Existence of Latent Infections of Bacillus anthracis, and Research Needed to Understand their Role in the Outbreaks of Anthrax. Microorganisms 2020; 8:E800. [PMID: 32466551 DOI: 10.3390/microorganisms8060800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 11/17/2022] Open
Abstract
Hugh-Jones and Blackburn and Turnbull’s collective World Health Organization (WHO) report did literature reviews of the theories and the bases for causes of anthrax outbreaks. Both comment on an often-mentioned suspicion that, even though unproven, latent infections are likely involved. Hugh-Jones suggested Gainer do an updated review of our present-day knowledge of latent infections, which was the basis for Gainer’s talk at the Biology of Anthrax Conference in Bari, Italy 2019. At the Conference Gainer met Vergnaud who presented anthrax genome studies that implied that the disease might have spread throughout Asia and from Europe to North America in a short time span of three or four centuries. Vergnaud wondered if latent infections might have played a role in the process. Several other presenters at the Conference also mentioned results that might suggest the existence of latent infections. Vergnaud subsequently looked into some of the old French literature about related observations, results, and discussions of early Pasteur vaccine usage (late 1800′s) and found mentions of suspected latent infections. The first part of the paper is a focused summary and interpretation of Hugh-Jones and Blackburn’s and Turnbull’s reviews specifically looking for suggestions of latent infections, a few additional studies with slightly different approaches, and several mentions made of presentations and posters at the Conference in Italy. In general, many different investigators in different areas and aspects of the anthrax study at the Conference found reasons to suspect the existence of latent infections. The authors conclude that the affected species most studied, including Homo sapiens, provide circumstantial evidence of latent infections and modified host resistance. The last part of the review explores the research needed to prove or disprove the existence of latent infections.
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Abstract
The Bacillus cereus group includes several Bacillus species with closely related phylogeny. The most well-studied members of the group, B. anthracis, B. cereus, and B. thuringiensis, are known for their pathogenic potential. Here, we present the historical rationale for speciation and discuss shared and unique features of these bacteria. Aspects of cell morphology and physiology, and genome sequence similarity and gene synteny support close evolutionary relationships for these three species. For many strains, distinct differences in virulence factor synthesis provide facile means for species assignment. B. anthracis is the causative agent of anthrax. Some B. cereus strains are commonly recognized as food poisoning agents, but strains can also cause localized wound and eye infections as well as systemic disease. Certain B. thuringiensis strains are entomopathogens and have been commercialized for use as biopesticides, while some strains have been reported to cause infection in immunocompromised individuals. In this article we compare and contrast B. anthracis, B. cereus, and B. thuringiensis, including ecology, cell structure and development, virulence attributes, gene regulation and genetic exchange systems, and experimental models of disease.
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Hidalgo J, Woc-Colburn L. Zoonotic Infections and Biowarfare Agents in Critical Care: Anthrax, Plague, and Tularemia. Highly Infectious Diseases in Critical Care 2020. [PMCID: PMC7122055 DOI: 10.1007/978-3-030-33803-9_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Bacterial zoonotic infections are rare in developed countries in the twenty-first century but may cause major morbidity and mortality in developing regions of the world. In addition, their potential use as biological weapons makes early recognition and effective empiric therapy important for the critical care practitioner. Anthrax, plague, and tularemia share overlapping presenting syndromes, including fulminant respiratory infections and less severe but still highly morbid lymphocutaneous infections. Although all three may be transmitted as infectious aerosols, only plague has a risk of direct human-to-human transmission. Diagnostic testing will require special precautions for laboratory staff and most often involvement of regional and national reference laboratories. Empiric therapy with aminoglycosides may be life-saving for plague and tularemia, while the treatment of anthrax is complex and varies depending on the site of infection. In outbreaks or for post-exposure prophylaxis, treatment with doxycycline or a fluoroquinolone is recommended for all three diseases.
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Affiliation(s)
- Jorge Hidalgo
- Division of Critical Care, Karl Heusner Memorial Hospital, Belize City, Belize
| | - Laila Woc-Colburn
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX USA
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