Arnold F. Kaufmann

Outbreak of leptospirosis associated with swimming

Between July 7 and 18, 1991, five boys from a small town in rural Illinois experienced the onset of an acute febrile illness subsequently confirmed as leptospirosis by serologic tests. A cohort study found that swimming in a small swimming hole, Steel Tunnel Pond, was associated with disease (P < 0.01), the attack rate being 28%. Leptospira interrogans serovar grippotyphosa was isolated from urine cultures from two of the case patients and from a culture of Steel Tunnel Pond water. A high seroprev-alence for grippotyphosa was found in animals near the pond. Drought conditions had been present in the month before the outbreak, creating an environment in the pond which probably facilitated transmission of the organism from area animals to humans. Although leptospirosis is infrequently reported in humans in the United States, it is endemic in animals and the potential for outbreaks exists, especially when environmental conditions are favorable.

Epidemiologic Responses to Anthrax Outbreaks: A Review of Field Investigations, 1950–2001

We used unpublished reports, published manuscripts, and communication with investigators to identify and summarize 49 anthrax-related epidemiologic field investigations conducted by the Centers for Disease Control and Prevention from 1950 to August 2001. Of 41 investigations in which Bacillus anthracis caused human or animal disease, 24 were in agricultural settings, 11 in textile mills, and 6 in other settings. Among the other investigations, two focused on building decontamination, one was a response to bioterrorism threats, and five involved other causes. Knowledge gained in these investigations helped guide the public health response to the October 2001 intentional release of B. anthracis, especially by addressing the management of anthrax threats, prevention of occupational anthrax, use of antibiotic prophylaxis in exposed persons, use of vaccination, spread of B. anthracis spores in aerosols, clinical diagnostic and laboratory confirmation methods, techniques for environmental sampling of exposed surfaces, and methods for decontaminating buildings.

AIRBORNE SPREAD OF BRUCELLOSIS

review of epidemic and endemic brucellosis at six abattoirs demonstrates a correlation between case distribution and flow of air from the kill department (stage II) to other areas within an abattoir. Air from the kill department disseminated to nearby departments led to abnormally high brucellosis attack rates for persons who worked in these areas at two abattoirs. Complete physical separation or maintaining negative air pressure in the kill department was associated with reduced risk for workers in other areas at four abattoirs. Cases in persons who had exposure to kill department air but no contact with animal tissues provide strong evidence for airborne transmission of infection. Brucellosis is also contracted through skin contact with infectious animal tissues, but this route of transmission appears less important than formerly believed.

Pneumonic tularemia on Martha's Vineyard.

IN the United States tularemia occurs in both sporadic and epidemic forms.1 2 3 Although ulceroglandular tularemia is readily diagnosed, pneumonic tularemia is difficult to detect in the absence of...

Bacillus anthracis incident, Kameido, Tokyo, 1993.

In July 1993, a liquid suspension of Bacillus anthracis was aerosolized from the roof of an eight-story building in Kameido, Tokyo, Japan, by the religious group Aum Shinrikyo. During 1999 to 2001, microbiologic tests were conducted on a liquid environmental sample originally collected during the 1993 incident. Nonencapsulated isolates of B. anthracis were cultured from the liquid. Multiple-locus, variable-number tandem repeat analysis found all isolates to be identical to a strain used in Japan to vaccinate animals against anthrax, which was consistent with the Aum Shinrikyo members’ testimony about the strain source. In 1999, a retrospective case-detection survey was conducted to identify potential human anthrax cases associated with the incident, but none were found. The use of an attenuated B. anthracis strain, low spore concentrations, ineffective dispersal, a clogged spray device, and inactivation of the spores by sunlight are all likely contributing factors to the lack of human cases.

Effects of Long-Term Storage on Plasmid Stability in Bacillus anthracis

ABSTRACT The plasmid profiles of 619 cultures of Bacillus anthracis which had been isolated and stored between 1954 and 1989 were analyzed using the Laboratory Response Network real-time PCR assay targeting a chromosomal marker and both virulence plasmids (pXO1 and pXO2). The cultures were stored at ambient temperature on tryptic soy agar slants overlaid with mineral oil. When data were stratified by decade, there was a decreasing linear trend in the proportion of strains containing both plasmids with increased storage time (P < 0.001). There was no significant difference in the proportion of strains containing only pXO1 or strains containing only pXO2 (P = 0.25), but there was a statistical interdependence between the two plasmids (P = 0.004). Loss of viability of B. anthracis cultures stored on agar slants is also discussed.

Psittacosis. A diagnostic challenge.

In the absence of recognized pneumonitis, psittacosis is unlikely to be considered as a cause of infection in patients with febrile illnesses. To identify findings useful in the diagnosis of psittacosis, the clinical and roentgenographic characteristics of 46 cases that occurred in two outbreaks among workers in turkey processing plants were reviewed. Headache (96% of patients), chills (93% of patients), and fever (89% of patients) were the most common symptoms; a nonproductive cough occurred in 65% of patients. Rales or rhonchi were detected in only six (18%) of 33 patients examined, but 21 (72%) of 29 patients receiving a chest film had roentgenographic evidence of pneumonia. We conclude that few diagnostically useful symptoms or signs occur in patients with psittacosis but that roentgenographically confirmed pneumonitis may occur commonly in patients with little clinical evidence of pneumonitis. A history of exposure to birds, in an individual with a flu-like illness, appears to be the single best clue to the diagnosis of psittacosis.

Age as a risk factor for cutaneous human anthrax: evidence from Haiti, 1973-1974.

To the Editor: Few cases of anthrax have been reported in children, in part because most exposures to Bacillus anthracis occur in workplace settings. Questions about the susceptibility of children to B. anthracis infection were raised when cutaneous anthrax developed in a 7-month-old child in New York City in 2001 after he was taken to visit his mother’s workplace (1). No cases of anthrax were reported in persons <24 years of age in the 1979 inhalational anthrax outbreak in the Soviet city of Sverdlovsk, despite a presumed general population exposure (2). Such reports have led some investigators to postulate that young persons may be less susceptible to anthrax than older persons.

The Kameido Anthrax Incident: A Microbial Forensics Case Study

Publisher Summary This chapter illustrates the Kameido Anthrax incident. The Aum Shinrikyo, a Japanese religious sect, attacked the Tokyo subway system with sarin, a chemical nerve agent. Subsequent investigations revealed that the sect had also attempted to develop and utilize biological weapons. In mid-1993, a bioterrorist attack with an aerosol containing Bacillus anthracis spores was launched in Kameido, Japan. On June 29–30, 1993, complaints about foul odors were registered with local environmental health authorities in Kameido in the Tokyo metropolitan area. The odors originated from the eight-story headquarters building of the Aum Shinrikyo. Some of the exposed persons reported appetite loss, nausea, and vomiting. Birds and pets were also reportedly ill, but the nature of these illnesses was not defined. Police investigations of the sarin attack on the Tokyo subway system revealed that the Aum Shinrikyo was also involved in bioterrorism. Following the conservative Japanese policy of not revealing criminal evidence until the time of trial in court, the true nature of the Kameido incident was first disclosed to the public in May 1996. Aum Shinrikyo members had confessed that the odors resulted from efforts to aerosolize a liquid suspension of B. anthracis spores. The motive was to trigger an inhalational anthrax epidemic and a subsequent world war. The war would culminate in the Aum Shinrikyo members becoming a super-race that would rule the world in accord with Asaharas preaching.

The Kameido Anthrax Incident

Publisher Summary This chapter illustrates the Kameido Anthrax incident. The Aum Shinrikyo, a Japanese religious sect, attacked the Tokyo subway system with sarin, a chemical nerve agent. Subsequent investigations revealed that the sect had also attempted to develop and utilize biological weapons. In mid-1993, a bioterrorist attack with an aerosol containing Bacillus anthracis spores was launched in Kameido, Japan. On June 29–30, 1993, complaints about foul odors were registered with local environmental health authorities in Kameido in the Tokyo metropolitan area. The odors originated from the eight-story headquarters building of the Aum Shinrikyo. Some of the exposed persons reported appetite loss, nausea, and vomiting. Birds and pets were also reportedly ill, but the nature of these illnesses was not defined. Police investigations of the sarin attack on the Tokyo subway system revealed that the Aum Shinrikyo was also involved in bioterrorism. Following the conservative Japanese policy of not revealing criminal evidence until the time of trial in court, the true nature of the Kameido incident was first disclosed to the public in May 1996. Aum Shinrikyo members had confessed that the odors resulted from efforts to aerosolize a liquid suspension of B. anthracis spores. The motive was to trigger an inhalational anthrax epidemic and a subsequent world war. The war would culminate in the Aum Shinrikyo members becoming a super-race that would rule the world in accord with Asaharas preaching.