CHAPTER 23 James W. Snyder1 and Michael A. Pentella2 1 Department of Pathology and Laboratory Medicine, University of Louisville Hospital and School of Medicine, Louisville, KY, USA 2 Masssachusetts Department of Public Health, Boston, MA, USA Ever since the anthrax attacks of 2001, known as Amerithrax, it has been recognized that diagnostic clinical laboratories are the first tier of an integrated response system of laboratories whose role is the early detection of biological agents, and rapid ruling out or referral of suspicious agents based on the use of standardized testing guidelines. Diagnostic laboratories are on the front line of the laboratory system that serves to protect the nation from the use of biological weapons. As a result of the emergency preparedness initiatives that have occurred nationally, there are strong linkages between clinical laboratories, public health laboratories, local government administration, and public health experts nationwide. This chapter is devoted to an overview of test systems in clinical microbiology that may be used to rule out microorganisms that might be suspected as agents of bioterrorism. Automated blood culture systems may be used to detect some biothreat agents and usually within a 5-day incubation protocol. The use of commercially available kits or automated test systems is not recommended for the identification of potential biothreat agents. This recommendation is based on the inability of some kits and automated systems to accurately identify these agents and because of the safety risk to the clinical laboratorian who may handle the potential biothreat agent without the benefit of adequate safety precautions. Diagnostic laboratories must partner with their nearest Laboratory Response Network (LRN) reference laboratory to complete the identification of the potential biothreat agent. In most instances, the LRN reference laboratory is the state public health laboratory. The Germ Theory of Disease, which explains how microorganisms invade the body and cause certain diseases, was unknown prior to the 19th century but use of biological weapons, in the form of microbial pathogens or toxins, dates back to the ancient Greeks and Romans. Prior to the 20th century, these weapons were used exclusively in military operations, commonly known as biowarfare, defined as the “intentional or threatened use of bacteria, fungi, or toxins from living organisms to produce death or disease in humans, animals, and plants,” and involves “intimidation of nations or people to accomplish political or social ends,” and targeted military personnel and supplies [7]. Although crude in nature, the weapons were used in three ways: (i) to poison or contaminate the enemy’s water and food supplies; (ii) expose the enemy to infectious agents and/or toxins using delivery systems such as catapults and arrows; or (iii) distributing biologically infected fomites (blankets, clothing previously used by or in contact with infected individuals) to transmit disease [8]. In 700 BC, the Assyrians intentionally poisoned water wells with rye ergot, a fungal mycotoxin; the Tartars, in the 1300s, catapulted plague-infected corpses over the walls of Kaffe (Crimera), resulting in infected residents leaving the city, which is believed to be responsible for the origin of the “Black Death” epidemic in Europe [11]. In 1710, the Russians catapulted plague-containing cadavers into the city of Reval, Estonia, and in 1785 the Tunisian Moslem military forces catapulted plague-infected clothing into the city of La Calle [8]. A chronological summary of biological warfare events from the 18th century to the present is summarized in Table 23.1. Table 23.1 Chronological examples of biological warfare events from the 18th century to present Beginning in the 19th century, the use of biowarfare became more sophisticated as a result of Koch’s postulates, which led to a better understanding of infectious diseases, specific microbial pathogens, and transmission of disease [6]. Significant developments in microbiology, especially the culturing of microorganisms, led to organism identification and association of agents with specific diseases. In both World Wars, the more developed nations advanced the use of biological agents through experimentation, refinement, and the capability to target their enemies in both overt and covert operations. During the first half of the 20th century, the military was the primary state-sponsored agency to use biological agents as weapons on a worldwide basis. Although the United States discontinued research and development of biological agents for offensive purposes in 1972 in support of the Biological Toxin Weapons Convention, and focused on a defensive strategy such as the development of vaccines, antibiotics, and protective measures, other countries, particularly the former USSR, continued to support and conduct research for offensive purposes through the program known as Biopreparat [8]. The threat of biological and chemical agents was a major concern for the US and coalition forces during Operation Desert Shield following the invasion of Kuwait by Iraq in 1990, and again in 2003 with Operation Iraqi Freedom. Although intelligence reports indicated that the Iraqi regime had an active biological and chemical program, no physical evidence was discovered before or during this period of military operations. With improvements and advances in the understanding in how to maximize the use of infectious agents or their byproducts combined with the availability of advanced equipment to produce and release agents to commit acts of bioterrorism, the period between 1980 and 1990 was still regarded as “crude rather than advanced terrorism.” For example, although later repudiated, a primitive laboratory located in a Red Army Faction “safe house” in Paris was alleged to contain a bathtub in which was stored containers filled with botulinum toxin [8]. In 1984 in Dulles, Oregon, a cult, the Rajneesh, for the purpose of influencing the outcome of local elections, purposely contaminated salad bars with Salmonella typhimurium. The objective was to prevent local citizens from voting in the local election. Although no deaths were recorded, 750 individuals were infected with 40 requiring hospitalization [8,10]. On several occasions a Japanese cult, Aum Shinrikhyo, attempted to release and disperse anthrax, botulinum toxin, Coxiella burnetti,
Bioterrorism
23.1 Introduction
23.2 History of bioterrorism
Year/event
Biological warfare example
1763
French and Indian War: British provide Native Americans with blankets from smallpox patients
1797
Intentional flooding of the plains adjacent to Mantua, Italy by Napoleon to facilitate the spread of malaria
1863
The sale of clothing from yellow fever and smallpox patients to Union troops by Confederate military personnel
World War I
German and French Agents use agents of anthrax and glanders
World War II
Japanese use agents of anthrax, plague and other diseases
Germans use anthrax on United States military personnel
1984
Spraying of Salmonella on salad bars in Dulles, Oregon by members of the Rajneesh Cult
2001
Letters laced with anthrax spores mailed to NBC News, American Media and office of Senator Tom Daschle
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
