The critical role of pathology in the investigation of bioterrorism-related cutaneous anthrax.
Cutaneous anthrax is a rare zoonotic disease in the United States. The clinical diagnosis traditionally has been established by conventional microbiological methods, such as culture and gram staining. However, these methods often yield negative results when patients have received antibiotics. During the bioterrorism event of 2001, we applied two novel immunohistochemical assays that can detect Bacillus anthracis antigens in skin biopsy samples even after prolonged antibiotic treatment. These assays provided a highly sensitive and specific method for the diagnosis of cutaneous anthrax, and were critical in the early and rapid diagnosis of 8 of 11 cases of cutaneous anthrax during the outbreak investigation. Skin biopsies were obtained from 10 of these 11 cases, and histopathological findings included various degrees of ulceration, hemorrhage, edema, coagulative necrosis, perivascular inflammation, and vasculitis. Serology was also an important investigation tool, but the results required several weeks because of the need to test paired serum specimens. Other tests, including culture, special stains, and polymerase chain reaction assay, were less valuable in the diagnosis and epidemiological investigation of these cutaneous anthrax cases. This report underscores the critical role of pathology in investigating potential bioterrorism events and in guiding epidemiological studies, a role that was clearly demonstrated in 2001 when B. anthracis spores were intentionally released through the United States postal system.
Infectious Disease Pathology Activity, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Wun-Ju
WJ
Shieh
Jeannette
J
Guarner
Christopher
C
Paddock
Patricia
P
Greer
Kathleen
K
Tatti
Marc
M
Fischer
Marci
M
Layton
Michael
M
Philips
Eddy
E
Bresnitz
Conrad P
CP
Quinn
Tanja
T
Popovic
Bradley A
BA
Perkins
Sherif R
SR
Zaki
D000328:Adult; D000818:Animals; D000881:Anthrax / Q000382:microbiology / Q000473:pathology*; D001408:Bacillus anthracis / Q000302:isolation & purification*; D001706:Biopsy; D023482:Bioterrorism; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D017192:Skin Diseases, Bacterial / Q000382:microbiology / Q000473:pathology*