title: Rapidly progressive, fatal, inhalation anthrax-like infection in a human: case report, pathogen genome sequencing, pathology, and coordinated response.
abstract: BACKGROUND
  Ten years ago a bioterrorism event involving Bacillus anthracis spores captured the nation's interest, stimulated extensive new research on this pathogen, and heightened concern about illegitimate release of infectious agents. Sporadic reports have described rare, fulminant, and sometimes fatal cases of pneumonia in humans and nonhuman primates caused by strains of Bacillus cereus , a species closely related to Bacillus anthracis.
  
  
  OBJECTIVE
  To describe and investigate a case of rapidly progressive, fatal, anthrax-like pneumonia and the overwhelming infection caused by a Bacillus species of uncertain provenance in a patient residing in rural Texas.
  
  
  METHODS
  We characterized the genome of the causative strain within days of its recovery from antemortem cultures using next-generation sequencing and performed immunohistochemistry on tissues obtained at autopsy with antibodies directed against virulence proteins of B anthracis and B cereus.
  
  
  RESULTS
  We discovered that the infection was caused by a previously unknown strain of B cereus that was closely related to, but genetically distinct from, B anthracis . The strain contains a plasmid similar to pXO1, a genetic element encoding anthrax toxin and other known virulence factors. Immunohistochemistry demonstrated that several homologs of B anthracis virulence proteins were made in infected tissues, likely contributing to the patient's death.
  
  
  CONCLUSIONS
  Rapid genome sequence analysis permitted us to genetically define this strain, rule out the likelihood of bioterrorism, and contribute effectively to the institutional response to this event. Our experience strongly reinforced the critical value of deploying a well-integrated, anatomic, clinical, and genomic strategy to respond rapidly to a potential emerging, infectious threat to public health.
authors: Department of Pathology and Laboratory Medicine, The Methodist Hospital System, Houston, Texas, USA.
authors: Angela M
authors: AM
authors: Wright
authors: Stephen B
authors: SB
authors: Beres
authors: Erin N
authors: EN
authors: Consamus
authors: S Wesley
authors: SW
authors: Long
authors: Anthony R
authors: AR
authors: Flores
authors: Roberto
authors: R
authors: Barrios
authors: G Stefan
authors: GS
authors: Richter
authors: So-Young
authors: SY
authors: Oh
authors: Gabriella
authors: G
authors: Garufi
authors: Hannah
authors: H
authors: Maier
authors: Ashley L
authors: AL
authors: Drews
authors: Kathryn E
authors: KE
authors: Stockbauer
authors: Patricia
authors: P
authors: Cernoch
authors: Olaf
authors: O
authors: Schneewind
authors: Randall J
authors: RJ
authors: Olsen
authors: James M
authors: JM
authors: Musser
mesh_terms: D000328:Adult; D000881:Anthrax / Q000473:pathology*; D000942:Antigens, Bacterial / Q000235:genetics*; D001409:Bacillus cereus / Q000235:genetics*; D017809:Fatal Outcome; D016680:Genome, Bacterial; D006801:Humans; D008297:Male
chemical_list: D000942:Antigens, Bacterial