ANTHRAX, HUMAN - USA (08): (NEW HAMPSHIRE)
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Date: Sun 18 Apr 2010
Source: Nashua Telegraph [edited]
<http://www.nashuatelegraph.com/news/709412-196/anthrax-victim-fine-mystery-remains.html >
Anthrax victim fine, mystery remains
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The woman who came down with anthrax after taking part in a drumming circle
in December [2009] has recovered and is doing fine, while the building
where the infection took place has been cleaned and reopened to the public
-- but even so, the event remains as inexplicable as ever. "It is a
mystery," said Dr Jodie Dionne-Odom, deputy New Hampshire state
epidemiologist. "We really don't know why it happened."
The woman, whose identity hasn't been released, became critically ill some
days after taking part in a drum circle [on 4 Dec 2009] at the United
Campus Ministry building in Durham, an event that drew some 60 people. She
is now home and has returned to drumming, Dionne-Odom said.
The woman apparently inhaled anthrax [in spore form] that had been carried
into the room on the animal hide on one of the drums, and which was
released into the air when the drum was beaten. Anthrax spores were later
found on 2 drums and on various items around the room. It's unusual for a
person to be infected with anthrax in the US. This case drew enormous
attention, however, because the woman came down with gastrointestinal
anthrax rather than inhaled anthrax, which made her unique in American
medical history. [Well, no. Gastroenteric anthrax is infrequent in the US
but not unknown. - Mod.MHJ]
Anthrax is a disease caused by a bacterium that can infect people through
the lungs, intestines, or even skin. Most cases are associated with cattle
handling or processing, but it has occasionally been linked to imported
drums made with animal hides, particularly from West Africa. [In the latter
instance] anthrax is usually contracted by people who inhale the bacteria,
which lodges in their lungs. It leads to cold-like symptoms that quickly
worsen and produce mortality rates of more than 80 per cent.
Much more rarely, anthrax bacteria lodge in the intestines after a person
eats meat contaminated with anthrax spores. The resulting disease is also
fatal far more often than not. The Durham case was unique because the woman
inhaled the spore rather than eating it, but came down with
gastrointestinal anthrax. [See discussion below. - Mod.MHJ]
Despite 5 months of medical forensics, it's still unclear why this
happened, other than sheer bad luck. The woman has no genetic or medical
reason to be susceptible to gastrointestinal anthrax, Dionne-Odom said.
Further, the bacterium spore was "plain old garden variety" anthrax, "not a
hyper-virulent strain" that might have caused the unusual circumstances.
Officials at the Centers for Disease Control and Prevention did genetic
typing on the spore in an attempt to pin down the spore's country of
origin, but it was a type known as A1.a, found all over the world,
Dionne-Odom said.
Officials still believe drumming caused the spore to be aerosolized, or
broken up into a small piece that floated in the air and then somehow
infected the woman. Beyond that, the case is a mystery, although
Dionne-Odom said it was possible that further CDC tests would find some
underlying cause for the case.
[byline: David Brooks]
--
communicated by:
ProMED-mail
<promed@promedmail.org >
[I am presuming that at some point an official report will be issued but as
we are in an extended hiatus I am taking this opportunity to cut this
thread at least for now. Patently some investigations are more productive
than others. This has left a number of questions. If it came from an
infected drum and the spores were inhaled, the spores would have been
caught either in the nose, or the mucociliary blanket in the bronchi and
then pushed back up the bronchi and tipped into the oesophagous; something
which happens a lot and unless the initial dose was high, nothing untoward
would follow. Why this person was affected and not the many other people
during this and previous drumming sessions with this/these drum(s) would
suggest that the exposure dose was probably minimal. Not mentioned here but
in previous communications, this person had intestinal parasites, including
hookworms, and these could well have put her at risk as the spores made
their way through her damaged intestines. Remember, cutaneous anthrax
follows from allowing bacteraemic blood to cover a cut.
That it was an A1.a strain posits many questions in the absence of a more
exact genotyping. Knowing the origins of the contaminated drum hides would
go a long way to solving this question. To date A1.a is not known in West
Africa whose drum hides have been to blame for various recent outbreaks in
the US and the UK. - Mod.MHJ]
[see also:
Anthrax, human - USA (07): (NH) decontamination 20100304.0710
Anthrax, human - USA (06): (NH) recovering 20100213.0517
Anthrax, human - USA (05): (NH) 20100128.0303
Anthrax, human - USA (04): (NH) 20100116.0190
Anthrax, human - USA (03): (NH) 20100111.0129
Anthrax, human - USA (02): (NH) 20100108.0094
Anthrax, human - USA: (NH) 20100107.0072
2009
---
Anthrax, human - USA (03): (NH) 20091230.4390
Anthrax, human - USA (02): (NH) 20091229.4374
Anthrax, human - USA: (NH) 20091227.4360 ]
.................mhj/mj/sh
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