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Inhalation Anthrax: Why Is It so Deadly?

With one death among four confirmed cases of inhalation anthrax and two additional suspicious deaths under investigation, the inhaled form of the disease is proving to be a very real threat in the hands of a bioterrorist. Dr. Emily Senay has more.

What's makes inhaled anthrax different from the cutaneous or skin form of anthrax that we've been hearing about?

Anthrax is a germ that can enter the body in three ways--through the skin via a break in the skin like a cut or sore, ingesting it by eating anthrax-infected animals, or inhaled through the nose or mouth. If enough anthrax spores are inhaled into the lungs, they can cause inhalation anthrax, the deadliest form of the disease. But it's also the hardest form of anthrax to get. That's because it takes a large number of spores--from eight to ten thousand of them--to cause the illness. And those individual spores all have to be inhaled very deeply into the lungs to cause serious problems.

Why is inhaled anthrax so dangerous?

When the individual dormant anthrax spores lodge in the tiny air sacs in the lungs known as the alveoli, the immune system recognizes and attacks them and can kill many of them. But some spores may also travel to the lymph nodes near the lungs. That's where they germinate into live anthrax bacteria, which release toxins that destroy the body's cells.

Without treatment to kill the anthrax bacteria, those toxins build up and cause a variety of problems that quickly lead to death within a few days. Pneumonia is caused by fluid build-up in the lungs and other serious problems like low blood pressure, meningitis, and organ failure can occur.

Why is it so difficult to inhale enough anthrax spores to cause the illness?

It takes a large quantity of individual spores to reach the innermost reaches of the lungs. Some anthrax spores are larger than others, and the spores tend to clump together in clusters too large to inhale that deeply. They might not be able to get past the body's outer defenses, like hairs and mucus in the nose, for instance.

How long does it take to develop symptoms of inhalation anthrax?

It can take anywhere from 1 to 60 days for the disease to incubate. The first symptoms are flu-like symptoms, fever, coughs, chills, nausea, and vomiting, but the difference is that with inhaled anthrax things get worse very very quickly. It is treatable with antibiotics if you catch it early on.

Should people take antibiotics if they are worried about getting anthrax?

No. The side effects can be strong and if everybody takes antibiotics without being sick we could create a new breed of germs, not just anthrax, that are resistant to these medicines. If you are sick with flu-like symptoms and you are worried, see your doctor. But right now the advice is not to take Cipro unless you have been somewhere that anthrax has been discovered.

If the death rate is so high from inhaation anthrax, why are doctors so confident the patients will recover?

We don't know everything about anthrax. There may be degrees of the disease. One explanation is that the statistics are outdated. We have better technology to fight the disease, and medical advances could improve the odds. Another hope is that better vigilance in spotting the initial symptoms in people at risk will better their chances of survival through aggressive treatment early on.

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