Quantitative pathology of inhalational anthrax I

Quantitative microscopic findings

Lev M. Grinberg, Faina A. Abramova, Olga V. Yampolskaya, David Walker, Jerome H. Smith

Research output: Contribution to journalArticle

174 Citations (Scopus)

Abstract

Forty-one cases of documented inhalational anthrax from the Sverdlovsk epidemic of 1979 traced to release of aerosols of Bacillus anthracis at a secret biologic-agent production facility were evaluated by semiquantitative histopathologic analysis of tissue concentrations of organisms, inflammation, hemorrhage, and other lesions in the mediastinum, mediastinal lymph nodes, bronchi, lungs, heart, spleen, liver, intestines, kidneys, adrenal glands, and central nervous system. These data were correlated with clinical, epidemiologic, and demographic data. The patients' courses, with a variable incubation period and short nonspecific course (4 days before hospitalization) with rapid demise (1 day of hospitalization before death), correlated with systemic bacterial infection and lesions. Bacillus anthracis were identified in all cases in which there was no antibiotic treatment or there was treatment for fewer than 21 hours. The lesions that were the most severe and apparently of longest duration were in the mediastinal lymph nodes and mediastinum. There and elsewhere, peripheral transudate rounded fibrin-rich edema; necrosis of arteries and veins was the most likely source of large hemorrhages displacing tissue or infiltrating tissue, respectively; and apoptosis of lymphocytes was observed. Respiratory function was compromised by mediastinal expansion, large pleural effusions, and hematogenous and retrograde lymphatic vessel spread of B. anthracis to the lung with consequent pneumonia. The central nervous system and intestines manifested similar hematogenous spread, vasculitis, hemorrhages, and edema. These pathologic findings are consistent with previous experimental studies showing transport of inhaled spores to mediastinal lymph nodes, where germination and growth lead to local lesions and systemic spread, with resulting edema and cell death, owing to the effects of edema toxin and lethal toxin. The identification of the vascular lesions as a basis for the prominent hemorrhages is a novel observation for human inhalational anthrax.

Original languageEnglish (US)
Pages (from-to)482-495
Number of pages14
JournalModern Pathology
Volume14
Issue number5
DOIs
StatePublished - May 2001

Fingerprint

Anthrax
Bacillus anthracis
Edema
Pathology
Hemorrhage
Lymph Nodes
Mediastinum
Intestines
Hospitalization
Central Nervous System
Lung
Lymphatic Vessels
Biological Factors
Exudates and Transudates
Pleural Effusion
Bronchi
Adrenal Glands
Germination
Vasculitis
Spores

Keywords

  • Bacillus anthracis
  • Edema
  • Hemorrhage
  • Inhalational anthrax
  • Mediastinum
  • Respiratory failure
  • Vasculitis

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Quantitative pathology of inhalational anthrax I : Quantitative microscopic findings. / Grinberg, Lev M.; Abramova, Faina A.; Yampolskaya, Olga V.; Walker, David; Smith, Jerome H.

In: Modern Pathology, Vol. 14, No. 5, 05.2001, p. 482-495.

Research output: Contribution to journalArticle

Grinberg, Lev M. ; Abramova, Faina A. ; Yampolskaya, Olga V. ; Walker, David ; Smith, Jerome H. / Quantitative pathology of inhalational anthrax I : Quantitative microscopic findings. In: Modern Pathology. 2001 ; Vol. 14, No. 5. pp. 482-495.
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