Treating Biological Attack Victims - Anthrax Types Although the media publicity has focused mostly on anthrax because of the contaminated letter attacks in the months following September 11, that is only one of the four best-known biological agents to which the enemy has access. The other three are botulism, bubonic plague, and smallpox. Anthrax Anthrax became a bug of interest to terrorists because it is readily available virtually anywhere on this planet. Its scientific name is Bacillus anthraces. The natural history of infectious disease from this germ shows that it has been limited to farm animals (mostly sheep and goats) with occasional cross-contamination to human handlers. This infection also carries the name of wool sorter's disease because the most frequent incidences in the United States in recent years have occurred among workers who handled raw sheep's wool or goat hair. Therefore, even when a mere handful of mail sorters and office workers became infected in urban areas, public health professionals immediately knew that this was a deliberate attack.   Since anthrax is an aerobic, spore-forming organism, it is especially dangerous because it thrives in open air, and the spores are like seeds with hard protective shells that a terrorist can spray into the air like fine dust particles. Thus humans can acquire them by inhalation, skin contact, and ingestion (swallowing). When laboratory microbiologists gather large quantities of anthrax spores, it takes on the appearance and consistency of powdered sugar. Hence, it is an ideal material for placement in aerosol cans. Terrorists can set them off like roach-bombs in public places. It would take only a few aerosol bombs in New York's Grand Central Station to infect about one million people during a morning rush hour.   As far as other methods of attack are concerned, we already know that terrorists can use the U.S. mail to send contaminated letters. Additionally, there is also the possibility of contamination of food supplies. Therefore, for your personal protection it is important that you know some more details about anthrax, such as the three different anthrax types (pulmonary, cutaneous, and gastrointestinal) and their incubation periods, the common symptoms of each type, and what hospitals need to do to treat and contain the infection. The most dangerous aspect of such an attack is that most people would not become aware of exposure to anthrax until it was too late.   Pulmonary anthrax With pulmonary anthrax, the spores enter the respiratory system through the nose and lodge in the base of the lungs (alveolar sacs). It only takes one spore to reach the final destination, hatch, and multiply exponentially. Initially, there is an incubation period of one to eight weeks. Following that, the victim gets the same symptoms as the common cold. Two to four days later, there is an abrupt onset of respiratory failure with collapse of the circulatory system. The disease is treatable only if caught during incubation or initial onset of symptoms.   Cutaneous anthraxThe cutaneous form of anthrax disease is a local infection of the skin after direct contact with spores or live bacteria. This usually occurs on the head, forearms, or hands. The symptoms start with itching and a red welt. Then a blister develops, with the skin finally ulcerating with formation of a thick black scab. This is less dangerous than the pulmonary type because there is more time, but treatment is the same. Without treatment, the infection would spread to the blood and become fatal.   Gastrointestinal anthrax The gastrointestinal form results from swallowing food or liquid contaminated with anthrax spores or bacilli. The food contamination most commonly occurs in meat. The symptoms are abdominal pain, nausea, vomiting, fever, vomiting blood, and bloody diarrhea. The infection usually enters the blood within two to three days after incubation, which takes from one to seven days. This type is usually fatal, with death resulting from septic shock. The only way to get an early confirmation of the diagnosis is a positive stool culture.