Bacillus anthracis induces NLRP3 inflammasome activation and caspase-8-mediated apoptosis of macrophages to promote lethal anthrax

Lethal toxin (LeTx)-mediated killing of myeloid cells is essential for Bacillus anthracis, the causative agent of anthrax, to establish systemic infection and induce lethal anthrax. The "LeTx-sensitive" NLRP1b inflammasome of BALB/c and 129S macrophages swiftly responds to LeTx intoxication with pyroptosis and secretion of interleukin (IL)-1β. However, human NLRP1 is nonresponsive to LeTx, prompting us to investigate B. anthracis host-pathogen interactions in C57BL/6J (B6) macrophages and mice that also lack a LeTx-sensitive Nlrp1b allele. Unexpectedly, we found that LeTx intoxication and live B. anthracis infection of B6 macrophages elicited robust secretion of IL-1β, which critically relied on the NLRP3 inflammasome. TNF signaling through both TNF receptor 1 (TNF-R1) and TNF-R2 were required for B. anthracis-induced NLRP3 inflammasome activation, which was further controlled by RIPK1 kinase activity and LeTx-mediated proteolytic inactivation of MAP kinase signaling. In addition to activating the NLRP3 inflammasome, LeTx-induced MAPKK inactivation and TNF production sensitized B. anthracis-infected macrophages to robust RIPK1- and caspase-8-dependent apoptosis. In agreement, purified LeTx triggered RIPK1 kinase activity- and caspase-8-dependent apoptosis only in macrophages primed with TNF or following engagement of TRIF-dependent Toll-like receptors. Consistently, genetic and pharmacological inhibition of RIPK1 inhibited NLRP3 inflammasome activation and apoptosis of LeTx-intoxicated and B. anthracis-infected macrophages. Caspase-8/RIPK3-deficient mice were significantly protected from B. anthracis-induced lethality, demonstrating the in vivo pathophysiological relevance of this cytotoxic mechanism. Collectively, these results establish TNF- and RIPK1 kinase activity-dependent NLRP3 inflammasome activation and macrophage apoptosis as key host-pathogen mechanisms in lethal anthrax.

COMPARISON OF PROPOLIS EFFECTS ON TUMOR NECROSIS FACTOR ALPHA AND MALONDIALDEHYDE BETWEEN INHALATION AND CUTANEOUS ANTHRAX ANIMAL MODELS

BACKGROUND

Inflammatory response and oxidative stress can be found in anthrax characterized by increased level of serum Tumor Necrosis Factor Alpha (TNF-α) and Malondialdehyde (MDA). The use of antibiotics in anthrax has been known to cause some disturbing side-effects, such as allergic reaction, nausea, vomiting, and antibiotic resistance. Thus, ethanolic extract of propolis (EEP) might be the alternative regimen, due to its anti-inflammatory and antioxidant properties. This study aimed to compare the effects of ethanolic extract of propolis (EEP) on TNF-α and MDA between the inhalation and cutaneous anthrax animal model.

MATERIALS AND METHODS

This was an experimental study with a post-test-only control group design on 40 samples of Rattus norvegicus. Samples were randomized into 5 groups: control, inhalation anthrax model, inhalation anthrax model + EEP, cutaneous anthrax model, and cutaneous anthrax model + EEP. After 14 days, the level of TNF-α and MDA were measured. To compare the data, we used the ANOVA test continued by the post-hoc Turkey test.

RESULTS

The results obtained showed that the level of TNF-α and MDA between the inhalation and cutaneous anthrax animal models treated with EEP were statistically different (p < 0.05). The P5 group showed the lowest level of TNF-α (6.822 ± 0.383 pg/ml) and MDA (2.717 ± 0.383 nmol/ml).

CONCLUSION

EEP has a better effect on reducing TNF-α and MDA in cutaneous anthrax animal models compared to the inhalation anthrax animal model.

Solution Structures of Bacillus anthracis Protective Antigen Proteins Using Small Angle Neutron Scattering and Protective Antigen 63 Ion Channel Formation Kinetics

We are studying the structures of bacterial toxins that form ion channels and enable macromolecule transport across membranes. For example, the crystal structure of the Staphylococcus aureus α-hemolysin (α-HL) channel in its functional state was confirmed using neutron reflectometry (NR) with the protein reconstituted in membranes tethered to a solid support. This method, which provides sub-nanometer structural information, could also test putative structures of the Bacillus anthracis protective antigen 63 (PA63) channel, locate where B. anthracis lethal factor and edema factor toxins (LF and EF, respectively) bind to it, and determine how certain small molecules can inhibit the interaction of LF and EF with the channel. We report here the solution structures of channel-forming PA63 and its precursor PA83 (which does not form channels) obtained with small angle neutron scattering. At near neutral pH, PA83 is a monomer and PA63 a heptamer. The latter is compared to two cryo-electron microscopy structures. We also show that although the α-HL and PA63 channels have similar structural features, unlike α-HL, PA63 channel formation in lipid bilayer membranes ceases within minutes of protein addition, which currently precludes the use of NR for elucidating the interactions between PA63, LF, EF, and potential therapeutic agents.

Using a Syrian (Golden) Hamster Biological Model for the Evaluation of Recombinant Anthrax Vaccines

In this paper, we demonstrate that a Syrian hamster biological model can be applied to the study of recombinant anthrax vaccines. We show that double vaccination with recombinant proteins, such as protective antigen (PA) and fusion protein LF1PA4, consisting of lethal factor I domain (LF) and PA domain IV, leads to the production of high titers of specific antibodies and to protection from infection with the toxicogenic encapsulated attenuated strain B. anthracis 71/12. In terms of antibody production and protection, Syrian hamsters were much more comparable to guinea pigs than mice. We believe that Syrian hamsters are still underestimated as a biological model for anthrax research, and, in some cases, they can be used as a replacement or at least as a complement to the traditionally used mouse model.

Potential Use for Serosurveillance of Feral Swine to Map Risk for Anthrax Exposure, Texas, USA

Anthrax is a disease of concern in many mammals, including humans. Management primarily consists of prevention through vaccination and tracking clinical-level observations because environmental isolation is laborious and bacterial distribution across large geographic areas difficult to confirm. Feral swine (Sus scrofa) are an invasive species with an extensive range in the southern United States that rarely succumbs to anthrax. We present evidence that feral swine might serve as biosentinels based on comparative seroprevalence in swine from historically defined anthrax-endemic and non–anthrax-endemic regions of Texas. Overall seropositivity was 43.7% (n = 478), and logistic regression revealed county endemicity status, age-class, sex, latitude, and longitude were informative for predicting antibody status. However, of these covariates, only latitude was statistically significant (β = –0.153, p = 0.047). These results suggests anthrax exposure in swine, when paired with continuous location data, could serve as a proxy for bacterial presence in specific areas.

Loss of Dihydroxyacid Dehydratase Induces Auxotrophy in Bacillus anthracis

Anthrax disease is caused by infection with the bacteria Bacillus anthracis which, if left untreated, can result in fatal bacteremia and toxemia. Current treatment for infection requires prolonged administration of antibiotics. Despite this, inhalational and gastrointestinal anthrax still result in lethal disease. By identifying key metabolic steps that B. anthracis uses to grow in host-like environments, new targets for antibacterial strategies can be identified. Here, we report that the ilvD gene, which encodes dihydroxyacid dehydratase in the putative pathway for synthesizing branched chain amino acids, is necessary for B. anthracis to synthesize isoleucine de novo in an otherwise limiting microenvironment. We observed that ΔilvD B. anthracis cannot grow in media lacking isoleucine, but growth is restored when exogenous isoleucine is added. In addition, ΔilvD bacilli are unable to utilize human hemoglobin or serum albumin to overcome isoleucine auxotrophy, but can when provided with the murine forms. This species-specific effect is due to the lack of isoleucine in human hemoglobin. Furthermore, even when supplemented with physiological levels of human serum albumin, apotransferrin, fibrinogen, and IgG, the ilvD knockout strain grew poorly relative to nonsupplemented wild type. In addition, comparisons upon infecting humanized mice suggest that murine hemoglobin is a key source of isoleucine for both WT and ΔilvD bacilli. Further growth comparisons in murine and human blood show that the auxotrophy is detrimental for growth in human blood, not murine. This report identifies ilvD as necessary for isoleucine production in B. anthracis, and that it plays a key role in allowing the bacilli to effectively grow in isoleucine poor hosts. IMPORTANCE Anthrax disease, caused by B. anthracis, can cause lethal bacteremia and toxemia, even following treatment with antibiotics. This report identifies the ilvD gene, which encodes a dihydroxyacid dehydratase, as necessary for B. anthracis to synthesize the amino acid isoleucine in a nutrient-limiting environment, such as its mammalian host. The use of this strain further demonstrated a unique species-dependent utilization of hemoglobin as an exogenous source of extracellular isoleucine. By identifying mechanisms that B. anthracis uses to grow in host-like environments, new targets for therapeutic intervention are revealed.

Ultrasensitive Detection of Bacillus anthracis by Real-Time PCR Targeting a Polymorphism in Multi-Copy 16S rRNA Genes and Their Transcripts

The anthrax pathogen Bacillus anthracis poses a significant threat to human health. Identification of B. anthracis is challenging because of the bacterium's close genetic relationship to other Bacillus cereus group species. Thus, molecular detection is founded on species-specific PCR targeting single-copy genes. Here, we validated a previously recognized multi-copy target, a species-specific single nucleotide polymorphism (SNP) present in 2-5 copies in every B. anthracis genome analyzed. For this, a hydrolysis probe-based real-time PCR assay was developed and rigorously tested. The assay was specific as only B. anthracis DNA yielded positive results, was linear over 9 log10 units, and was sensitive with a limit of detection (LoD) of 2.9 copies/reaction. Though not exhibiting a lower LoD than established single-copy PCR targets (dhp61 or PL3), the higher copy number of the B. anthracis-specific 16S rRNA gene alleles afforded ≤2 unit lower threshold (Ct) values. To push the detection limit even further, the assay was adapted for reverse transcription PCR on 16S rRNA transcripts. This RT-PCR assay was also linear over 9 log10 units and was sensitive with an LoD of 6.3 copies/reaction. In a dilution series of experiments, the 16S RT-PCR assay achieved a thousand-fold higher sensitivity than the DNA-targeting assays. For molecular diagnostics, we recommend a real-time RT-PCR assay variant in which both DNA and RNA serve as templates (thus, no requirement for DNase treatment). This can at least provide results equaling the DNA-based implementation if no RNA is present but is superior even at the lowest residual rRNA concentrations.

Evaluation of the AV7909 Anthrax Vaccine Toxicity in Sprague Dawley Rats Following Three Intramuscular Administrations

AV7909 is a next-generation anthrax vaccine under development for post-exposure prophylaxis following suspected or confirmed Bacillus anthracis exposure, when administered in conjunction with the recommended antibacterial regimen. AV7909 consists of the FDA-approved BioThrax® vaccine (anthrax vaccine adsorbed) and an immunostimulatory Toll-like receptor 9 agonist oligodeoxynucleotide adjuvant, CPG 7909. The purpose of this study was to evaluate the potential systemic and local toxicity of AV7909 when administered via repeat intramuscular injection to the right thigh muscle (biceps femoris) to male and female Sprague Dawley rats. The vaccine was administered on Days 1, 15, and 29 and the animals were assessed for treatment-related effects followed by a 2-week recovery period to evaluate the persistence or reversibility of any toxic effects. The AV7909 vaccine produced no apparent systemic toxicity based on evaluation of clinical observations, body weights, body temperature, clinical pathology, and anatomic pathology. Necrosis and inflammation were observed at the injection sites as well as in regional lymph nodes and adjacent tissues and were consistent with immune stimulation. Antibodies against B. anthracis protective antigen (PA) were detected in rats treated with the AV7909 vaccine, confirming relevance of this animal model for the assessment of systemic toxicity of AV7909. In contrast, sera of rats that received saline or soluble CPG 7909 alone were negative for anti-PA antibodies. Overall, 3 intramuscular immunizations of Sprague Dawley rats with AV7909 were well tolerated, did not induce mortality or any systemic adverse effects, and did not result in any delayed toxicity.

Mechanism of Action of Monoclonal Antibodies That Block the Activity of the Lethal Toxin of Bacillus Anthracis

Neutralization of the lethal toxin of Bacillus anthracis is an important topic of both fundamental medicine and practical health care, regarding the fight against highly dangerous infections. We have generated a neutralizing monoclonal antibody 1E10 against the lethal toxin of Bacillus anthracis and described the stages of receptor interaction between the protective antigen (PA) and the surface of eukaryotic cells, the formation of PA oligomers, assembly of the lethal toxin (LT), and its translocation by endocytosis into the eukaryotic cell, followed by the formation of a true pore and the release of LT into the cell cytosol. The antibody was shown to act selectively at the stage of interaction between Bacillus anthracis and the eukaryotic cell, and the mechanism of toxin-neutralizing activity of the 1E10 antibody was revealed. The interaction between the 1E10 monoclonal antibody and PA was found to lead to inhibition of the enzymatic activity of the lethal factor (LF), most likely due to a disruption of true pore formation by PA, which blocks the release of LF into the cytosol.

Development of Digital Health Messages for Rural Populations in Tanzania: Multi- and Interdisciplinary Approach

BACKGROUND

Health workers have traditionally delivered health promotion and education to rural communities in the Global South in paper leaflet formats or orally. With the rise of digital technologies, health promotion and education can be provided in innovative and more effective formats, which are believed to have a higher impact on disease prevention and treatment.

OBJECTIVE

The aim of this tutorial is to illustrate how a multi- and interdisciplinary approach can be applied in the design process of digital health messages for use in the Global South.

METHODS

The multi- and interdisciplinary team of the Non-discriminating access for Digital Inclusion (DigI) project digitalized and customized available government-approved paper-based health promotion messages into a screen-suitable format. The team worked closely together and used its diverse expertise to develop digital health messages with disease-specific content in Tanzania's national language (Swahili) as well as English. The development process included the following phases: a local needs assessment; identification of government-approved health promotion materials in a nondigital format; identification of key health messages; creation of a practical and engaging story, easy to understand for the general public; drafting of a storyboard for an animated video with review, feedback, and revisions; forward and backward translation; audio recording of the story in both languages; finalization and presentation of the animations; development of relevant questions related to the health messages in each domain; and development of web and mobile apps to access the digital health messages.

RESULTS

Between 2017 and 2019, we developed key health messages, quizzes, and animated health videos to address HIV/AIDS, tuberculosis, Taenia solium cysticercosis and taeniasis, and anthrax, all of which are of public health importance in Tanzania. Feedback from local stakeholders and test users was included in various phases of the process. The 4 videos and other content are available in local information spots on a digital health platform (DigI platform), established by the DigI project, in both Tanzanian Swahili and English.

CONCLUSIONS

Our methodological multi- and interdisciplinary approach ensures that the digital health messages for the public are clear, high quality, and align with the government's objectives for health promotion. It also demonstrates the diversity of scientific disciplines required when collaborating on a digital health project. We recommend this approach to be applied to the development of other digital health messages for a wide range of diseases.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/25128.

Complement C5 inhibition protects against hemolytic anemia and acute kidney injury in anthrax peptidoglycan-induced sepsis in baboons

Late-stage anthrax infections are characterized by dysregulated immune responses and hematogenous spread of Bacillus anthracis, leading to extreme bacteremia, sepsis, multiple organ failure, and, ultimately, death. Despite the bacterium being nonhemolytic, some fulminant anthrax patients develop a secondary atypical hemolytic uremic syndrome (aHUS) through unknown mechanisms. We recapitulated the pathology in baboons challenged with cell wall peptidoglycan (PGN), a polymeric, pathogen-associated molecular pattern responsible for the hemostatic dysregulation in anthrax sepsis. Similar to aHUS anthrax patients, PGN induces an initial hematocrit elevation followed by progressive hemolytic anemia and associated renal failure. Etiologically, PGN induces erythrolysis through direct excessive activation of all three complement pathways. Blunting terminal complement activation with a C5 neutralizing peptide prevented the progressive deposition of membrane attack complexes on red blood cells (RBC) and subsequent intravascular hemolysis, heme cytotoxicity, and acute kidney injury. Importantly, C5 neutralization did not prevent immune recognition of PGN and shifted the systemic inflammatory responses, consistent with improved survival in sepsis. Whereas PGN-induced hemostatic dysregulation was unchanged, C5 inhibition augmented fibrinolysis and improved the thromboischemic resolution. Overall, our study identifies PGN-driven complement activation as the pathologic mechanism underlying hemolytic anemia in anthrax and likely other gram-positive infections in which PGN is abundantly represented. Neutralization of terminal complement reactions reduces the hemolytic uremic pathology induced by PGN and could alleviate heme cytotoxicity and its associated kidney failure in gram-positive infections.

GPS Telemetry Reveals a Zebra With Anthrax as Putative Cause of Death for Three Cheetahs in the Namib Desert

Anthrax is a bacterial disease caused by Bacillus anthracis that affects wildlife, livestock and also humans in different parts of the world. It is endemic in some parts of Africa, including Namibia, with species differing in their susceptibility to the disease. Carnivores are typically less susceptible to anthrax than herbivores. Most carnivore species survive infection and have high seroprevalence against anthrax, whereas most herbivore species have low seroprevalence and typically die quickly when infected. Several reports have shown that cheetahs, unlike most other large carnivores, are susceptible to anthrax leading to a sudden death. This finding was suggested to be linked to the low genetic variability of cheetahs which might reduce an adequate immune response and thus explain such a high susceptibility to the disease. Here, we report an incidence of three free-ranging cheetahs that died within 24 h after feeding on a mountain zebra that tested positive for anthrax in the Namib Desert. We were able to reconstruct this incidence with the data recorded in the GPS (Global Positioning System) collar worn by one of the cheetahs and retrieved in the field. It is very likely that the cheetahs died from anthrax, although Bacillus anthracis could not be isolated from tissue and soil samples by bacterial culturing. The mountain zebra is the first described case of a wild animal that tested positive for anthrax in this arid area in southwestern of Namibia. We discuss the negative laboratory results of the cheetahs in the light of new insights of their immune system and its potential to mount a response against this bacteria.

Clindamycin Protects Nonhuman Primates Against Inhalational Anthrax But Does Not Enhance Reduction of Circulating Toxin Levels When Combined With Ciprofloxacin

BACKGROUND

Inhalational anthrax is rare and clinical experience limited. Expert guidelines recommend treatment with combination antibiotics including protein synthesis-inhibitors to decrease toxin production and increase survival, although evidence is lacking.

METHODS

Rhesus macaques exposed to an aerosol of Bacillus anthracis spores were treated with ciprofloxacin, clindamycin, or ciprofloxacin + clindamycin after becoming bacteremic. Circulating anthrax lethal factor and protective antigen were quantitated pretreatment and 1.5 and 12 hours after beginning antibiotics.

RESULTS

In the clindamycin group, 8 of 11 (73%) survived demonstrating its efficacy for the first time in inhalational anthrax, compared to 9 of 9 (100%) with ciprofloxacin, and 8 of 11 (73%) with ciprofloxacin + clindamycin. These differences were not statistically significant. There were no significant differences between groups in lethal factor or protective antigen levels from pretreatment to 12 hours after starting antibiotics. Animals that died after clindamycin had a greater incidence of meningitis compared to those given ciprofloxacin or ciprofloxacin + clindamycin, but numbers of animals were very low and no definitive conclusion could be reached.

CONCLUSION

Treatment of inhalational anthrax with clindamycin was as effective as ciprofloxacin in the nonhuman primate. Addition of clindamycin to ciprofloxacin did not enhance reduction of circulating toxin levels.

Anthrax Surveillance and the Limited Overlap Between Obligate Scavengers and Endemic Anthrax Zones in the United States

Anthrax is a zoonosis caused by the spore-forming bacterium Bacillus anthracis, with potential for high fatality rate, especially in herbivores. Upon host death, spores can enter the soil surrounding the carcass and be ingested by other animals feeding in the same location. Accordingly, surveillance to quickly identify and decontaminate anthrax carcasses is crucial to outbreak prevention. In endemic anthrax areas such as Texas and Africa, vultures are used as a surveillance tool for identifying presence and location of dead animals. However, many anthrax outbreaks in the United States have occurred in areas outside the ranges of both black and turkey vultures. Here, we used a longitudinal camera trap survey at carcass sites in southwestern Montana to investigate the utility of facultative avian scavengers on disease and carcass surveillance in a reemerging anthrax risk zone. From August 2016 to September 2018, camera traps at 11 carcass sites were triggered 1996 times by avian scavengers. While the majority were facultative avian scavengers such as corvids and eagles, our results suggest that facultative scavengers cannot replace vultures as a surveillance tool in this ecosystem due to their absence during the anthrax risk period (June to August), reduced search efficiency, or low flight patterns. We found that the conditions in Montana likely parallel systems elsewhere in the continental United States. Using ecological niche models of B. anthracis distribution overlaid with relative abundance maps of turkey vultures, we found that much of North Dakota, South Dakota, Minnesota, Wyoming, Nebraska, and Iowa have areas of anthrax risk, but low or absent turkey vulture populations. Without vultures in these areas, surveillance capacity is reduced, and it becomes more difficult to identify anthrax cases, meaning fewer carcasses are decontaminated, and consequently, outbreaks could become more frequent or severe.

Neutralization of the anthrax toxin by antibody-mediated stapling of its membrane-penetrating loop

Anthrax infection is associated with severe illness and high mortality. Protective antigen (PA) is the central component of the anthrax toxin, which is one of two major virulence factors of Bacillus anthracis, the causative agent of anthrax disease. Upon endocytosis, PA opens a pore in the membranes of endosomes, through which the cytotoxic enzymes of the toxin are extruded. The PA pore is formed by a cooperative conformational change in which the membrane-penetrating loops of PA associate, forming a hydrophobic rim that pierces the membrane. Due to its crucial role in anthrax progression, PA is an important target for monoclonal antibody-based therapy. cAb29 is a highly effective neutralizing antibody against PA. Here, the cryo-EM structure of PA in complex with the Fab portion of cAb29 was determined. It was found that cAb29 neutralizes the toxin by clamping the membrane-penetrating loop of PA to the static surface-exposed loop of the D3 domain of the same subunit, thereby preventing pore formation. These results provide the structural basis for the antibody-based neutralization of PA and bring into focus the membrane-penetrating loop of PA as a target for the development of better anti-anthrax vaccines.

Eu(III)-DO3A and BODIPY dyad as a chemosensor for anthrax biomarker

The sensitive and selective determination of Bacillus anthracis spores before the infection is vital for human health and safety. Dipicolinic acid (DPA) is an excellent biomarker due to its presence in the nucleus of bacterial spores at high concentrations (up to 1 M, about 15% dry weight). In the present work, a new molecular chemosensor 1, based on europium(III)-DO3A and BODIPY dyad, is developed to detect DPA in phosphate-buffered saline (PBS) buffered solution and tap water samples. Also, 1 can be used as a ratiometric optical chemosensor to track DPA.

Enzyme-Linked Phage Receptor Binding Protein Assays (ELPRA) Enable Identification of Bacillus anthracis Colonies

Bacteriophage receptor binding proteins (RBPs) are employed by viruses to recognize specific surface structures on bacterial host cells. Recombinant RBPs have been utilized for detection of several pathogens, typically as fusions with reporter enzymes or fluorescent proteins. Identification of Bacillus anthracis, the etiological agent of anthrax, can be difficult because of the bacterium's close relationship with other species of the Bacillus cereussensu lato group. Here, we facilitated the identification of B. anthracis using two implementations of enzyme-linked phage receptor binding protein assays (ELPRA). We developed a single-tube centrifugation assay simplifying the rapid analysis of suspect colonies. A second assay enables identification of suspect colonies from mixed overgrown solid (agar) media derived from the complex matrix soil. Thus, these tests identified vegetative cells of B. anthracis with little processing time and may support or confirm pathogen detection by molecular methods such as polymerase chain reaction.

A Suggested Diagnostic Approach for Sporadic Anthrax in Cattle to Protect Public Health

The repeated occurrence of anthrax in grazing animals should be a reminder of a widespread presence of Bacillus anthracis spores in the environment. Its rapid diagnosis is critical to protect public health. Here, we report a case of anthrax in cattle that was investigated using conventional and molecular methods. In 2015, six cows suddenly died within three days and the number of dead animals increased to a total of 12 within two weeks. At necropsy, anthrax was suspected. Therefore, spleen tissue samples were collected (from 6/12 animals) and laboratory tests (microscopy, cultivation, and real-time PCR) performed. The results of tissue staining for microscopy and cultivation were in congruence, while B. anthracis real-time PCR outperformed both. Spleen tissues from all six animals were real-time PCR-positive, while B. anthracis was successfully cultivated and detected by microscopy from the spleen of only three animals. Additionally, the ear tissue from another (1/12) cow tested positive by real-time PCR, supporting the suitability of ear clippings for molecular confirmation of B. anthracis. Genotyping of the isolates using multiple-locus variable-number tandem repeat analysis (MLVA) revealed a common source of infection as all three typed isolates had an indistinguishable MLVA genotype, which has not been observed previously in Europe. The results indicate that molecular testing should be selected as the first-line tool for confirming anthrax outbreaks in animals to ensure timely protection of public health.

Knowledge, attitude and practices (KAP) towards Anthrax among livestock farmers in selected rural areas of Bangladesh

BACKGROUND

Bacillus anthracis is a zoonotic bacterium that affects wide numbers of vertebrate animals and man and has life threating potential both in animal s as well as humans.

METHODS

A cross sectional study was conducted to assess the knowledge about, attitudes towards, and practices addressing (KAPs) anthrax among community members in selected upazillas' of Meherpur and Sirajgonj districts for the prevention and control of anthrax using a structured questionnaire.

RESULTS

A total of 424 community members were considered in this study irrespective of their age and sex. Most of the respondents were female (57.54%) and about half were illiterate (47.40%). Most of the respondents (86.32%) were self-employed with crop and livestock farming. Among the self-employed farmers, cattle (63.73%) were the highest reared animals. Among the respondents, 37.26% had no knowledge about anthrax. On the other hand, among the existing knowledge level, 46.69% received information of anthrax from neighbour, 74.05% and 56.82% were concerned about the mode of transmission of anthrax from animal to human through eating, handling and soil. Respondents usually collected vaccine from quack (58.25%) and vaccination status was highest in Kamarkhand (52.03%) and lowest in Gangni upazilla (10.82%). Overall 62.74% community members considered that anthrax is a fatal disease for livestock and 82.54% people disposed carcass in buried method.

CONCLUSION

The study findings indicated that the community members had average knowledge on cause, symptoms, transmission and prevention of anthrax. The supplied vaccine was found negligible with the number of livestock in the studied upazilas. Veterinary and Medical health planners should design and implement interventions for awareness building on anthrax under One Health (OH) approach for educating the community people on anthrax control and prevention.

Reindeer Anthrax in the Russian Arctic, 2016: Climatic Determinants of the Outbreak and Vaccination Effectiveness

The Yamal Peninsula in the Russian Federation experienced a massive outbreak of anthrax in reindeer (Rangifer tarandus) in July–August 2016, with 2,650 (6.46% of the total susceptible population) animals infected, of which 2,350 died (case fatality rate of 88.67%). In our study, we analyzed climatic and epidemiological factors that could have triggered the outbreak. The cancelation of reindeer vaccination against anthrax in 2007 resulted in an increase in population susceptibility. In response to the outbreak, total vaccination of all susceptible animals was resumed. To assess the vaccination effectiveness, we tested 913 samples of blood serum taken from vaccinated reindeer using an antigenic erythrocyte diagnostic kit to detect specific anti-anthrax antibodies via an indirect hemagglutination assay (IHA) 9 months after vaccination. We found that 814 samples had sufficiently high levels of anti-anthrax antibodies to indicate a protection level of 89% (95% confidence interval: 87–91%) of the whole reindeer population. Abnormally high ambient temperature in the summer of 2016 contributed to the thawing of permafrost and viable Bacillus anthracis spores could have become exposed to the surface; the monthly average air temperatures in June, July, and August 2016 were 20–100% higher than those of the previous 30-year period, while the maximum air temperatures were 16–75% higher. Using the projected climate data for 2081–2100 according to the “worst case” RCP8.5 scenario, we demonstrated that the yearly air temperature may average above 0°C across the entire Yamal Peninsula, while the yearly number of days with a mean temperature above 0°C may rise by 49 ± 6 days, which would provide conditions for reactivation of soil anthrax reservoirs. Our results showed that the outbreak of anthrax occurred under conditions of a significant increase in air temperature in the study area, underlined the importance of vaccination for controlling the epidemic process, and demonstrated the effectiveness of monitoring studies using the IHA diagnostic kit for detecting erythrocyte anthrax antigens.

Public Discussion of Anthrax on Twitter: Using Machine Learning to Identify Relevant Topics and Events

Background

Social media allows researchers to study opinions and reactions to events in real time. One area needing more study is anthrax-related events. A computational framework that utilizes machine learning techniques was created to collect tweets discussing anthrax, further categorize them as relevant by the month of data collection, and detect discussions on anthrax-related events.

Objective

The objective of this study was to detect discussions on anthrax-related events and to determine the relevance of the tweets and topics of discussion over 12 months of data collection.

Methods

This is an infoveillance study, using tweets in English containing the keyword “Anthrax” and “Bacillus anthracis”, collected from September 25, 2017, through August 15, 2018. Machine learning techniques were used to determine what people were tweeting about anthrax. Data over time was plotted to determine whether an event was detected (a 3-fold spike in tweets). A machine learning classifier was created to categorize tweets by relevance to anthrax. Relevant tweets by month were examined using a topic modeling approach to determine the topics of discussion over time and how these events influence that discussion.

Results

Over the 12 months of data collection, a total of 204,008 tweets were collected. Logistic regression analysis revealed the best performance for relevance (precision=0.81; recall=0.81; F₁-score=0.80). In total, 26 topics were associated with anthrax-related events, tweets that were highly retweeted, natural outbreaks, and news stories.

Conclusions

This study shows that tweets related to anthrax can be collected and analyzed over time to determine what people are discussing and to detect key anthrax-related events. Future studies are required to focus only on opinion tweets, use the methodology to study other terrorism events, or to monitor for terrorism threats.

Disease or drought: environmental fluctuations release zebra from a potential pathogen-triggered ecological trap

When a transmission hotspot for an environmentally persistent pathogen establishes in otherwise high-quality habitat, the disease may exert a strong impact on a host population. However, fluctuating environmental conditions lead to heterogeneity in habitat quality and animal habitat preference, which may interrupt the overlap between selected and risky habitats. We evaluated spatio-temporal patterns in anthrax mortalities in a plains zebra (Equus quagga) population in Etosha National Park, Namibia, incorporating remote-sensing and host telemetry data. A higher proportion of anthrax mortalities of herbivores was detected in open habitats than in other habitat types. Resource selection functions showed that the zebra population shifted habitat selection in response to changes in rainfall and vegetation productivity. Average to high rainfall years supported larger anthrax outbreaks, with animals congregating in preferred open habitats, while a severe drought forced animals into otherwise less preferred habitats, leading to few anthrax mortalities. Thus, the timing of anthrax outbreaks was congruent with preference for open plains habitats and a corresponding increase in pathogen exposure. Given shifts in habitat preference, the overlap in high-quality habitat and high-risk habitat is intermittent, reducing the adverse consequences for the population.

Insufficient Anthrax Lethal Toxin Neutralization Is Associated with Antibody Subclass and Domain Specificity in the Plasma of Anthrax-Vaccinated Individuals

Anthrax vaccine adsorbed (AVA) is a significant line of defense against bioterrorist attack from Bacillus anthracis spores. However, in a subset of individuals, this vaccine may produce a suboptimal quantity of anti-protective antigen (PA), antibodies that are poorly neutralizing, and/or antibody titers that wane over time, necessitating annual boosters. To study individuals with such poor responses, we examine the properties of anti-PA in a subset of vaccinated individuals that make significant quantities of antibody but are still unable to neutralize toxin. In this cohort, characterized by poorly neutralizing antibody, we find that increased IgG4 to IgG1 subclass ratios, low antibody avidity, and insufficient antibody targeting domain 4 associate with improper neutralization. Thus, future vaccines and vaccination schedules should be formulated to improve these deficiencies.

Outbreak of Anthrax Associated with Handling and Eating Meat from a Cow, Uganda, 2018

On April 20, 2018, the Kween District Health Office in Kween District, Uganda reported 7 suspected cases of human anthrax. A team from the Uganda Ministry of Health and partners investigated and identified 49 cases, 3 confirmed and 46 suspected; no deaths were reported. Multiple exposures from handling the carcass of a cow that had died suddenly were significantly associated with cutaneous anthrax, whereas eating meat from that cow was associated with gastrointestinal anthrax. Eating undercooked meat was significantly associated with gastrointestinal anthrax, but boiling the meat for >60 minutes was protective. We recommended providing postexposure antimicrobial prophylaxis for all exposed persons, vaccinating healthy livestock in the area, educating farmers to safely dispose of animal carcasses, and avoiding handling or eating meat from livestock that died of unknown causes.

An Estimate of Global Anthrax Prevalence in Livestock: A Meta-analysis

Background and Aim:

Anthrax, caused by the soil-borne spore-forming bacteria called Bacillus anthracis, is a zoonotic disease that persists worldwide in livestock and wildlife and infects humans. It is a great hazard to livestock; henceforth, evaluating the global concerns about the disease occurrence in livestock is essential. This study was conducted to estimate the global prevalence of anthrax and predict high-risk regions, which could be an input to veterinarians to take necessary steps to control and avoid the disease.

Materials and Methods:

A literature review was performed using online databases, namely, PubMed, Google Scholar, Scopus, Biomed Central, and Science Direct, to extract relevant publications worldwide between 1992 and 2020.</AQ9> Initially, 174 articles were selected, and after scrutinizing, 24 articles reporting the prevalence of anthrax were found to be adequate for the final meta-analysis. The statistical study was accompanied by employing fixed effects and random effects models using R.

Results:

The pooled prevalence of anthrax globally was 28% (95% confidence interval, 26-30%) from 2452 samples through the fixed effects model. Continent-wise subgroup analysis through the random effects model revealed that the pooled prevalence of anthrax was highest in Africa (29%) and least in North America (21%).

Conclusion:

In these publications, anthrax causes economic loss to farmers and, thus, to the world. Hence, controlling anthrax infections in high-risk regions are essential by implementing appropriate control measures to decrease the effect of the disease, thereby reducing economic loss.