July 10, 2002 ROCHESTER, MINN. -- In the July issue of Mayo Clinic Proceedings, researchers outline new methods for safely and accurately identifying a suspected bioterrorism agent and detail what physicians should know about the symptoms and treatments needed for the highest priority level of infectious agents, such as anthrax, smallpox, botulism, tularemia and plague.
"The threat of a bioterrorism attack has become a real concern in the United States. An effective response depends largely upon physician recognition of signs and symptoms associated with infectious agents (bacteria and viruses) that may be used in bioterrorism attacks, says Franklin R. Cockerill, III, M.D. Of equal importance is the rapid and accurate laboratory identification of the specific infectious agent used in the attack."
In a smallpox case, there is concern for the infection of many others, because of the contagiousness of the virus and the decontamination steps required to stop the threat of others being infected.
Yet, there are only two laboratories in the United States currently equipped to analyze specimens, such as suspected smallpox viruses, in an environment where the investigators aren't at high risk of infection. The laboratories are known as Biosafety Level 4 facilities: the Centers for Disease Control in Atlanta and the U.S. Army Medical Research Institute of Infectious Diseases in Frederick, Md.
Mayo Clinic researchers have found a new use for a common piece of equipment available in most laboratories and even in dental offices: the autoclave. The autoclave method uses a 15-minute steaming process that reaches 250 degrees Fahrenheit. Autoclaving a specimen similar to the smallpox virus, Mayo Clinic researchers report, kills the virus' infectivity, but retains the needed DNA that can be used in the Lightcycler® Polymerase Chain Reaction (PCR) test. Earlier, Mayo Clinic researchers were able to use the Lightcycler® device to rapidly identify anthrax, speeding up the identification process from days to minutes.
"The autoclave adds another dimension for more local ability to detect these agents particularly with smallpox," said Franklin R. Cockerill, M.D., chair of the Mayo Clinic Division of Microbiology.
Indeed, the researchers' results showed that they were able to identify the DNA in all samples regardless of whether they were autoclaved or not. Coupled with the assays that allow the Lightcycler® to identify viruses, a quicker response can help health officials begin measures to stop the spread of the virus. In the past, samples of the suspected smallpox virus would need to be transported to the CDC by a secured vehicle.
The common availability of standard autoclave sterilization procedures in almost every medical facility for inactivating smallpox virus or B anthracis (anthrax) in patient specimens allows laboratory diagnosis of possible bioterrorism events due to smallpox virus by qualified laboratories at the local level.
The autoclave study was done by Mark J. Espy, MS; Lynne M. Sloan, MT (ASCP); Jon E. Rosenblatt, M.D.; Dr. Cockerill; and Thomas F. Smith, Ph.D. All are from Mayo Clinic. Dr. Smith first developed the idea as researchers were discussing the need for more laboratories in the United States with the capabilities to test biothreat agents, said Dr. Cockerill.
Mayo Clinic researchers also write in this issue about their results using the Lightcycler® device, which shortens the time for processing specimens using rapid-cycle real-time PCR assays. Developed with Roche Applied Science, Mayo researchers outline the results of their test, which is now commercially available.
The Lightcycler® study was completed by James R. Uhl; Constance A. Bell, Ph.D., now with the Tripler Army Medical Center in Honolulu; Sloan; Espy; Drs. Smith, Rosenblatt and Cockerill.
Having the necessary equipment to detect bioterrorism attacks is important. Mayo Clinic researchers in a special article also explain that despite the unpredictable nature of bioterrorism, disaster preparedness and knowledge of essential diagnostic and epidemiological principles can contribute substantially toward combating this new threat.
The special article on physician preparedness and knowledge of bioterrorism agents was done by Prathiba Varkey, MBBS, MPH; Gregory A. Poland, M.D.; Dr. Cockerill; Dr. Smith and Philip T. Hagen, M.D., all of Mayo Clinic.
The Mayo Clinic Proceedings articles highlight the need of physician awareness and laboratory preparedness to effectively respond to threats of bioterrorism, states an editorial in the issue written by Richard F. Meyer, Ph.D., and Stephen A. Morse, MSPH, Ph.D., both from the Rapid Response and Advanced Technology Laboratory, Centers for Disease Control and Prevention, Atlanta.
"An effective public health response to a bioterrorism event will depend on a few key factors: the ability of medical professionals to rapidly recognize the clinical signs and symptoms of disease caused by a biothreat agent; the capability of laboratory professionals to rapidly detect and confirm the identity of the agent; an epidemiological investigation to determine the source of the infection; and most importantly, communication and coordination among all the responders involved in the event," write Drs. Meyer and Morse.
Mayo Clinic Proceedings is a peer-reviewed and indexed general internal medicine journal, published for 75 years by Mayo Foundation, with a circulation of 130,000 nationally and internationally.
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