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Volume 8, Number 10—October 2002
THEME ISSUE
Bioterrorism-related Anthrax

Bioterrorism-related Anthrax

Molecular Subtyping of Bacillus anthracis and the 2001 Bioterrorism-Associated Anthrax Outbreak, United States

Alex R. Hoffmaster*Comments to Author , Collette C. Fitzgerald*, Efrain Ribot*, Leonard W. Mayer*, and Tanja Popovic*
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA;

Main Article

Table 3

Molecular subtyping by MLVA and pagA sequencing performed on 28 clinical specimens from seven patients with inhalational anthraxa,b

Patient no.b Specimen typec Interval after antimicrobial therapy (days)d MLVA loci detected pagA Bacillus anthracis LRN PCRe
1 Pleural fluid 4 All negative Negative Positive
Pleural fluid 4 All negative Negative Positive
Blood 4 All negative Negative Negative
Lung 4 All negative ND ND
Lung 4 vrrA ND Negative
Heart blood 4 vrrA, vrrB1 Negative Negative
Pericardial blood 4 All negative Negative Positive
2 Thoracentesis fluid 4 vrrA Negative Positive
Serum 10 All negative Negative Positive
Respiratory wash 4 All negative Negative Positive
Pleural fluid 4 All negative Negative Positive
3 Blood culture 0 All negative Negative Positive
5 Blood culture 0 All negative Negative Positive
Blood culture 0 All negative Negative Positive
6 Blood culture 0 vrrA, vrrB1, vrrB2,,vrrC2 Negative Positive
10 Pleural fluid 1 vrrA, vrrB1, vrrB2, vrrC1, vrrC2, CG3, pXO1, pXO2 Positive Positive
Pleural fluid 1 vrrA, vrrB1, vrrB2, vrrC1, vrrC2, CG3, pXO1, pXO2 Positive Positive
Blood 1 All negative Negative Positive
CSF 3 All negative Negative Positive
Lung 3 vrrA, CG3 Negative Positive
Lymph node 3 vrrA, vrrB1, vrrB2, vrrC1, vrrC2, CG3, pXO1, pXO2 Positive Positive
11 Pleural fluid 2 All negative Positive Positive
Blood 2 All negative Negative Negative
Blood culture -1 All negative ND ND
Blood culture -1 All negative ND Positive
Blood culture -1 All negative ND ND
Blood culture -1 All negative ND Positive
Lymph node 4 vrrA, vrrB1, vrrB2, vrrC1, vrrC2, CG3 Positive Positive

aMLVA, multiple-locus variable-number tandem repeat analysis; pagA, protective antigen gene; LRN, Laboratory Response Network; PCR, polymerase chain reaction.
bPatients 1–10 described in Jernigan et al. (19) and patient 11 in Barakat et al (20)
cSpecimens collected postmortem.
dNumber of days the specimen was collected following or before the initiation of antimicrobial therapy. Specimens collected the same day as the initiation of therapy were designated as day 0 but were collected before antibiotic therapy.
eResults using the Laboratory Response Network PCR assay for detection of B. anthracis during the outbreak (18).

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