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Preliminary Tests Detect Possible Biotoxin

Aired April 22, 2003 - 11:09   ET


LEON HARRIS, CNN ANCHOR: Dr. Sanjay Gupta has sneaked up here in the set to join us as we've been watching these live pictures coming in from our affiliate KING.
Sanjay, first of all, what do you know -- you've been able to sneak out and go dig up some more information about this botulinum and the plague, but what we heard a moment ago was that it wasn't necessarily -- the test indicated it wasn't necessarily exactly those toxins. However, it was some sort of a -- maybe a precursor or whatever. Is that the way it works with these or what?

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: That is right. I mean, a lot of these tests are designed to be very, very sensitive. You talk about false positives. Mike Brooks just mentioned that. They're designed to err on the side of falsely positive so that you don't miss anything.

It doesn't mean that the toxins aren't there, it just means that they're very, very sensitive for that particular purpose. And what we're talking about here are the toxins associated with two bacteria, one bacteria that causes plague, one bacteria that causes botulinum. And both of these are bacteria that secrete these -- pretty problematic toxins. The botulinum toxin can actually paralyze your muscles, which is how it can actually cause death. The plague toxin can cause all sorts of other problems in the body. But one thing, I think, is important to point out right off the top is these are bacteria that people know how to treat nowadays. They also know how to prevent some of the symptoms, some of the deadly symptoms, from actually causing that problem.

HARRIS: All right. But the way -- the way of infection, the method of infection, does it happen through the skin contact, do you have to breathe it in or what?

GUPTA: Well, it sounds like, if you want to sort of carry the equation out, if it was in an envelope, if it was a powder that they were counting on inhalational aspects of this particular toxin. Nobody knows for sure. And incidentally, the brown powder sort of mix (ph) -- just sort of thinking off the top of my head. The color itself really doesn't say much about what type of bacteria it is, although it may say something about the refinery process. If you're trying to refine this powder, when you get a crystalline white powder, that usually indicates to a scientist that they've done a good job in terms of really condensing this, really making a pure bacterial -- or bacterial toxin substance. If it's brown, that could suggest, just from a scientific standpoint, that there may be some contaminants in it. That is important... HARRIS: It hasn't been refined fully?

GUPTA: ... because it may give you a sense -- exactly. May give you a sense just how weaponized -- that is a term people like to throw around -- how distilled this particular bacteria is, if that's, in fact, what it is.

HARRIS: Can you guess right now what the people -- the four who are in the hospital right now, what they may be going through?

GUPTA: Well, it's hard to say because these types of bacteria, they could do anything from just causing a simple sort of allergic- type reaction, almost, to actually getting someone quite sick. I will say that in most instances, it takes several hours for the toxins to actually exert their effect. Botulinum a lot quicker than plague, but if it were the worst-case scenario, they might be on a ventilator, actually, because their diaphragm muscles aren't working well. But that's speculation beyond what anybody knows at this point.

HARRIS: Well, we'll keep you up here to keep you speculating, then, because that's all we have at this point to work with.

But just to walk us through what a person may be going through if they have been exposed to that sort of toxin or that sort of bacteria within a matter of hours, and you are saying that, if that were the case, they wouldn't necessarily have had their body degraded to a point where they couldn't be saved?

GUPTA: That's right, and a very important point. You know, we hear so much about these potentially deadly bacteria and viruses. When we talked about anthrax so much over a year ago, we learned even then that there were good treatments for anthrax. We didn't know that before we saw the first scare. But botulinum with plague, we know that there are good antibiotics, there are good ways of addressing the symptoms.

I'll give you an example. If someone stopped breathing because of the botulinum toxin, because it actually paralyzed their diaphragm, someone could actually put on a ventilator to the point where the machine would breathe for them until that toxin was gone from their system. They could also be administered an anti-toxin. They could also be administered antibiotics, try and get rid of the actual offending agent, in this case the bacterial toxin.

All those things are things that can be done, but I think the reason that people are jumping on this so quickly and appropriately is because timing is the key to all this stuff. You got to recognize it. You got to treat it quickly. You got to get the diagnosis made, and if you do that it's a very salvageable sort of problem. But again, it's sort of early to say. These tests are very sensitive, which means they err on the side of false positive for good reason. You don't want to miss something. You would rather have a false positive than a false negative, and also you have all these treatment options now.

HARRIS: So how then, would you rank this, botulinum or this plague bacteria that we're talking about here, or the bacteria -- is it one bacteria that can actually create both, or whatever?

GUPTA: Two different bacteria.

HARRIS: Well, how would you rate them in terms of toxicity? We are looking at the other ones, we look at the anthrax, we look at ricin, and most of the other ones that we have talked about this morning.

GUPTA: That's a good question, and the World Health Organization has actually done something like that. They looked at all sorts of different things to try and rank how effective a weapon of bioterror, something might be. They look at just how virulent it might be, meaning how sick does it make people. They look at how easily can it be weaponized. Anthrax we talked so much about actually creating that white powder. They talk about how easily can it be spread from person to person. How communicable is it?

These -- both botulinum and plague sort of rank lower down on that list, certainly well below anthrax, well below smallpox. Those are the ones that still sort of top the list because they meet those criteria. But obviously, these can get people very sick. Now, with botulinum in particular, it has actually been -- people in the past have tried to use this as a weapon of bioterror. A Japanese terrorist group called Aum Shinrikyo tried to use this particular agent unsuccessfully. There was a contamination effort in Oregon, actually, to try and swing an election back in Oregon. This was many years ago, also unsuccessful. People did get sick, nobody died. I think that that's an important message as well, in that these things can be treated.

HARRIS: The plague brings back so many different memories. You're saying that really can't be communicated very easily or quickly between people?

GUPTA: It can be transmitted between people, but the difference here is that it can be treated very easily. You know, we didn't know that about anthrax before. We learned that Cipro worked so well against anthrax, but plague can be treated. You may remember this, Leon, I think -- just in New York, maybe last fall, there was a case of plague, a couple, actually, from Arizona, a man and wife, they actually went back to New York and were diagnosed with plague. Now, they were treated. They needed the antibiotic, they needed all that sort of thing to try and get them out of that, but obviously it didn't work, and we do have good treatments for that nowadays.

HARRIS: That is right. All right. Good deal. Thanks, doctor.


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