BIOTERRORISM: BEYOND ANTHRAX AND SMALLPOX
SOME GENERAL THOUGHTS
This second issue of "Health E-Bytes"
is intended to not only discuss potential modalities of future bioterrorism
attacks, but also to reiterate the enormous benefit that optimally
dosed intravenous and oral vitamin C would offer such infected or
poisoned individuals. I have already had individuals ask me how they
could get intravenous vitamin C for themselves and their families
in the event of a sudden toxin and/or infectious exposure. The answer
at this point in time, unfortunately, is that it would be difficult
for many to get treated in this fashion and impossible for everyone
to get treated in this fashion. That is why I am making the effort
to publish this newsletter. Wonderful information that never gets
widely disseminated is of little or no substantive value for the general
population.
With these thoughts in mind, then, I
urge all readers of this newsletter to forward it not only to friends,
but also to as many members of the professional health community as
possible. Even though 95 out of 100 doctors might just chuckle when
they read these newsletters, perhaps the other 5 will be open-minded
enough to seriously and scientifically evaluate what is being said.
Any doctor who examines the original literature citations on the information
that I am presenting can only conclude that vitamin C is as amazing
as I say it is, or they can conclude that many different clinicians
and primary researchers are simply lying in order to accumulate scientific
publications for their resumes. If even one doctor eventually realizes
the practical impact of this information and starts treating patients
with critical infectious diseases with proper doses of vitamin C,
a very significant impact will eventually be made on many patients.
One practicing physician impacts the health and lives of many people.
And what does Dr. Levy get from all of
this? For my more cynical readers, I may eventually sell a few more
of my books, and I may eventually get more readers to visit my website
and other linked websites. However, my primary purpose is to get long-overlooked
and long-ignored information its proper recognition. I want to see
sick patients in need of treatment get the best treatment available.
That’s all.
A few more potential bioweapons will
now be discussed. There are actually very many more bioweapons than
these that could end up being used, but the following three agents
have been considered prime candidates for bioterrorists for some time
now. These agents, plague, tularemia, and botulinum toxin, will be
separately discussed and analyzed.
PLAGUE (BUBONIC PLAGUE, PNEUMONIC
PLAGUE)
Human plague is caused by a type of bacteria
known as Yersinia pestis. Humans usually contract this disease
when bitten by plague-infected fleas. It has been noted in the past
that epidemics of this disease in humans were often preceded by the
death of large numbers of rats, further forcing fleas to leave their
preferred rodent hosts and seek out humans (Inglesby et al., 2000).
Clinically, plague can present in three
different forms: bubonic, septicemic, and pneumonic. Most naturally
occurring cases are bubonic. This form of infection has an incubation
period of 2 to 6 days. The clinical onset of symptoms is characteristically
abrupt, with a sudden onset of headache, muscle and joint aches, fever,
and chills. Often only hours later, swollen, tender lymph nodes will
appear in the neck, armpit, and groin areas, indicating a rapid progression
of the disease through the body. These swollen lymph nodes are known
as buboes, giving rise to the name bubonic. When this form of the
plague goes untreated, more than 50% of those infected will die.
Septicemic plague is almost uniformly
fatal when left untreated. This form of plague involves a large amount
of infection in the bloodstream. Bubonic plague can sometimes lead
to septicemic or even pneumonic plague. Those patients who progress
rapidly to a septicemic form of plague probably have weaker or more
compromised immune systems, which facilitates the rapid spread of
the disease in the blood.
Pneumonic plague, somewhat like inhalation
anthrax, requires early and aggressive treatment to avert a fatal
outcome. Furthermore, unlike bubonic or even septicemic plague patients,
pneumonic plague is readily catagious (Ratsitorahina et al., 2000).
If used in the future as a bioweapon,
the plague will not be spread by large numbers of infected fleas.
Rather, the spread would be most probably achieved by inhalation of
an aerosol form of Y. pestis microorganisms, which would result
immediately in a large number of people getting the pneumonic form
of the plague. Furthermore, this would greatly accelerate the transmission
of the disease among susceptible populations of people, in contrast
to the amount of transmission that would occur if the plague infection
presented in the bubonic form.
Early diagnosis would be critically important
for the survival of individuals exposed to an inhalation form of plague.
Until the first case was confirmed in the laboratory, patients would
be considered to have gotten a very aggressive form of pneumonia.
Broad spectrum antibiotic therapy would save some if instituted soon
enough. The antibiotics that have been most effective in treating
the plague include streptomycin, gentamicin, doxycycline, tetracycline,
and chloramphenicol. The antibiotics commonly used for infection prevention
after known exposure are tetracycline, doxycycline, and trimethoprim-sulfamethoxazole
(Conn’s Current Therapy 2001).
A vaccine is no longer available for
the plague. Furthermore, the vaccine that had been developed only
showed benefit against the bubonic form of plague. It did not appear
to prevent or lessen the consequences of the pneumonic form of plague
(Speck and Wolochow, 1957).
For the same reasons discussed in the
first issue of "Health E-Bytes," vitamin C would be an excellent
adjunct therapy for the plague. Both oral and intravenous administrations
of vitamin C would result in a significant bolstering of the immune
system. While a high enough dose of vitamin C could logically be completely
effective as a monotherapy treatment for the plague, there is certainly
no reason not to take both the appropriate antibiotics along with
the vitamin C. Furthermore, since no specific reference could be found
in the literature on vitamin C and plague, it would be inappropriate
to try to treat the plague with only vitamin C, even though it’s effect
on other bacterial diseases would predict a high likelihood of complete
clinical success in the treatment of plague.
TULAREMIA
Tularemia is a disease caused by a type
of bacteria known as Francisella tularensis. Although not one
of the potential bioweapons that is familiar to many people, the transmissibility
of tularemia could make it especially effective as a bioweapon. F.
tularensis is one of the most infectious of disease-causing bacteria,
and the inhalation of as few as 10 organisms has been known to cause
disease (Saslaw et al., 1961).
The inhalation form of tularemia, which
would be the type of tularemia likely seen in a bioterrorist attack,
tends to present abruptly, with fever, chills, body aches, runny nose,
and sore throat. Cough with chest discomfort and other signs of pneumonia
can then appear (Pullen and Stuart, 1945). Left untreated, one third
or more of patients with pneumonic tularemia can be expected to die
(Stuart and Pullen, 1945). Properly treated, however, less than 2%
of patients should die (Evans et al., 1985).
Vaccination for tularemia is presently
not advised except for laboratory personnel who are routinely working
with F. tularensis bacteria (Dennis et al., 2001). A wide variety
of antibiotics are available to effectively treat this disease at
this time. However, laboratory manipulation has been demonstrated
to produce strains of tularemic bacteria that are resistant to some
of the commonly used antibiotics (Overholt et al., 1961; Pavlov et
al., 1996). This raises the unsettling possibility that tularemic
bacteria prepared specifically for biowarfare may not be as readily
killed with antibiotics as the bacteria found in the naturally occurring
disease. To be sure, take all recommended antibiotics for any tularemic
infection, but don’t neglect to add the vitamin C as previously discussed.
In reviewing the scientific literature, I could find no cases of infectious
disease that were shown to be initially susceptible to vitamin C,
only to later develop a resistance to vitamin C. This development
of resistant strains of bacteria appears to occur only when man-made
antimicrobial drugs are used for a long enough period of time.
BOTULINUM TOXIN
Botulinum toxin should probably result
in more fear and anxiety over its possible use as a bioweapon than
just about any other agent. This is because it is extremely potent
and capable of killing easily. Furthermore, it is a refined toxin;
there is no infection to be attacked.
Botulinum toxin is presently considered
to be the most poisonous substance known (Gill, 1982). Although it
would be very difficult to accomplish technically, there is enough
potency in one gram of botulinum toxin to kill over one million people
if properly dispersed (Arnon et al., 2001).
Botulinum toxin is produced by the metabolism
of the bacterial species known as Clostridium botulinum. Although
only a very small dose of this toxin can be fatal when swallowed,
a roughly 100-fold smaller dose can be expected to be fatal
if inhaled.
The symptoms of botulism are those of
a progressive paralysis starting in the muscles of head and neck,
proceeding eventually to weakness of the other muscles in the body,
including the arms and legs. Death results from respiratory insufficiency
from either the relaxation of the throat musculature blocking air
entry into the lungs, or from inadequate air movement by the weakened
respiratory muscles surrounding and supporting the chest cavity.
The treatment of botulism, aside from
supportive care, involves an antitoxin that immunologically neutralizes
the botulinum toxin. However, an early clinical diagnosis and prompt
treatment are essential to save the exposed patient.
Vitamin C is just as useful for the treatment
of a pure toxin as it is for the treatment of an infectious disease.
Jahan et al. (1984) and Dey (1966) both showed that vitamin C could
effectively neutralize tetanus toxin. Tetanus toxin is also produced
by a Clostridium species of bacteria, like botulinum toxin.
Klenner (1974) reported curing a four year-old receiving a "full
strike" from a highly poisonous moccasin snake. Klenner (1957)
also reported the complete clinical neutralization of the toxin associated
with a black widow spider bite. Calabrese (1985) reported on the effects
of vitamin C on a group of 24 pesticides, heavy metals, hydrocarbons,
and gaseous pollutants, noting that vitamin C reduced the toxicity
of the vast majority of these agents. It should also be noted that
these were predominantly diverse, rather than similar, agents.
Vitamin C has also been seen to neutralize
the toxicity of a number of different bacterial toxins produced in
the anaerobic environment of deep dental infections. When tested against
specific critical enzymes, many of these toxins were substantially
more toxic than botulinum toxin. Nevertheless, patients who were clinically
ill from the effects of this group of toxins invariably showed dramatic
improvement from the infusion of enough vitamin C.
Regardless of the mechanism, which is
probably not singular in nature anyway, vitamin C should be the agent
of choice for all acute poisonings. In many cases, the ascorbate
ion in vitamin C directly neutralizes the toxin. In other cases, the
vitamin C improves immune function enough to help negate the toxic
effect through immune mechanisms. Remember that an acute infusion
of vitamin C is virtually harmless. Klenner typically started a vitamin
C infusion in his office on all of his sick patients even before he
made a diagnosis. He never hurt anyone with this practice, and he
helped very many. In any case of suspected poisoning, start high-dose
intravenous vitamin C with vigorous hydration immediately, and then
proceed with a diagnostic workup so that specific antibiotics and/or
specific antitoxin therapies can later be added to the treatment.
In an acutely poisoned and/or infected patient, there is no good reason
not to proceed with the vitamin C infusion immediately, as all poisonings
and infections rapidly metabolize what vitamin C is present in the
body, making an acutely-induced scurvy-like state part of the clinical
presentation. Any scurvy-like state requires vitamin C to be resolved,
and such a state will make any existing infection or toxic medical
condition worse and more difficult to treat effectively.
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