Thomas E. Levy, M.D., J.D.
Issue No. 2
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
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 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.,
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
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.
Arnon, S., R. Schechter, T. Inglesby, D. Henderson, J.
Bartlett, M. Ascher, E. Eitzen, A. Fine, J. Hauer, M.
Layton, S. Lillibridge, M. Osterholm, T. O'Toole, G.
Parker, T. Perl, P. Russell, D. Swerdlow, and K.
Tonat. (2001) Botulinum toxin as a biological weapon.
Medical and public health management. The Journal of
the American Medical Association 285(8):1059-1070.
Calabrese, E. (1985) Does exposure to environmental
pollutants increase the need for vitamin C? Journal of
Environmental Pathology, Toxicology and Oncology
Conn's Current Therapy 2001. (2001) Edited by Rakel, R. and
E. Bope, Philadelphia, PA: W.B. Saunders Company.
Dennis, D., T. Inglesby, D. Henderson, J. Bartlett, M.
Ascher, E. Eitzen, A. Fine, A. Friedlander, J. Hauer,
M. Layton, S. Lillibridge, J. McDade, M. Osterholm, T.
O'Toole, G. Parker, T. Perl, P. Russell, and K. Tonat.
(2001) Tularemia as a biological weapon. Medical and
public health management. The Journal of the American
Medical Association 285(21):2763-2773.
Dey, P. (1966) Efficacy of vitamin C in counteracting
tetanus toxicity. Naturwissenschaften 53(12):310.
Evans, M., D. Gregory, W. Schaffner, and Z. McGee. (1985)
Tularemia: a 30-year experience with 88 cases.
Gill, M. (1982) Bacterial toxins: a table of lethal
amounts. Microbiological Reviews 46(1):86-94.
Inglesby, T., D. Dennis, D. Henderson, J. Bartlett, M.
Ascher, E. Eitzen, A. Fine, A. Friedlander, J. Hauer,
J. Koerner, M. Layton, J. McDade, M. Osterholm, T.
O'Toole, G. Parker, T. Perl, P. Russell, M. Schoch-
Spana, and K. Tonat. (2000) Plague as a biological
weapon. Medical and public health management. The
Journal of the American Medical Association
Jahan, K., K. Ahmad, and M. Ali. (1984) Effect of ascorbic
acid in the treatment of tetanus. Bangladesh Medical
Research Council Bulletin 10(1):24-28.
Klenner, F. (1957) The black widow spider: case history.
Tri-State Medical Journal pp. 15-18.
Klenner, F. (1974) Significance of high daily intake of
ascorbic acid in preventive medicine. Journal of the
International Academy of Preventive Medicine 1(1):45-
Overholt, E., W. Tigertt, P. Kadull, et al. (1961) An
analysis of forty-two cases of laboratory-acquired
tularemia. The American Journal of Medicine 30:785-
Pavlov, V., A. Mokrievich, and K. Volkovoy. (1996) Cryptic
plasmid pFNL10 from Francisella novicida-like F6168:
the base of plasmid vectors for Francisella
tularensis. FEMS Immunology and Medical Microbiology
Pullen, R. and B. Stuart. (1945) Tularemia: analysis of 225
cases. The Journal of the American Medical Association
Ratsitorahina, M., S. Chanteau, L. Rahalison, L.
Ratsifasoamanana, and P. Boisier. (2000)
Epidemiological and diagnostic aspects of the outbreak
of pneumonic plague in Madagascar. Lancet
Saslaw, S., H. Eigelsbach, J. Prior, H. Wilson, and S.
Carhart. (1961) Tularemia vaccine study. II.
Respiratory challenge. Archives of Internal Medicine
Speck, R. and H. Wolochow. (1957) Studies on the
experimental epidemiology of respiratory infections:
experimental pneumonic plague in Macaccus rhesus. The
Journal of Infectious Diseases 100:58-69.
Stuart, B. and R. Pullen. (1945) Tularemic pneumonia:
review of American literature and report of 15
additional cases. The American Journal of the Medical
Copyright 2001 by Thomas E. Levy, M.D., J.D.
All Rights Reserved
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