ANTHRAX - Continued

with B. anthracis, and therefore may pose a slight risk. Products that are frequently handled, such as blankets or purses, potentially pose a greater risk than wall hangings or other items with which there is little body contact. Depending upon personal choice, the owner may choose to decontaminate or destroy finished products.

The patient developed inhalation anthrax on January 17 with fever and symptoms of an upper respiratory infection. He became acutely ill on January 21 and was hospitalized that day with a complaint of fever, chills, pharyngitis, headache, nausea, anorexia, and left-sided pleurisy. Admission examination revealed 38.3°C fever, decreased breath sounds on the left side, spasticity of the left lower and upper extremities, unresponsiveness to simple commands, and a disconjugate gaze. A radiograph revealed left pleural effusion and possible enlargement of the left hilum. The pleural fluid and a peripheral blood smear contained large gram positive bacilli.

His cerebrospinal fluid had 7,300 WBC/mm3 (83% neutrophils and 17% lymphocytes), 130,000 RBC/mm3, 440 mg protein/dl and 88 mg glucose/dl, and numerous gram positive bacilli.

Despite intravenous aqueous penicillin (5 million units every 6 hours), intramuscular streptomycin (500 mg every 12 hours), and intensive supportive therapy, the patient died 28 hours after admission. Pertinent autopsy findings included: anterior mediastinal and left pulmonary hilar adenopathy with necrosis and hemorrhage, posterior mediastinal hemorrhage, bilateral pleural and pericardial effusions, atelectasis of the left lung, tracheobronchitis, splenomegaly, and cerebral edema and diffuse subarachnoid hemorrhage. Bacillus anthracis was isolated from both clinical and autopsy specimens. The patient was a self-employed weaver who frequently worked with a variety of imported yarns. He had not traveled outside of the local community for at least 2 weeks prior to

onset of his illness, and had no probable source of infection other than his work materials.

Yarn from both Creative Handweavers and Tahki Imports, Ltd., was obtained and cultured. Bacillus anthracis was recovered from a variety of animal-origin yarns obtained from both distributors. The contaminated products, sold in 4 ounce skeins or balls, include camel hair, goat hair, or sheepswool in varying combinations. The yarn is coarse and thick, may be natural in color (white, gray, tan, or red) or dyed. Commonly sold in plastic bags, the yarn is most often used in handicrafts, such as wall hangings and macrame objects. Yarn distributed by Tahki Imports is labeled with the company name; that from Creative Handweavers is not. Although these distributors also sell pure cotton and pure synthetic fibers, these products are not known to be implicated. The Consumer Product Safety Commission says that persons turning in yarn or items made from the yarn to health departments should get a receipt with the following information: name of yarn owner; date product is being turned in; description of product; and health department identification. This receipt should be taken to the place of purchase for refund. Refunds will be for the price of yarn only.

(Reported by FJ Collie, MD, San Luis Obispo; HH Kusumoto, MD, San Luis Obispo County Health Dept; WH Carnes, MD, SC Suffin, MD, School of Medicine, University of California, Los Angeles; J Chin, MD, State Epidemiologist, SB Werner, MD, California State Dept of Health; R Altman, MD, State, Epidemiologist, M Goldfield, MD, New Jersey State Dept of Health; JS Marr, MD, New York City Epidemiologist, Bur of Preventable Diseases; Office of Product Defect Identification, Consumer Product Safety Commission, Bethesda, Maryland; Bacteriology Div, Bur of Laboratories, Field Services Div, Bacterial Zoonoses Branch and Bacterial Zoonoses Laboratory Section, Bacterial Diseases Div, Bur of Epidemiology, CDC.)

In early July 1975 the Health Department of Edison Township reported an outbreak of salmonellosis to the New Jersey State Department of Health. Subsequent investigations by the latter department in association with the health departments of Edison Township, Bridgewater Township, and Camden County, uncovered 3 other outbreaks and 1 individual case of intestinal disease due to Salmonella saintpaul in New Jersey in July and August, all related to the consumption of pre-cooked roast beef. The United States Department of Agriculture (USDA) recalled the lots of affected roasts from 9 states.

Outbreak Number 1

On July 2 investigations of 2 separate cases of a group B salmonella infection revealed that both patients had eaten roast beef sandwiches at a luncheonette on June 28, just before onset of illness. The suspect roast beef had been used to prepare sandwiches for 11 individuals, all of whom developed intestinal illness, with a mean incubation period of 18 hours after eating the roast beef; 5 were hospitalized. S. saint-paul was found in stool specimens of 10 of these individuals.

The luncheonette manager apparently had divided the roast beef into 2 parts; 1 part was partially sliced to prepare the sandwiches. When the manager suspected that illness may

have been caused by the roast beef sandwiches, he discarded the rest of this piece and returned the other part to the original supplier. Both sections were recovered and cultured; both contained S. saint-paul.

The wholesaler (Distributor #1), who had purchased pre-cooked, wrapped beef roasts from company A, an outof-state firm, was 1 of 9 meat distributors of 2 brand-named roast beef products of company A in New Jersey. (Hereafter, these distributors will be referred to by number.) Forty-one unopened beef roasts, with production lots ranging from June 18 to July 9, were obtained from these distributors and cultured. Four were positive for S. saint-paul; 3, from Distributor 1, were positive both on the surface and in the interior. These 3 were produced on June 24 and 25 - the production lot from which the luncheonette meat was probably obtained. The other positive roast beef came from a July 7 production lot from Distributor 2. In addition, a roast beef from a production lot of July 1 was positive for Salmonella

tennessee.

Following this investigation, the New Jersey State Department of Health Laboratory tabulated all S. saint-paul human isolates for the preceding 3 months. Attempts were made to reach each patient by telephone. Eighteen out of 28 (Continued on page 39)

TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES FOR WEEKS ENDING FEBRUARY 7, 1976 AND FEBRUARY 1, 1975 (5th WEEK) - Continued

*Delayed Reports: TB: Ohio delete 11 (1975), Mich. delete 1, N.C. delete 2 (1975), Alaska 4; RMSF: Okla. 1; Gonorrhea: N.H. 6 Mil, D.C. 58 Civ, Wash 100 Mil; Syphilis: N.H. 1 Mil, Wash. 15 Civ, 1 Mil; Animal Rabies: Wisc. 1, Wyo. 1.