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"The Secret Life of Germs" author Philip Tierno

Philip M. Tierno, Jr., Ph.D., is the author of "The Secret Life of Germs: Observations and Lessons from a Microbe Hunter." Recently appointed to Mayor Guiliani's Bioterrorism Task Force, Dr. Tierno is director of clinical microbiology and diagnostic immunology at both New York University and Mount Sinai Medical Centers in New York City. Tierno became Internationally known for his work in resolving the mystery of Toxic Shock Syndrome.

CNN: Thank you for joining us today, Philip Tierno, and welcome.

PHILIP TIERNO: I appreciate being here.

CNN: Give us an update on the bioterrorism task force set up by Mayor Giuliani following the anthrax outbreaks.

TIERNO: The task force is working on this last case, the one that has been a puzzlement to date. I am an advisor to the mayor and his governmental body on matters about bioterrorism.

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CNN: Anthony Fauci, who heads the National Institutes for Health, has said the major anthrax threats appear to be over. Would you agree?

TIERNO: Thus far, there have been no further cases, and it looks like the tale of this event has concluded. So unless someone else delivers a letter or a weapon in a different way, it's over. But it won't be over until we catch the person or people who did this.

CHAT PARTICIPANT: What are the ways in which this bacterium spreads?

TIERNO: The organism can infect people in three different ways, giving rise to three different syndromes. The most serious is inhalation anthrax. In this form, it's really a bi-phasic disease, meaning it has two forms. You start out with mild flu-like symptoms, which is phase one. The incubation period, the time from when you're first exposed to the time you express symptoms, is usually 1-5 days, but can be as long as 60 days. The second phase doesn't occur until there's a period of well-being between the two phases. Then the next phase is the acute phase, which develops 2-5 days later. That can be characterized by sort of an acute respiratory distress, such as difficulty in breathing, sweating, high temperature, and turning blue, basically, from lack of oxygen. An xray, if performed at this point, would show something that's very characteristic of anthrax, that is, a mediastinal widening, the lymph nodes under the lungs. That's very characteristic. Shock and death can occur 24-36 hours after that event.

A second type of anthrax would be cutaneous, the skin form. This requires that the skin's integrity be breached, in other words, there has to be a cut, a scratch or a lesion on the skin for these spores to germinate. The incubation period here is 2-7 days. The lesion on the skin starts out as an itchy pimple, which eventually becomes like a blister. Development of many vesicles will occur, which join together, eventually rupturing, and forming an open ulcer, which, characteristically will develop a black eschar, which is like a scab. the center. Characteristically, the lesion may be very swollen, marked edema. When the eschar falls off, which is usually a week or two later, it leaves a permanent scar.

The third type of anthrax is called gastrointestinal anthrax. That's a form we've not seen in this country, ever, and a person would get that by eating raw or undercooked meat of an infected animal. You get characteristic GI symptoms. The fatality rate differs on all these anthrax types. The inhalation is the most severe, in the past, thought to have 90% fatality, although in our cases here in this country, we've shown it to be 40% fatality, and that's more or less because of the advanced antibiotic therapy, and the ICU support that is much more advanced than it was when the statistics were first out. Untreated skin anthrax has a fatality, untreated, of about 20%, but treated, it's less than 1%. Usually you survive. The GI, untreated, would be 25-60% fatality.

CHAT PARTICIPANT: Have there been any leads yet as to who is sending the anthrax or where it is coming from or how many letters have been sent?

TIERNO: As far as where it's coming from, obviously nobody knows. That's in progress. Whether it's homegrown or a foreign agent within the US, no one knows. Until more information is forthcoming, anything would be speculation. As far as how many letters, nobody can tell for sure whether the letters sent and recovered were the only letters. It appears that is the case, but no one really knows. Since there are no further cases at this point, hopefully we're at the end of this particular episode.

CHAT PARTICIPANT: What do you think will happen with the anthrax investigation? Do you think that someone will be caught, and do you think that the terrorists are done polluting the mail system?

TIERNO: I think that any country can always have an assault upon it by a crazed individual, or an individual with very deep beliefs. That's always a possibility, just as it's always a possibility that a person can carry a bomb, and blow it up on himself in the presence of others. It's difficult to prevent every event. But if the perpetrators of this event are caught, that will go a long way to preventing it from happening again. It's of paramount importance.

CNN: Kathy Nguyen is the woman who died of inhalation anthrax in New York City. Yet investigators can't seem to figure out how she caught it. What has her death taught germ hunters such as yourself about anthrax?

TIERNO: First, it doesn't leave necessarily a trail that is easy to follow. Secondly, this individual might have been exposed, and obviously was exposed, to sufficient spores to cause her death, either by some episode that might have occurred in a post office she visited, or she might have been exposed to it on her job, or inadvertently, by crossing paths with a terrorist. Or, she might have purposely or unknowingly been a party to the terrorist event.

Elderly people may succumb more readily to inhalation anthrax than younger people, so that if others were in the vicinity of this exposure, and were young, they may not have come down with any problem. We know from studies that individuals who deal with hides of animals can be exposed to spores over an eight-hour period, and as many as 500-1000 spores inhaled over that period do not cause inhalation anthrax. So, she must have been exposed to a sufficient amount, and that would vary, depending on the individual and the quality of the spore.

CHAT PARTICIPANT: Mr Tierno, do you feel this will [encourage] research for advanced systems to bio-scan people and objects coming into the country and those already inside they country?

TIERNO: Certainly it has sparked a great deal of research, and numerous companies have come out with various devices that can operate in a real time fashion to give quick turnaround time identification on anthrax, as well as other bioterrorist instruments or agents. So yes, I do believe this will spark further invention.

CHAT PARTICIPANT: Having survived anthrax once, can you be infected again?

TIERNO: If you survive anthrax, you can develop antibody. We know that people who have survived an anthrax challenge have developed antibody from reports in the literature. But you must develop specific antibodies to what are called the "virulence factors" or toxins of the bacterium. Obviously, there is a vaccine available, which evokes antibody response.

CHAT PARTICIPANT: It seems they have to go through a great deal to kill many people with anthrax; wouldn't it be easier to spread small pox?

TIERNO: You first have to have smallpox, which is a possibility, but not a probability. Since smallpox was wiped from the face of the earth, there are only two countries that had any stockpile of this agent, and they are the US and Russia. While it is entirely possible that someone might have gotten access to the Russian supply, and therefore this poses a threat, so far we see no evidence that that's the case. If it were, I believe we can meet the challenge. much the same way that the eradication program wiped smallpox from the face of the earth.

CNN: Your book talks about germs in general. How much of it was devoted to bioterrorism?

TIERNO: I have a chapter on bioterrorism, with the caveat being to put us at a state of readiness and alert us to the possibility of germ terrorism. Little did I know how prophetic the part on anthrax was. It was written about 3 years ago, and updated right before publication. It talks in general about germs, and educates the public to give them means to reduce their every day risk of infections, and infectious disease. It's written for the lay public in an entertaining fashion, with a lot of vignettes and stories. It covers just about everything you wanted to know about germs, but probably didn't know to ask. It has a positive upbeat message.

CHAT PARTICIPANT: What are other viable threats you see, and would an anthrax test adequately be able to identify other harms...could we possibly already have an outbreak of some other agent and not know it because we are so focused on anthrax?

TIERNO: No, I think that the governmental bodies are so alert to what's going on throughout America, so many new plans have been put into effect, so many surveillance systems are operating, I think that we would be able to readily identify any new threat or any new disease that might be perpetrated on us. And I think we would be able to respond effectively, just as the mayor and other governments involved did, in such an exemplary way with this anthrax threat. I think the caveat here is that we're even more alert and armed, and we understand more than we did before this occurred. If you want to find a good side of this event, then that is it, that we're more alert than ever in history, and we stand ready for whatever will come.

CNN: Do you have any closing comments to share with us?

TIERNO: I think one of the interesting aspects of my book is that I talked about germs in general from a historical point of view as well as from the modes of transmissions of germs, but the beginning message starts with Howard Hughes -- a good example of the predicament that most people are in. He had an image of a handsome aviator, an heir to a great fortune, a movie producer, and even a husband to many Hollywood starlets. But the image that strikes me, and the one I remember, is that of an aging, lonely, unkempt, drug-addicted recluse, ensconced at a terribly high expense in a Las Vegas suite, obsessively trying to keep things operating-room clean, living in fear that a germ would infect and kill him. When it comes to germs, we all have a little Howard Hughes in us. If he had read my book, as I hope you will, he would not have had that feeling. He would have had a better perspective on the importance of germs, as the seeds of illness, but also the seeds of life. Without germs, man could not exist on this planet. There would be no food, oxygen, nitrates, no recycling of organic matter, so life could continue. In the beginning was the germ, and we came afterward, believe it or not. Man has accomplished something extraordinary, by being able to explore the gargantuan potential of germs. We are now for the first time harnessing their power for the good of all mankind. In fact, using germs, we can accomplish some of the biggest problems facing mankind, disease, hunger and pollution. If I might quote one line: "How strange yet fitting that the future of nature's greatest creature, man, depends upon an intimate cooperation with nature's least, the germ."

CNN: Thank you for joining us today.

TIERNO: You're very welcome. Good bye and I hope you enjoy the book. It should be very lively and informative.

Philip Tierno joined the chat room via telephone from New York and provided a typist. The above is an edited transcript of the interview on Thursday, November 08, 2001 at 2 p.m. EDT.


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