ANTHRAX

Anthrax is a serious infectious zoonotic disease caused by gram-positive bacteria

that can cause severe illness in both HUMANS and ANIMALS.

ZOONOTIC: meaning it is transmitted from animals to humans

CAUSATIVE ORGANISM

Anthrax is caused by the bacterium BACILLUS ANTHRACIS

It was shown to cause disease by Robert Koch in 1876 when he took a blood sample from an

infected cow, isolated the bacteria, and put them into a mouse.

The bacterium normally rests in spore form in the soil, and can survive for decades in this state.

Spore forming bacteria withstand extreme conditions of starvation, acidity, temperature, and

desiccation by producing resistant forms called “spores

Spores are unaffected by high-temperature treatment and can germinate under favorable

conditions, which may subsequently cause problems

Herbivores are often infected while grazing, especially when eating rough, irritant, or spiky

vegetation; the vegetation has been hypothesized to cause wounds within the gastrointestinal tract,

permitting entry of the bacterial spores into the tissues.

Herbivores are animals that eat plants

The spores germinate at the site of entry into the tissues and then spread by the circulation to the

lymphatics, where the bacteria multiply.

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WHERE ANTHRAX IS FOUND

Anthrax is most common in agricultural regions of

• Central and South America,

• sub-Saharan Africa,

• central and southwestern Asia,

• southern and eastern Europe, and

• the Caribbean.

NOTE

Anthrax is more common in countries that do not have programs that routinely vaccinate animals

against anthrax.

ANTHRAX AS A BIOTERRORISM WEAPON

A biological attack, or bioterrorism, is the intentional release of viruses, bacteria, or other germs

that can sicken or kill people, livestock, or crops. Bacillus anthracis, the bacteria that causes

anthrax, is one of the most likely agents to be used in a biological attack.

RISK FACTORS

• Veterinarians

• Farmers

• Individuals who handle animal wool, hair, hides, or bone meal products.[5]

• Travelers

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 • Laboratory professionals

• Mail handlers, military personnel, and response workers who may be

exposed during a bioterror event involving anthrax spores.

TYPES OF ANTHRAX

The type of illness a person develops depends on how anthrax enters the body. Typically, anthrax

gets into the body through the skin, lungs, or gastrointestinal system. All types of anthrax can

eventually spread throughout the body and cause death if they are not treated with antibiotics.

1. CUTANEOUS ANTHRAX

When anthrax spores get into the skin, usually through a cut or scrape, a person can develop

cutaneous anthrax. This can happen when a person handles infected animals or contaminated

animal products like wool, hides, or hair.

NOTE

Cutaneous anthrax is the most common form of anthrax infection, and it is also considered to

be the least dangerous.

Without treatment, up to 20% of people with cutaneous anthrax die. However, with proper

treatment, almost all patients with cutaneous anthrax survive.

INHALATION ANTHRAX

When a person breathes in anthrax spores, they can develop inhalation anthrax. People who

work in places such as wool mills, slaughterhouses, and tanneries may breathe in the spores

when working with infected animals or contaminated animal products from infected animals.

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Inhalation anthrax starts primarily in the lymph nodes in the chest before

spreading throughout the rest of the body, ultimately causing severe breathing

problems and shock.

NOTE

Inhalation anthrax is the deadliest form of anthrax.

Without treatment, inhalation anthrax is almost always fatal. However, with aggressive

treatment, about 55% of patients survive.

GASTROINTESTINAL ANTHRAX

When a person eats raw or undercooked meat from an animal infected with anthrax, they can

develop gastrointestinal anthrax. Once ingested, anthrax spores can affect the upper

gastrointestinal tract (throat and esophagus), stomach, and intestines, causing a wide variety of

symptoms.

INJECTION ANTHRAX

Just as the name, it is the type of anthrax you get through injection.

Mostly found among PWIDs.

Symptoms may be similar to those of cutaneous anthrax, but there may be infection deep under

the skin or in the muscle where the drug was injected. Injection anthrax can spread throughout

the body faster and be harder to recognize and treat.

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HOW PEOPLE GET ANTHRAX

People get infected with anthrax when spores get into the body. When this happens, the spores

can be activated and become anthrax bacteria. Then the bacteria can multiply, spread out in the

body, produce toxins (poisons), and cause severe illness.

People get anthrax by:

• Breathing in spores,

• Eating food or drinking water that is contaminated with spores, or

• Getting spores in a cut or scrape in the skin.

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NOTE

Anthrax is NOT contagious. You cannot catch anthrax from another person

the way you might catch a cold or the flu. In rare cases, person-to-person

transmission has been reported with cutaneous anthrax, where discharges from skin lesions

might be infectious.

CERTAIN ACTIVITIES CAN INCREASE THE CHANCES OF GETTING ANTHRAX

Working with infected animals or animal products

Most people who get sick from anthrax are exposed while working with infected animals or

animal products such as wool, hides, or hair.

Inhalation anthrax can occur when a person inhales spores that are in the air (aerosolized)

during the industrial processing of contaminated materials, such as wool, hides, or hair.

Cutaneous anthrax can occur when workers who handle contaminated animal products get

spores in a cut or scrape on their skin.

Eating raw or undercooked meat from infected animals

People who eat raw or undercooked meat from infected animals may get sick

with gastrointestinal anthrax. This usually occurs in countries where livestock are not routinely

vaccinated against anthrax and food animals are not inspected prior to slaughter.

In the United States, gastrointestinal anthrax has rarely been reported. This is because yearly

vaccination of livestock is recommended in areas of the United States where animals have had

anthrax in the past, and because of the examination of all food animals, which ensures that they

are healthy at the time of slaughter

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 NOTE

When the spores get inside the body, from any route mentioned from above, the spores then

become anthrax bacteria. Then the bacteria can multiply, spread out in the body, produce toxins

(poisons), and cause severe illness

SYMPTOMS OF ANTHRAX

The symptoms of anthrax depend on the type of infection and can take anywhere from 1 day

to more than 2 months to appear. All types of anthrax have the potential, if untreated, to

spread throughout the body and cause severe illness and even death.

Cutaneous anthrax symptoms can include:

• A group of small blisters or bumps that may itch

• Swelling can occur around the sore

• A painless skin sore (ulcer) with a black center that appears after the small blisters or bumps

Most often the sore will be on the face, neck, arms, or hand

Inhalation anthrax symptoms can include:

• Fever and chills

• Chest Discomfort

• Shortness of breath

• Confusion or dizziness

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• Cough

• Nausea, vomiting, or stomach pains

• Headache

• Sweats (often drenching)

• Extreme tiredness

• Body aches

Gastrointestinal anthrax symptoms can include:

• Fever and chills

• Swelling of neck or neck glands

• Sore throat

• Painful swallowing

• Hoarseness

• Nausea and vomiting, especially bloody vomiting

• Diarrhea or bloody diarrhea

• Headache

• Flushing (red face) and red eyes

• Stomach pain

• Fainting

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• Swelling of abdomen (stomach)

Injection anthrax symptoms can include:

• Fever and chills

• A group of small blisters or bumps that may itch, appearing where the drug was injected

• A painless skin sore with a black center that appears after the blisters or bumps

• Swelling around the sore

• Abscesses deep under the skin or in the muscle where the drug was injected

Injection anthrax symptoms are similar to those of cutaneous anthrax, but injection anthrax can

spread throughout the body faster and be harder to recognize and treat than cutaneous anthrax.

Skin and injection site infections associated with injection drug use are common and do not

necessarily mean the person has anthrax.

DIAGNOSIS OF ANTHRAX

Gram stain and culture

Direct fluorescent antibody (DFA) test and polymerase chain reaction (PCR) assay

Occupational and exposure history is important.

Cultures and Gram stain of samples from clinically identified sites, including cutaneous or

mucosal lesions, blood, pleural fluid, cerebrospinal fluid, ascites, or stool, should be done.

Sputum examination and Gram stain are unlikely to identify inhalation anthrax because

airspace disease is frequently absent.

A PCR test and immunohistochemical methods (eg, DFA) can help.

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Nasal swab testing for spores in people potentially exposed to inhalation

anthrax is not recommended because the negative predictive value is

unknown. Although a positive nasal swab culture indicates exposure, a

negative nasal swab does not mean that exposure has not occurred.

Sputum examination and Gram stain are unlikely to identify inhalation anthrax because

airspace disease is frequently absent.

Chest x-ray (or CT) should be done if pulmonary symptoms are present. It typically shows

widening of the mediastinum (because of enlarged hemorrhagic lymph nodes) and pleural

effusion. Pneumonic infiltrates are uncommon.

Lumbar Puncture should be done if patients have meningeal signs or a change in mental status.

If a lumbar puncture cannot be done, central nervous system imaging by CT with contrast or

MRI with contrast should be done to document meningeal enhancement characteristics of

meningitis and identify hemorrhagic parenchymal lesions characteristic of anthrax

meningoencephalitis.

An enzyme-linked immunosorbent assay (ELISA) can detect antibody in serum, but

confirmation requires a 4-fold change in antibody titer from acute to convalescent specimens.

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