Anthrax

Anthrax has been described since biblical times, with the plague that killed the Egyptians cattle likely being the first recorded incidence. It is primarily a disease of cattle, goat and sheep and is most common in developing nations. Humans contract the disease primarily through contact with infected animals or their parts. The notable exception being the recent experience in the United States of deliberate spread of anthrax spores via the postal system.

In humans the disease mostly affects three organ systems: skin, lungs and gastrointestinal. Nearly 95% of the cases manifest’s as a skin ulcer with central necrosis, lung involvement resembles pneumonia and gastrointestinal symptoms are of nausea, vomiting and diarrhea.

It is caused by the bacteria bacillus anthracis.

Where does it occur?

It is primarily seen in live stock growing areas of developing nations and is prevalent in Africa, Asia, Central and South America, Eastern and parts of Southern Europe. In other countries the prevalence is very low and cases are rare.

How is it transmitted?

It is transmitted through contact with soil contaminated with anthrax spores in regions where livestock have anthrax, contact with infected animal products like hair, hide, bone etc, or ingesting meat from infected animals.

Skin disease occurs via contact with an already existing skin lesion, lung disease occurs via inhalation of spores while working with wool /hair, tanning hides or processing bone meal etc. Intestinal disease occurs through ingestion of contaminated meat products.

Is it contagious from person to person?

It is generally not contagious from person to person with lung and intestinal disease. There have been rare reports of transmission of skin disease from an infected individual’s ulcer through direct contact. The spores can remain and be viable on environments for years.

What is the risk for travelers?

The risk for travelers is generally low, unless engaged in agricultural, animal husbandry or working with animal hair, skin and bones in those areas where anthrax is prevalent in live stock.

 

What are the signs and symptoms?

Skin disease: Initially a small pimple like lesion develops that is itchy, it subsequently enlarges to 1-3 cm area of ulcer with some boils around it and a central black crust.

Lung disease: Symptoms are of a respiratory illness with cough, fever, fatigue, body aches and chest pressure. After 3-4 days, one might sense improvement of symptoms followed by rapid deterioration with shortness of breath and respiratory failure.

Gastrointestinal disease: Symptoms include nausea, vomiting, fever and decreased appetite. Subsequently one sees diarrhea, bloody stools and shock.

Rarely one can see meningitis with headache, stiff neck, change in level of consciousness etc, as the bacteria spreads through the blood stream to the central nervous system from any of the above three organs.

Are there any lab tests to diagnose the illness?

Bacillus anthracis bacteria can be seen under the microscope in body fluids and blood; it will grow in culture as well. Antibody tests are available but are not likely timely in making the diagnosis.

 

Is there any treatment?

Ciprofloxacin is considered the antibiotic of choice. Other agents that are also used in combination are doxycycline, clindamycin, linezolid, rifampin, amoxicillin etc.

What preventive measures can be taken?

If engaged in high risk activities like laboratory work with anthrax, veterinary work in high risk areas, working in tanneries or military personnel can obtain a vaccine called biothrax.

Otherwise avoid high risk activities with live stock and soil in risk prone areas

How soon will one experience symptoms?

Generally symptoms are seen 2-7 days after exposure.

 

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