Anthrax

Anthrax is a serious infectious disease caused by gram-positive, rod-shaped bacteria known as Bacillus anthracis. It can occur in four forms: skin, lungs, intestinal, and injection. Although it is rare, people can get sick with anthrax if they come in contact with infected animals or contaminated animal products. Contact with anthrax can cause severe illness in both humans and animals.

How do people get infected with anthrax?

• People get infected with anthrax when spores get into the body. When anthrax spores get inside the body, they can be “activated.” When they become active, the bacteria can multiply, spread out in the body, produce toxins (poisons), and cause severe illness.
• This can happen when people breathe in spores, eat food or drink water that is contaminated with spores, or get spores in a cut or scrape in the skin.
• There's no evidence that anthrax is transmitted from person to person, but it's possible that anthrax skin lesions may be contagious through direct contact.

Where is anthrax 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.
• Anthrax is rare in the United States, but sporadic outbreaks do occur in wild and domestic grazing animals such as cattle or deer. Anthrax is more common in developing countries and countries that do not have veterinary public health programs that routinely vaccinate animals against anthrax. In the United States, yearly vaccination of livestock is recommended in areas where animals have had anthrax in the past.

Symptoms

Anthrax shares many symptoms with more common conditions, such as flu and pneumonia. A health care provider will rule these out first before considering anthrax, unless there is a specific reason to suspect it.

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 (skin) 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 hands
• Inhalation (lungs) anthrax symptoms can include:
  • Fever and chills
  • Chest Discomfort
  • Shortness of breath
  • Confusion or dizziness
  • Cough
  • Nausea, vomiting, or stomach pains
  • Headache
  • Sweats (often drenching)
  • Extreme tiredness
  • Body aches
• Gastrointestinal (intestinal) 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
  • 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
  • As the disease progresses, symptoms can include shock, multiple organ failure and meningitis.
  • 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.
  • It's contracted through injecting illegal drugs and has been reported only in Europe so far.

Complications

The most serious complication of anthrax is inflammation of the membranes and fluid covering the brain and spinal cord, leading to massive bleeding (hemorrhagic meningitis) and death.

Who is at risk?

• Anyone who has come in contact with anthrax spores could be at risk of getting sick. Most people will never be exposed to anthrax. However there are activities that can put some people at greater risk of exposure than others.
  • People Who Handle Animal Products
    • Occupational exposure to infected animals or their products (such as skin, wool, and meat)
    • Historically, inhalational anthrax was called woolsorters' disease because it was an occupational hazard for people who sorted wool.
  • Veterinarians, esp. those dealing with livestock
  • Livestock producers
  • Travelers
  • Laboratory Professionals
    • It can be contracted in laboratory accidents or by handling infected animals, their wool or their hides.
  • Mail handlers, military personnel, and response workers who may be exposed during a bioterror event involving anthrax spores as exemplified by the 2001 anthrax attack that killed five and made 22 people sick.
  • Those who inject illegal drugs, such as heroin

Prevention:

• The anthrax vaccine is currently provided only to people who are at an increased risk of coming in contact with anthrax spores, such as members of the U.S. military, certain laboratory workers, and some people who handle animals or animal products (for example, farmers, veterinarians, and livestock handlers). The vaccine is not licensed for use in children under age 18, adults over age 65, or pregnant and nursing women.
  • The vaccine doesn't contain live bacteria and can't lead to infection, but it can cause side effects, ranging from soreness at the injection site to more-serious allergic reactions.
  • It is not available to the public.
• Avoiding infected animals
  • If you live or travel in a country where anthrax is common and herd animals aren't routinely vaccinated, avoid contact with livestock and animal skins as much as possible. Also avoid eating meat that hasn't been properly cooked.
  • Even in developed countries, it's important to handle any dead animal with care and to take precautions when working with or processing imported hides, fur or wool.

Treatment

• is with antibiotics, which must be started soon after infection, before the levels of toxins and harmful bacteria within the body become too high for drugs to eliminate.
• The type of antibiotics will depend on how the infection occurred, the individual's age and medical history.

Exposure

• The spores of anthrax are able to survive in harsh conditions for decades or even centuries. Such spores can be found on all continents, including Antarctica. Disturbed grave sites of infected animals have been known to cause infection after 70 years.
  • Russian researchers estimate arctic permafrost contains around 1.5 million anthrax-infected reindeer carcasses, and the spores may survive in the permafrost for 105 years. There is a risk that global warming in the Arctic can thaw the permafrost, releasing anthrax spores in the carcasses. In 2016, an anthrax outbreak in reindeer was linked to a 75-year-old carcass that defrosted during a heat wave

Epidemiology:

• Globally, at least 2,000 cases occur a year
• United States:
  • The last fatal case of natural inhalational anthrax in the United States occurred in California in 1976, when a home weaver died after working with infected wool imported from Pakistan.
• United Kingdom:
  • In November 2008, a drum maker in the United Kingdom who worked with untreated animal skins died from anthrax
  • In December 2009, an outbreak of anthrax occurred amongst heroin addicts in the Glasgow and Stirling areas of Scotland, resulting in 14 deaths. The source of the anthrax is believed to be dilution of the heroin with bone meal in Afghanistan.
• From: Wikipedia - List of anthrax outbreaks
  • 1979 - On April 2, 1979 outbreak of anthrax infection happened in Sverdlovsk, USSR - 64 people died during April and June
  • 2001 - In September, 2001 letters containing anthrax spores were mailed to several news media offices and two U.S. Senators, killing five people and infecting 17 others.
    • NPR, The Anthrax Investigation - Timeline: How the Anthrax Terror unfolded. 15 Feb 2011 - five killed/died in 2001
  • 2009 - in New Hampshire one woman was confirmed to have gastrointestinal anthrax (survived)
  • 2014 - October 2014, an outbreak of anthrax in a village in India allegedly killed seven people.
  • 2016 - In July 2016, nearly 100 people have been hospitalized amid an anthrax outbreak from nomadic communities in northern Siberia, Russia and more than 2,300 reindeer died from anthrax infections in Yamalo-Nenets Autonomous Okrug. A 12 year-old child also died due to the outbreak.[12] Scientists believe the melting unearthed the frozen carcass of a reindeer that died in the previous anthrax outbreak in 1968.

Discovery

• Robert Koch, a German physician and scientist, first identified the bacterium that caused the anthrax disease in 1875 in Wolsztyn (now part of Poland). His pioneering work in the late 19th century was one of the first demonstrations that diseases could be caused by microbes. In a groundbreaking series of experiments, he uncovered the lifecycle and means of transmission of anthrax. His experiments not only helped create an understanding of anthrax, but also helped elucidate the role of microbes in causing illness at a time when debates still took place over spontaneous generation versus cell theory.

Resources & Additional Reading:

• CDC - Anthrax
• Wikipedia - Anthrax
• MedlinePlus - Anthrax (has info in Spanish)
• Mayo Clinic - Anthrax, Overview
• MedicalNewsToday - Anthrax: Causes, treatments, and risks. By: James McIntosh; Reviewed by Jill Seladi-Schulman, PhD. Updated 19 Jul 2017
• Understanding Anthrax. By Joe Kays & April Frawley Birdwell, Summer 2006, Vol.11, No.2
• GT Emergency Management - County Distributes Sample Medication in Anthrax Release Drill. By: Sylvia Carignan, 18 May 2016
• Anthrax Fact Sheet

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