By: Syed ShahZaib Shah 1

Anthrax

Title: Anthrax

Subtitles are following

1: Definition and History.

2: Traits of Anthrax Bacterium.

3: Infection.

4: Symptoms.

5: How common is anthrax and who can get it?

6: Causes.

7: Test and Diagnosis.

8: Treatment.

9: Prevention.

10: References
By: Syed ShahZaib Shah 2
Anthrax

Definition & Some History of Anthrax

Anthrax is a serious illness caused by a spore-forming bacterium,

Bacillus anthracis. Although anthrax affects mainly livestock and wild
game, humans can become infected through direct or indirect contact
with sick animals. Normally, anthrax isn't transmitted from person to
person, but in rare cases, anthrax skin lesions may be contagious.
The causative agent of anthrax, Bacillus anthraces, was discovered
in 1877 by Robert Koch. The Bacillus is a large, Gram-positive,
facultatively anaerobic, endospore-forming rod. The endospores form
only under aerobic conditions and are not found in tissues or
circulating blood. But if an infected animal`s blood is spilled during an
autopsy, Bacilli exposed to air rapidly form endospores.
Anthrax is an acute infectious disease caused by the spore-forming
bacterium Bacillus anthracis. Anthrax most commonly occurs in wild
and domestic lower vertebrates (cattle, sheep, goats, camels,
antelopes, and other herbivores), but it can also occur in humans
when they are exposed to infected animals or tissue from infected
animals.
Anthrax is a disease predominantly of ruminant animals and their
handlers, variously known as "Woolsorter's disease," Splenic Fever,
Charbon, or Milzbrand. It has received enormous attention as a
means of biological terror in the United States following the 11
September 2001 destruction of the World Trade Center buildings.
Because it is possible to disperse anthrax spores in the air (though
with some difficulty), anthrax is touted as a leading candidate for
"terrorists" to use against populations. However, many irrational fears
attend this possibility, and a hysteria is sweeping across the United
States in which every unknown powder is seen as "anthrax."
Most often, anthrax bacteria enter your body through a wound in your
skin. You can also become infected by eating contaminated meat or
inhaling the spores. Symptoms, which depend on the way you're
infected, can range from skin sores to nausea and vomiting or shock.
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Anthrax
Prompt treatment with antibiotics can cure most anthrax infections
contracted through the skin or contaminated meat. Inhaled anthrax is
more difficult to treat and can be fatal.

Roots of Anthrax in Germ Warfare

The British in 1941 tested an aerial anthrax bomb on tiny Gruinard Island off
the coast of Scotland. The 60 sheep placed there as 'guinea pigs" were all
killed by the germ warfare bomb. Unfortunately, the island remained
contaminated with viable anthrax spores for more than 40 years, making it
uninhabitable until protests in the 1980s led the British government to
sterilize the entire island with burning followed by treatment with
formaldehyde. The United States actively pursued the development of
anthrax as a biological weapon. It seems be significant that the strain which
was used in the US attacks during the Fall of 2001 appear to be identical to
one developed by the US Army for germ warfare

TRAITS OF THE ANTHRAX BACTERIUM

Bacillus anthracis, the causative agent of anthrax, is a large Gram positive

rod, forming serpentine chains (streptobacilli) with ends squared off at
regular intervals. They are facultative anaerobic bacilli. They are easy to
culture, forming sticky colonies, with tiny "medusa heads" extending out.
It liquefies gelatin, stabs producing "inverted fir tree" in the gelatin. It is
distinguished from other Bacilli by its non-motility and presence of a
capsule.

Spores (central spores no wider than bacterium) are seen in 2-3 day old
cultures, but not in clinical specimens. They resist heat and certain
antiseptics for moderate periods of time.
Capsule is a polypeptide of poly D-glutamic acid, and is a hapten (forms
active antigen when combined with other molecules).
Colonies are round, and appear like "cut glass" or "ground glass" in
transmitted light. They are gray and non-hemolytic on Blood Agar.
Toxin: three heat-labile components, none are active alone. The virulence
factor potentiates other two factors
By: Syed ShahZaib Shah 4
Anthrax
Lethal factor PA + LF = death (found in plasma of dying animals)
edema factor PA + EF = edema
virulence dependant on (single) capsule (anti phagocytic) and toxins

INFECTION:
Humans are moderately resistant to the disease, with 20,000 to 100,000
cases per year worldwide. Infection acquired via one of three routes, through
the skin, by inhalation, or by ingestion. Cutaneous infection constitute 95%
of infections, and are acquired through minor abrasion, injured skin or at
pressure point of contaminated hide against skin. Rarely, it is contracted by
inhalation of spores, causing "Woolsorter's disease," (often through the
processing contaminated goat hair). According to the Merck Manual,
"Inhaling spores under adverse conditions (e.g. the presence of an acute
respiratory infection) may result in pulmonary anthrax which is often fatal."
Infections due to ingestion are rare in humans. It is not communicable from
person to person. The incubation period is generally 3-5 days. Spores
germinate in tissue at site of entry, lead to gelatinous edema. The pathogens
spread by the lymphatics to blood stream shortly before (and after) death. It
can be spread among animals via biting flies, insects and vultures, but this
mode of transmission is thought to be rare.

How is anthrax transmitted?

Anthrax infection can occur in three forms: cutaneous (skin), inhalation, and
gastrointestinal. B. anthracis spores can live in the soil for many years, and
humans can become infected with anthrax by handling products from
infected animals or by inhaling anthrax spores from contaminated animal
products. Anthrax can also be spread by eating undercooked meat from
infected animals. It is rare to find infected animals in the United States.
The symptoms of Anthrax are following

Symptoms
You can contract anthrax when spores enter an open wound in your skin.
The infection begins as a raised, sometimes itchy, bump resembling an
insect bite. But within a day or two, the bump develops into an open, usually
painless sore with a black center.
By: Syed ShahZaib Shah 5
Anthrax
There are three types of anthrax, each with different signs and symptoms. In
most cases, symptoms develop within seven days of exposure to the
bacteria.

Cutaneous anthrax

This form of anthrax enters your body through a cut or other sore on your
skin. It's by far the most common form of the disease. It's also the mildest —
with appropriate treatment, cutaneous anthrax is seldom fatal. Most (about
95%) anthrax infections occur when the bacterial spore enters a cut or
abrasion on the skin, such as when handling contaminated wool, hides,
leather or hair products (especially goat hair) of infected animals.
Symptoms of cutaneous anthrax include:

• A raised, itchy bump resembling an insect bite that quickly develops

into a painless sore with a black center
• Swelling in the sore and nearby lymph glands

Cutaneous anthrax infection has the following

characteristics:
• Skin infection begins as a small, raised bump that might itch-
similar to an insect or spider bite.
• Within 1 to 2 days, the bump develops into a fluid-filled blister
about 1cm to 3cm in diameter. Within 7 to 10 days, the blister
usually has a black center of dying tissue (eschar) surrounded
by redness and swelling. The blister is usually painless.

Additional blisters may develop.

Other symptoms may include:

• Swollen lymph nodes close to the area of the blister.

• Fever.
• Headache.
• A general feeling of discomfort.

About 20% of untreated cases of cutaneous anthrax will result in

death. Deaths are rare with appropriate antimicrobial therapy.
By: Syed ShahZaib Shah 6
Anthrax
Gastrointestinal anthrax

This form of anthrax occurs after eating meat contaminated with the
bacteria that cause anthrax. Gastrointestinal anthrax can be more
serious than cutaneous anthrax but can be treated effectively with
prompt use of antibiotics. But if untreated, gastrointestinal anthrax
causes:

• Ulcers at the base of the tongue or tonsils.

• Sore throat.
• Loss of appetite.
• Vomiting.
• Fever.

You contract this form of anthrax by eating undercooked meat from

an infected animal. Signs and symptoms include:

• Nausea
• Vomiting, which is often bloody in the later stages of the
disease
• Loss of appetite
• Fever
• Severe, bloody diarrhea in the later stages of the disease
• Sore throat and difficulty swallowing
• Abdominal pain.
• Vomiting of blood.
• Bloody diarrhea
• Swollen neck

Inhalation (pulmonary) anthrax

Inhalation anthrax develops when you breathe in anthrax spores. It's

the most deadly form of the disease and even with treatment is often
fatal. The incubation period for this form of anthrax may be 60 days or
more, although it is usually 2 to 3 days.:Initial signs and symptoms of
inhalation anthrax include:

• Flu-like symptoms, such as sore throat, mild fever, fatigue and

muscle aches, which may last a few hours or days
By: Syed ShahZaib Shah 7
Anthrax
• Mild chest discomfort

As the disease progresses, you may experience:

• High fever
• Trouble breathing
• Shock
• Meningitis — a potentially life-threatening inflammation of the
brain and spinal cord

Death can occur within 24 to 36 hours after such complications

occur. Respiratory symptoms may be similar to those of
pneumenia.
After the disease becomes severe, it is difficult to treat, and survival is
unlikely. Inhalational anthrax is not contagious. You must inhale the
spores from the environment to develop this form of anthrax. Even
with the outbreaks in 2001, this type of exposure is still very rare.

The symptoms of inhalational anthrax infection may resemble those

of influenza (flu), except for these key differences:3

• Shortness of breath, which may occur with anthrax infection, is not

a common symptom of the flu.
• A runny nose, which often occurs with the flu, is not common in
anthrax.

Oropharyngeal anthrax
This is the least common form of anthrax. The incubation period is
from 1 to 7 days. Initial symptoms include:

• Fever.
• Swollen lymph nodes in the neck.
• Severe throat pain.
• Difficulty swallowing.
• Ulcers at the base of the tongue.

As infection progresses, swelling can make breathing difficult.

By: Syed ShahZaib Shah 8
Anthrax
When to seek medical advice

Many common illnesses start with symptoms that resemble the flu.
Anthrax is rare in the developed world, and the chances that your
sore throat and aching muscles are due to anthrax are extremely
small.
If you think you may have been exposed — for example, if you work
in an environment where anthrax is likely to occur — see a doctor
immediately for evaluation and care. If you develop signs and
symptoms of the disorder after exposure to animals or animal
products in parts of the world where anthrax is common, seek prompt
medical attention. Early diagnosis and treatment are crucial.

How common is anthrax and who can get it?

Anthrax is most common in agricultural regions where it occurs in

animals. These include South and Central America, Southern and
Eastern Europe, Asia, Africa, the Caribbean, and the Middle East.
When anthrax affects humans, it is usually due to an occupational
exposure to infected animals or their products. Workers who are
exposed to dead animals and animal products from other countries
where anthrax is more common may become infected with B.
anthracis (industrial anthrax). Anthrax outbreaks occur in the United
States on an annual basis in livestock and wild game animals such as
deer.

Causes
Anthrax spores are formed by bacteria that occur naturally in soil in
most parts of the world. The spores can remain dormant for years
until they find their way into a host — usually wild or domestic
livestock, such as sheep, cattle, horses, goats and camels. Although
rare in the United States, anthrax is still common throughout the
developing world, especially sub-Saharan Africa.
Most human cases of anthrax occur as a result of exposure to
infected animals or their meat or hides. In the United States, a few
By: Syed ShahZaib Shah 9
Anthrax
people have developed anthrax while making traditional African
drums from the skins of infected animals.
One of the few known instances of non-animal transmission occurred
in the United States in 2001 when 22 people developed anthrax after
being exposed to spores sent through the mail. Five of those who
were infected died.

Risk factors
To contract anthrax, you must come in direct contact with anthrax
spores. This is more likely if you

• Are in the military and deployed to an area with a high risk of

exposure to anthrax
• Work with anthrax in a laboratory setting
• Handle animal skins, furs or wool from areas with a high
incidence of anthrax
• Work in veterinary medicine, especially if you deal with livestock .
• Handle or dress game animals — in the United States,
seasonal outbreaks of anthrax are common among livestock
and game animals, such as deer

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

• Tests and diagnosis

Your doctor will first want to rule out other, more common conditions
that may be causing your signs and symptoms, such as flu (influenza)
or pneumonia. You may have a rapid flu test to quickly diagnose a
case of influenza. If other tests are negative, you may have further
tests to look specifically for anthrax, such as:
By: Syed ShahZaib Shah 10
Anthrax
• Skin testing. A sample of fluid from a suspicious lesion on
your skin or a small tissue sample (biopsy) may be tested in a
lab for signs of cutaneous anthrax.
• Blood tests. You may have a small amount of blood drawn
that's checked in a lab for anthrax bacteria.
• Chest X-ray or computerized tomography (CT) scan.
Your doctor may request a chest X-ray or CT scan to help
diagnose inhalation anthrax.
• Endoscopy and stool samples. To diagnose intestinal
anthrax, your doctor may examine your throat or intestine with
an endoscope — a thin, flexible tube with a tiny camera at its
tip. In some cases, a sample of your stool may be checked for
anthrax bacteria.
• Spinal tap (lumbar puncture). In this test, your doctor
inserts a needle into your spinal canal and withdraws a small
amount of fluid. A spinal tap is usually done only to confirm a
diagnosis of anthrax meningitis.

Anthrax is diagnosed by culture and isolation of the causative

bacterium, B. anthracis; by detecting the bacterial DNA or antigens;
or by measuring specific antibodies in the blood of persons with
suspected cases. The bacteria can be cultured from the blood, skin
lesions, fluid from the lungs or respiratory secretions, spinal fluid, or
other affected tissues prior to the start of antibiotic treatment.
Detection of the DNA or antigens of the bacteria, and detection of
antibodies in the blood of suspected cases, are important tools for
diagnosis because positive culture is unlikely after antibiotic treatment
has been started.

Treatments and drugs

The standard treatment for anthrax is a 60-day course of an
antibiotic, such as ciprofloxacin or doxycycline. Which antibiotic or
combination of antibiotics will be most effective for you depends on
the type of anthrax you have, your age, overall health and other
factors. Treatment is most effective when started as soon as
possible.
By: Syed ShahZaib Shah 11
Anthrax
(in the extreme unlikelyhood that you contract anthrax) is most straight
forward with simple penicillin G. Erythromycin, tetracycline and a variety
of other antibiotics are also highly effective. Broad spectrum antibiotics
such as Cipro (with all their deleterious side effects) are not appropriate
without clear evidence that the bacteria are resistant to most antibiotics.
Anthrax has little or no history of antibiotic resistance.
Although some cases of anthrax respond to antibiotics, advanced inhalation
anthrax may not. By the later stages of the disease, the bacteria have often
produced more toxins than drugs can eliminate.
Another treatment of Anthrax is by Penicillin which is the antibiotic of
choice. For patients who are allergic to penicillin, many other antibiotics are
effective, including erythromycin, tetracycline and chloramphenicol. The
typical treatment for cutaneous anthrax is a 7 day course of Penicillin G,
600,000 U IM. Ciprofloxacin (Cipro) is being widely touted and there has
been a stampede to buy it up by the frightened public. This broad-spectrum
antibiotic is very expensive and has serious possible side effects. It is an
illogical choice to treat anthrax, especially when simple penicillin G is
effective and readily available. Furthermore, doctors should not be
prescribing antibiotics for patients in the absence of indications. It only
contributes to the appearance of antibiotic resistant bacteria.
Because the anthrax bacterium has had little exposure to penicillin it is likely
to be sensitive to it (as opposed to many other common bacterial infections).
Indeed, widespread use of Cipro against this anthrax is unwise because it
will favor development of resistance in common pathogens. As always, no
antibiotics should be taken without clear indication of bacteria infection.
Basic polypeptides kill anthrax, including polylysine.

Prevention
Antibiotics are recommended to prevent infection in anyone exposed
to the spores. Ciprofloxacin and doxycycline are approved by the
Food and Drug Administration for post-exposure prevention of
anthrax in adults and children. Levofloxacin is also approved for use
in adults.

Anthrax vaccine
By: Syed ShahZaib Shah 12
Anthrax
An anthrax vaccine for humans is available, but it's not 100 percent
effective. 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. The vaccine isn't
recommended for children, pregnant women or older adults.
Traditionally, vaccination has consisted of three shots given two
weeks apart, followed by three additional shots given at six, 12, and
18 months. But some research has shown that a less stringent
schedule may be equally effective with fewer side effects.
The vaccine isn't intended for the general public. Instead, it's
reserved for military personnel, scientists working with anthrax and
people in other high-risk professions.
The anthrax vaccine is manufactured and distributed by BioPort,
Corporation, Lansing, Michigan. The vaccine is a cell-free filtrate
vaccine, which means it contains no dead or live bacteria in the
preparation. The final product contains no more than 2.4 mg of
aluminum hydroxide as adjuvant. Anthrax vaccines intended for
animals should not be used in humans.

Adverse reactions to the anthrax vaccine

Mild local reactions occur in 30% of recipients and consist of slight
tenderness and redness at the injection site. Severe local reactions are
infrequent and consist of extensive swelling of the forearm in addition to the
local reaction. Systemic reactions occur in fewer than 0.2% of recipients.

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.
By: Syed ShahZaib Shah 13
Anthrax
A way to prevent infection

In countries where anthrax is common and vaccination levels of animal

herds are low, humans should avoid contact with livestock and animal
products and avoid eating meat that has not been properly slaughtered and
cooked. Also, an anthrax vaccine has been licensed for use in humans. The
vaccine is reported to be 93% effective in protecting against anthrax.
Animal products which can carry spores can be autoclaved to destroy the
spores: hides, bristles, hair.
All work with Bacillus anthracis should be carried out in biological safety
cabinet. Protective clothing and gloves worn gloves should be used when
handling infected animals.

Anthrax can be spread from person-to-person

Person-to-person transmission is extremely unlikely and has only reported

with cutaneous anthrax, where discharges from skin lesions are potentially
infectious. Communicability is not a concern in managing or visiting with
patients with inhalation anthrax.
By: Syed ShahZaib Shah 14
Anthrax
References:

1: Fundamentals of Microbiology, 5th Ed., (1996).

(By Alcamo).
2: Merck Manual 15th Ed, (1999).
(By Beers & Berkow)
3: Modern Microbiology Principles and Applications, (1992).
(By Birge, Edward)
4: Review of Medical Microbiology, 9th, (1970).
(By Jawetz et al)
5: Microbiology in Patient Care, (1994).
(By Morello et al)
6: Medical Microbiology, 2nd, (1994).
(By Murray et al)
7: Microbiology, An Introduction, 7th Ed., (2001).
(By Totora, Funke and Case)
8: Merck Index, 11th Ed, (1989).
(By Budavari, Ed)
9: Microbiology Principles & Explorations, 6th Ed, (2005).
(By Jacquelyn G.Black)
10: By Web Pages,
(Anthrax), (Anthrax, Symptoms), (Bing Health Article –
Anthrax).

The End