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Making Sense of ... Anthrax

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What is anthrax?

Anthrax is a bacterial infection caused by the spore-forming bacterium Bacillus anthracis.

Where is anthrax usually found?

Anthrax exists naturally in wild and domestic animals, such as cattle, sheep, goats, and other herbivores, it can also occur in humans who are exposed to infected animals or tissue from infected animals.

Anthrax can be found globally, but it is more common in developing countries or countries without veterinary public health programs. Antrax is found parts of South and Central America, Southern and Eastern Europe, Asia, Africa, the Caribbean, and the Middle East.

How common is anthrax?

Worldwide incidence is unknown, but outside of 'at risk' areas, anthrax is extremely rare. In the United States, only 236 anthrax cases were reported between 1955 and 1999, an average of about five per year. Most of those were in people who work with animal products.

Anthrax has, however been seen as a convenient and inexpensive biological weapon, and this unquantifiable risk should be taken seriously.

How is anthrax transmitted?

Anthrax affects humans via occupational exposure to infected animals or their products. Workers in other counties, who are exposed to imported dead animals and animal products, may become infected with B. anthracis (industrial anthrax).

Anthrax can be transmitted in three different ways:

  • Cutaneous (skin), B. anthracis spores can live in the soil for many years, and humans can become infected by contact with the soil, or handling products from infected animals
  • Inhalationor of anthrax spores from contaminated animal products. i, and .
  • Gastrointestinal: Anthrax can be spread by eating undercooked meat from infected animals.

Can anthrax be spread from person-to-person?

There is no evidence of unintended infection, even from people with inhalation anthrax; ther is a risk of infection from spores released into the atmosphere or air supply accidentally (eg from a laboratory) or intentionally (eg terrorism)

Who is most at risk?

  • People working with imported meat or hides from endemic areas
  • People travelling 'rough' in endemic areas
  • Military personnel

What are the symptoms of anthrax?

Cutaneous: Infection usually occurs when spores enter via a cut or abrasion on the skin, such as when handling wool, hides, leather or hair from infected animals. Skin infection begins as a raised itchy bump that may be mistaken for an insect bite; within 48 hours, it develops into a vesicle and then a painless ulcer, usually 1-3 cm in diameter, with a characteristic black necrotic (dead) area in the center. Lymph glands in the adjacent area may swell. About one in five untreated cases of cutaneous anthrax will result in death.

Inhalation: Flu-like symptoms will progress over several days to severe breathing problems; inhalation anthrax is usually fatal.

Gastrointestinal: Acute inflammation of the gut shows as nausea, loss of appetite, vomiting, and fever. These usually lead to abdominal pain, severe diarrhea, and vomiting of blood. Intestinal anthrax has a death rate approaching 50%.

How is anthrax diagnosed?

Diagnosis is confirmed by isolating B. anthracis from the blood, skin lesions, or respiratory secretions or by measuring specific antibodies in the blood.

Tests are available to confirm the diagnosis within an hour; testing is taking place in Switzerland for a test that will confirm the presence of anthrax in a few minutes.

Is there a treatment for anthrax?

Antimicrobial treatment is usually effective if commenced in good time. If left untreated, the disease can be fatal. Treatment success (and the time available) depends on the form of the disease (cutaneous, inhalation or intestinal). Ciprofloxacin is still the antibiotic of choice ('first line therapy') - but antimicrobial therapies are subject to culture and sensitivity results from the laboratory; doxycycline and procaine penicillin may be used. In pregnant women, drugs and dosages may need to be reviewed to ensure the foetus gains maximum benefit (Meaney-Delman 2013).

In 2012, the U.S. Food and Drug Administration approved raxibacumab injection to treat inhalational anthrax. Raxibacumab is a monoclonal antibody that neutralizes toxins produced by B. anthracis that can cause massive and irreversible tissue injury and death (FDA 2012).

Is there a way to prevent infection?

There is an animal vaccine, which is not unioversally used; there is also an anthrax vaccine for use in humans, which offers over 90% protection against anthrax.

In areas where anthrax is common and animal vaccination levels are low, contact with livestock and animal products must be avoided, meat that has not been properly slaughtered and thoroughly cooked should also be avoided.

What is the mortality rate for anthrax?

Untreated cutaneous anthrax has a mortality rate which varies from five to twenty per cent. Deaths are rare with early diagnosis and appropriate antibiotic therapy.

What is the anthrax vaccine?

The vaccine is a cell-free filtrate vaccine, which means it contains no dead or live bacteria in the preparation. Mild local reactions, such as tenderness and redness at the injection site, occur in almost a third of recipients. Severe local reactions, involving extensive swelling of the forearm as well as the local reaction, are infrequent. Systemic reactions are rare.

What is the protocol for anthrax vaccination?

The immunization consists of three subcutaneous injections given two weeks apart followed by three additional subcutaneous injections given at 6, 12, and 18 months. Annual booster injections of the vaccine are recommended thereafter. Pregnant women are only vaccinated if absolutely necessary.

Who should get vaccinated against anthrax?

  • People who work with the organism in laboratories
  • People who work with imported animal hides or furs where there is a risk of exposure to anthrax spores.
  • People who handle potentially infected animal products in high-incidence areas.
  • Military personnel posted in high risk locations.

Are there adverse reactions to the anthrax vaccine?

The most common reactions are temporary redness, swelling or a small lump at the injection site; even these occurrancies have been uncoomon, with about 100 reports after some 400,000 people had received the vaccine.

Can anthrax be controlled environmentally?

Antrax can survive in the ground as a spore for many years before being activated and infecting animals or people; in its natural cylcle, the death of the infected creature then allows reinfection of the ground. Until the next time.

Is there legal protection for workers and others?

Workers are entitled to appropriate training and protective equipment

References

U.S. Food and Drug Administration, FDA approves raxibacumab to treat inhalational anthrax [Press Release]

Meaney-Delman D, et al; Prophylaxis and treatment of anthrax in pregnant women, DJ.Obstet Gynecol. 2013 Oct;122(4):885-900 abstract

Bibliography and Further Information Sources

If this article hasn't answered your question, email me at the address below, and I'll try to get the information you seek. I regret I cannot assist with individual cases or essays and school projects, but if it's something I've missed, I'll be happy to try and help.

Article written by Andrew Heenan BA (Hons), RGN, RMN

First Published: 19 January 2006
Last updated: 08 February 2014
© Andrew Heenan 2006 et seq

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