Anthrax - Symptoms, Diagnosis, Treatment, and Prevention

Introduction

Anthrax is found all over the world. It is most common in agricultural areas, where it affects animals. It is more prevalent in developing countries or countries that lack veterinary public health programs. Anthrax is reported more frequently in some parts of the world than others, including South and Central America, Africa, the Caribbean, Southern, and Eastern Europe, Asia, and the Middle East. It has been sporadic in the United States recently and had been limited to the cutaneous (skin) form until cases in Florida and New York City in 2001. Anthrax affects humans due to occupational interactions with infected animals or their products. However, anthrax is thought to be one of several potential agents used for bioterrorism.

What Is Anthrax?

Anthrax is a deadly infectious disease caused by Bacillus anthracis, a gram-positive, rod-shaped bacteria. It is found naturally in soil and affects domestic and wild animals worldwide. Anthrax can make people sick if they come in contact with infected animals or contaminated animal products. Anthrax can infect both humans and animals and cause severe illness.

Infection can occur through inhalation of bacteria spores, skin wounds, or contaminated food or water. Antibiotics are the first line of defense against this potentially fatal infection. Other treatments are available, including a vaccine.

How Does Anthrax Spread?

Anthrax is typically transmitted as a spore. (A spore is the dormant form of bacteria that takes when there is no food supply). When better conditions exist, like in the human body, spores can grow and cause disease). Anthrax is typically transmitted in one of three ways. Most people who have been exposed to anthrax become ill within a week, but inhalation of anthrax can take up to 42 days:

• Skin (Cutaneous) Anthrax - Most anthrax infections occur when individuals come in contact with contaminated animal products such as wool, bone, hair, and hide. When bacteria enter a cut or scratch in the skin, it causes an infection. The most common and least lethal form of anthrax is cutaneous anthrax.

• Inhalation (Lung) Anthrax - Some anthrax infections are caused when individuals inhale bacteria spores. It is the lethal form of anthrax. It has the potential to cause severe breathing problems as well as death. Because people who work in wool mills, slaughterhouses, and tannery workers may inhale spores from infected animals, inhaling anthrax is also known as woolsorter's disease.

• Gastrointestinal Anthrax - Some people may suffer from consuming undercooked infected meat. The bacteria cause problems with the esophagus, throat, stomach, and intestines. In the United States, gastrointestinal anthrax is uncommon. Before slaughter, livestock in the United States are vaccinated against anthrax, and sick animals are identified.

• Injection Anthrax - People who inject heroin risk contracting injection anthrax. This strain is more common in northern Europe and has yet to be reported in the United States. Anthrax injection causes infection deep beneath the skin or in the muscle.

Anthrax is not contagious, so you cannot catch it from another person, like the common cold or flu. Domestic and wild animals can contract the disease by inhaling or ingesting spores from contaminated soil, plants, or water. Cattle, antelope, sheep, goats, and deer are examples of these animals. In areas where domestic animals have previously been infected with anthrax, routine vaccination can help avoid outbreaks.

Who Is at Risk of Anthrax?

Certain people are more vulnerable to anthrax exposure, including:

• Farmers and animal handlers.

• Military personnel and visitors to countries known to have anthrax problems.

• Bacterial researchers and laboratory technicians.

• Veterinarians who work with infected animals.

• Workers in the wool mill, tannery, and slaughterhouse.

• Drum makers who work with animal hides.

• Users of heroin.

What Are the Symptoms of Anthrax?

The symptoms of anthrax vary depending on the type of infection and can appear anywhere from one day to more than two months. However, if left untreated, all types of anthrax have the potential to spread throughout the body, causing severe illness and even death.

• Symptoms of Cutaneous Anthrax Include:

  • A cluster of tiny blisters or bumps that itch.

  • Swelling around the sore.

  • A painless skin sore with a black center develops following the appearance of small blisters or bumps.

  • The sore is usually on the neck, face, arms, or hand.

• Symptoms of Anthrax Inhalation Include:

  • Chills and fever.

  • Discomfort in the chest.

  • Breathing difficulty.

  • Dizziness or confusion.

  • Cough.

  • Vomiting, nausea, or stomach pains.

  • Headache.

  • Profuse sweating.

  • Fatigue.

  • Body aches.

• Symptoms of Gastrointestinal Anthrax Include:

  • Chills and fever.

  • Neck or glandular swelling.

  • Sore throat.

  • Painful swallowing.

  • Hoarseness.

  • Vomiting and nausea, particularly bloody vomiting.

  • Diarrhea, especially bloody diarrhea.

  • Headache.

  • Flushing (a flushed red face) and red eyes.

  • Stomach ache.

  • Fainting.

  • Abdominal swelling (stomach).

Symptoms of Injection Anthrax Include:

• Chills and fever.

• A cluster of small blisters or bumps may itch where the drug was injected.

• After the blisters or bumps, a painless skin sore with a black center appears.

• Swelling surrounding the sore.

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

The symptoms of injection anthrax are similar to those of cutaneous anthrax, but injection anthrax spreads more quickly and is more difficult to recognize and treat than cutaneous anthrax. Skin and injection site infections are common among drug users and do not always indicate anthrax.

How Is Anthrax Diagnosed?

Depending on the symptoms and the type of anthrax, your doctor may order one or more of the following tests:

• Skin lesion biopsy.

• Blood tests.

• Chest X-ray.

• Computed tomography (CT) scan.

• Lab tests on stool or mucus.

• Lumbar puncture (spinal tap).

How Is Anthrax Managed?

Antibiotics and antitoxins are the treatments available to doctors for anthrax patients. Patients with severe anthrax should be hospitalized. They may require extensive treatment, such as continuous fluid drainage and mechanical ventilation, to help them breathe.

• Antibiotics

Antibiotics, including intravenous antibiotics, can treat all types of anthrax infections. However, if someone exhibits anthrax symptoms, they must seek medical attention as soon as possible to have the best chance of full recovery. Doctors will choose antibiotics that are effective in treating anthrax and safe for the patient based on their medical history.

• Antitoxins

Anthrax spores can be "activated" once they enter the body. When anthrax bacteria become active, they can multiply, spread throughout the body, and produce toxins or poisons. Toxins from anthrax cause severe illness in the body. Antitoxin is one possible treatment after anthrax toxins have been released into the body. Antitoxins target the anthrax toxins released in the body. Antitoxin should be used in conjunction with other treatment options by doctors. There are currently a few types of antitoxins that can be used to treat anthrax.

• Vaccine

Anthrax vaccine adsorbed, is a vaccine that prevents anthrax infection, also treats infected people. The vaccine is administered in three doses over four weeks. Antibiotics will be administered concurrently.

How to Prevent Anthrax?

The anthrax vaccine has a 90 percent success rate in preventing infection. However, the vaccine is only available to people aged 18 to 65 who work in high-risk occupations. The vaccine is given to you in five doses over 18 months. Following that, you will need an annual booster shot. The vaccine also prevents infection if you have been intentionally exposed to anthrax. In the United States, livestock grazing in anthrax-prone areas, such as certain parts of Texas, are given an anthrax vaccine explicitly designed for animals.

The anthrax vaccine is not widely available to the public. So if you are going to an area where anthrax is a problem, you should not:

• Consume raw or undercooked meat.

• Handle or purchase animal hide or hair souvenirs.

• Pet or touch animals.

Conclusion

People who work in certain occupations or travel to developing countries have a higher chance of being exposed to anthrax-causing bacteria. Talk to your doctor about getting the anthrax vaccine if you work in a high-risk industry. Most anthrax patients recover after receiving timely treatment with antibiotics or other therapies. Inhalation anthrax is more lethal and difficult to treat. For these reasons, anthrax inhalation is regarded as a potential bioterrorism threat. If an individual suspect being exposed to anthrax, a doctor must be contacted immediately for treatment. Rapid treatment can prevent severe infection and life-threatening symptoms and increase the chances of full recovery.