Understanding Anthrax

“Anthrax is a disease of wild and domesticated animals that is transmitted to human beings by contact with infected animals or their products and, rarely, by insect vectors which act as mechanical carriers of the etiologic organism,” says a textbook of medicine.

Robert Koch first described the bacteria that cause anthrax –bacillus anthracis – in 1877. The recent events in the U.S. have rekindled our interest in this organism.

One interesting feature of this organism is that it can form a spore. Boiling for 10 minutes can kill the spores but they can survive for many years in soil and animal products, an important factor in the persistence and spread of the disease, says the textbook.

Anthrax is worldwide. There have been outbreaks of anthrax in Southern Europe, Africa, Australia, Asia, and on both American continents. Cattle, horses, sheep, goats, and swine are most commonly infected. The disease tends to occur in late summer and early fall.

How do humans get the disease?

By butchering, skinning, or dissecting infected carcasses or by handling contaminated hides, wool, hair, or other materials.

The disease is seen mainly in agriculture and industrial employees.

Recent reports from U.S. indicate that one person died from inhalation of the bacteria and there are some reports of skin involvement after handling contaminated mail.

Inhalation anthrax is very rare. The last suspected case in Canada occurred in the early 1960s. Since then there has been an isolated case of confirmed skin anthrax in 1991, says the Canadian Medical Association (CMA) message sent to all the physicians on this subject.

Human anthrax has three main clinical forms: cutaneous (affects the skin), inhalation (affects the lungs), and gastrointestinal (affects the gut). Infection occurs when the spores enter the skin through a cut or abrasion (cutaneous), or enter the respiratory tract (inhalation), or the spores are ingested when eating infected animals (gastrointestinal).

Human to human transmission is extremely rare and reported only with cutaneous anthrax. A painless ulcer, known as “malignant pustule”, characterizes cutaneous anthrax. There is extensive swelling of the tissues around the ulcer. Lymph glands may be enlarged. And sometimes the skin infection is widespread and rapidly fatal.

CMA’s message advises physicians to become familiar with the signs and symptoms of inhalation anthrax. Inhalation anthrax starts with flu-like symptoms, but progresses to acute respiratory distress with x-ray changes in the chest and shock over 3-5 days. How does one know if the initial flu-like symptoms are the beginning of anthrax? Very difficult to know. Health care providers are advised to look for unusual cases of
respiratory distress.

Intestinal anthrax resembles an acute abdomen with massive diarrhoea similar to cholera, says the textbook of medicine. The disease is usually eventually fatal.

In the current situation, what sort of preventive measures can you take?

Carefully look at your mail before you open. Do you recognise the sender? Besides that, there isn’t much you can do. The CMA says that you should not go to a doctor or hospital unless you are sick. Do not buy and horde medicines or antibiotics. Do not buy gas masks. But antibiotics are the appropriate preventive measures if you are exposed to the bacteria.

There is a vaccine to protect against inhalation anthrax, says the CMA message. It is not widely available. It is usually given to people who are likely to be exposed to anthrax due to their occupation. It is a six-dose course taken over 18 months.

So, it is anthrax today. What’s next? We do not know. As somebody has said, “These are times that try men’s souls.” And David Owen said, “Very few wars are brought to an end tidily.” Looks like, the present war is not going to be any different.

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