Anthrax: Symptoms & Treatment [Archives:2001/52/Health]

December 24 2001

Dr.Ihab A. Eltom
Anthrax or malignant pustule which occurred in USA, and caused so much public distress and worry is primarily a disease of animals, particularly sheep and cattle and, to a lesser extent, horses and dogs.
The disease is caused by bacillus anthraces, a germ positive microorganism that was first isolated by Robert Koch in 1877. .Human beings accidentally encounter this disease in the agricultural settings, but also it can be isolated, multiplied and manufactured as powder to be used as a biologic weapon. When bacillus anthraces gets access to the skin of the human beings it makes local skin infection that may become generalized. The animal is infected by ingestion of the spores that probably enter the body through microscopic cuts or abrasions of the oral or intestinal mucus. The infected animal remains asymptomatic until few hours before death. In human beings, the most common form of human anthrax is industrial anthrax, which results from contact with the animal product such as wool, hide, goat hair, skin and even bones.
The human beings become infected in one of the following three mechanisms:
1- The organism can gain access through small abrasions or cuts and multiply locally with fairly dramatic inflammatory response.
2- They may also gain access by inhalation, where they multiply in the lung, and are swept to the draining hailer nodes where marked hemorrhagic necrosis may occur. And this constitutes the most severe form of the disease. The mortality rate in this form of the disease exceeds 90% of the infected individuals.
3- A rare method of the infection is the ingestion of the infected meat, with resultant of the invasion and ulceration of the gastrointestinal mucosa.
Clinical Manifestations:
Coetaneous Anthrax begins 2 to 5 days after the infection as small papules that develop within few days into vesicles filled with dark bluish fluid commonly known as malignant pustule. This lesion is classically found in the hand, forearm or head.
The pulmonary form, also known as wool-sorters disease, is acquired by inhalation, and the patient symptoms are typically those of respiratory infection with fever, malaise and myalgia. Within few days it becomes a very severe infection with respiratory distress and cyanosis. Death usually occurs within 24 hours.
Bacillus anthraces is quite susceptible to penicillin, which is curative if it is used during the early course of the infection. The problem is with the pulmonary anthrax, the diagnosis usually made postmortem because the patient will seek the medical attention in the late course of the disease when the disease progresses and it will be very difficult to treat because of the sepsis and the endotoxin that will be released from the bacteria when penicillin will be used in the late course of the illness. That is why identification of the infected person and diagnosis of the illness early play a very important role in recovery.