This document provides an overview of anthrax, including its history, epidemiology, causative organism, transmission, clinical manifestations, management, prevention and control. It notes that anthrax is caused by Bacillus anthracis spores and primarily affects herbivores. The most common form is cutaneous anthrax, which presents as a characteristic skin lesion. Treatment involves antibiotics like penicillin. Prevention strategies include vaccinating animals and properly disposing of infected carcasses.

1. By;
Randa Abdalla

2. Contents:
 Introduction
 History
 Epidemiology
 Causative organism
 Transmission
 Clinical manifestation
 Management
 Prevention and control

3. Introduction
 Malignant pustule, Malignant oedema, Woolsorter
disease,Ragpicker disease.
 From the Greek word anthrakos for coal
 Caused by spores
 Primarily a disease of domesticated & wild animals
 Herbivores such as sheep, cows, horses, goats.
 Anthrax zones
 Soil rich in organic matter (pH < 6.0)

4. History of Anthrax (Early history)
 Although anthrax dates back more than 3,000 years,
it was not recognized as a disease until the 18th
century.
 1500 B.C - A “plague of boils” in Egypt affected the
Pharaoh’s cattle. ‘Boils’ are symptomatic of anthrax.
 1600s - The “Black Bane” thought to be anthrax, in
Europe kills over 60,000 cattle.
 1700s - There are some accounts of human cases.

5. History (1800s)
 Early 1800s - The first human cases of cutaneous anthrax
in the US and UK were reported in men who contracted the
disease after having been in contact with infected
livestock.
 The disease was called Wool Sorter’s disease or Rag
Picker’s disease because it affected workers in those
trades.
 1868 - Anthrax was observed under a microscope.
 1876 - German bacteriologist Robert Koch confirmed
bacterial origin of anthrax.

6. History (Early 1900s)
 1915 - German agents injected horses, mules, and cattle
with anthrax . This was the first recorded use of anthrax
as a biological weapon.
 1937 - Japan started a biological warfare program in
Manchuria, including tests involving anthrax.
 1942 - UK demonstrated experiments using anthrax at
Gruinard Island off the coast of Scotland.
 1943 - United States began developing anthrax weapons.
 1945 - In Iran an anthrax outbreak killed more than 1
million sheep.

7. History (Late 1900s)
 1950s and 60s - U.S. biological warfare program continues
after WWII at Fort Detrick, Maryland
 1969 - President Nixon ended United States' offensive
biological weapons program, but defensive work still
continues.
 1970 - Anthrax vaccine for humans was approved by U.S.
FDA.
 1978-80 - The world's largest outbreak of human anthrax
via insect vectors or contaminated meat struck Zimbabwe,
Africa where more than 10,000 cases were recorded and
over 180 people died.
 1979 - In Soviet Union, aerosolized anthrax spores were
released accidentally at a military facility, affecting 94 and
killing 64 people.

8. History (Recent years)
 1991 - About 150,000 U.S. troops were vaccinated for
anthrax in preparation for Gulf War.
 1990-93 - The cult group, Aum Shinrikyo, released
anthrax spores in Tokyo, fortunately no one was injured.
On February 27, 2004, the leader of this group was given
a sentence of death at a district court in Tokyo.
 1995 - Iraq produced 8,500 liters of concentrated anthrax
as part of the biological weapon program under Saddam
Hussein’s administration.
 2001 - Letters containing anthrax spores were mailed to
many places in the US such as NBC, New York Times,
and Media in Miami. In Florida, a man died after inhaling
anthrax at the office.

9. Outbreaks in Thailand
 This picture is 9 days
after the onset of
symptoms of oral-
pharyngeal anthrax.
 1982 - In rural Northern
Thailand, an outbreak of 52
cases of cutaneous anthrax
and 24 cases of oral-
pharyngeal anthrax occurred.
 Oral-pharyngeal anthrax: an
unusual manifestation of
human
infection with B. anthracis.
 1987 - 14 cases of both oral-
pharyngeal and abdominal
anthrax occurred.
 Caused by the consumption of
contaminated water and
buffalo meat.

10. Natural Outbreaks in North Dakota
 The highest occurrence of
Anthrax outbreaks in the US
 1989-1999 - 26 cases of
infected livestock were
reported.
 2000 - 33 cases were reported
during July-September.
 Total of 180 animals (beef
cattle, horses, and bison) died
and one person was infected
with cutaneous anthrax.

11. Epidemiology
 Distribution worldwide
 Not common in West. Common in Africa ( Zimbabwe),
S.E. Asia, China, South America, Turkey, Pakistan, India
 Human to human or animal to animal transmission is rare (
not contagious)
 Grazing animals become infected through ingestion of
spores in the soil ( Carcasses become the source)

13. Causative organism
 - Etiologic agent: Bacillus anthracis Cohn 1875.
 - Large (8 x 1.2 mm) Gram positive, nonmotile,
weakly hæmolytic; central spores, straight ends,
encapsulated in vivo, produces long chains.
 - Pathogenic to herbivores, man, lab animals.

14.  - Habitat: Parasitic; persists in “cursed” fields.
 - Sporulation only in aerobic conditions.
 - Capsule antigen: poly D-glutamic acid g-peptide
 - Immunogenic protein toxin, edematizing, lethal.

15. Bacillus anthracis: culture

16. (blue)
(red)

17. STAGES OF INFECTION
 Encounter: organism and body surfaces
 Adhesion: generalized and receptor-specific
 Initial multiplication  in situ colonization
 Invasión  breaching of anatomic barriers
 Lymphatic stage  invasion of bloodstream
 Generalized infection, metastases.

18. Transmission

19. Transmission:
 Contact with tissues of animals (cattle, sheep, goats,
horses, pigs and others) dying of the disease.
 Biting flies that have partially fed on such animals.
 Contact with contaminated hair, wool, hides or
products made from them (e.g. drums, brushes, rugs).
 Contact with soil associated with infected animals or
with contaminated bone meal used in gardening.

20. Transmission cont.
 Inhalation anthrax results from inhalation of
spores in risky industrial processes—such as
tanning hides and processing wool or bone—
with aerosols of B. anthracis spores in an
enclosed, poorly-ventilated area.
 Intestinal and oropharyngeal anthrax may arise
from ingestion of contaminated undercooked
meat; there is no evidence that milk from
infected animals transmits anthrax.

21. Transmission cont.
 The disease spreads among grazing animals
through contaminated soil and feed; and
among omnivorous and carnivorous animals
through contaminated meat, bone meal or
other feeds derived from infected carcases.
 Accidental infections may occur among
laboratory workers.

22. Transmission cont.
 Anthrax is not transmitted person to person.
 Articles and soil contaminated with spores in
endemic areas may remain infective for
many years.

23. Clinical manifestations

24. Clinical manifestations:
 Anthrax is an illness with acute onset.
 characterised by several distinct clinical forms including:
1. a skin lesion
2. a respiratory illness
3. abdominal distress
 Ninety percent of cases are cutaneous anthrax

25. Cutaneous Anthrax
• Mainly in professionals( Veterinarian, butcher, Zoo
keeper
• Spores infect skin- a characteristic gelatinous edema
develops at the site (Papule- Vesicle-Malignant Pustule-
Necrotic ulcer)
• 80-90% heal spontaneously ( 2-6wks)
• 0-20% progressive disease – develop septicemia
• 95-99% of all human anthrax occur as cutaneous
anthrax

26. Site of Malignant pustule
 Head: usually no complication
 Face: severe, superinfection; gangrene near eye
 Neck, breast or chest wall: massive edema, over thorax and
sometimes involving scrotum
 Shoulders, arms: may be multiple, small lesions
 Forearms, fingers: atypical on palms
 General symptoms, fever, chills, depend on site.
 Weakness, hypotension are danger signs.

28. Notice the edema and typical lesions

30. Intestinal Anthrax
• Due to in ingestion of infected carcasses
• Mucosal lesion to the lymphatic system
• Rare in developed countries
• Extremely high mortality rate

31. Intestinal Anthrax
 Nausea, anorexia, vomiting, fever
 Progresses to severe abdominal pain and
bloody emesis and diarrhea
 Ascites may develop on day 2 - 4
 Death 2 to 5 days after onset of symptoms
 Very difficult to diagnose

32. Cecal Lesion
from eating undercooked Carabao... (AFIP)

33. PULMONARY ANTHRAX
• Require very high infective dose ( > 10,000 spores)
• Acquired through inhalation of spores ( Bioterrorism -
aerosol)
• Present with symptoms of severe respiratory infection( High
fever & Chest pain)
• Haemorrhagic mediastinitis
• Progress to septicemia very rapidly
• 10 7 to 10 9 bacilli/ ml of blood at the time of death
• Mortality rate is very high > 95%

36. Anthrax Meningitis
 Usually a complication of anthrax septicemia.
 Subarachnoid haemorrhage is a common
feature
 Very often fatal

37. Anthrax meningitis:
Subarachnoid Haemorrhage
(AFIP)

38. Anthrax - Disease in
animals
 Fulminating, acute, subacute or chronic.
 Apoplectic death: “fall” - animals found dead.
 Acute: excitable, then depressed, cardiac and
respiratory distress, trembling, staggering, convulsions.
 Edematous lesions, blood exudes, incoagulable.
 Death in 1-2 days, or 4-5.
 Chronic infection in more resistant animals: pigs.

39. Diagnosis:
 Clinical; symptoms and signs.
 Incubation period—From 1 to 7 days,
although incubation periods up to 60 days
are possible

40.  Laboratory confirmation requires at least
one of the following:
1. isolation of Bacillus anthracis from a clinical
specimen
2. demonstration of B. anthracis in a clinical
specimen by immunofluorescence
3. significant antibody titres developing in an
appropriate clinical case.

41. Management

42. Management:
 Investigation
Obtain a history of travel and contact with imported
animal
 Restriction
Standard infection control precautions apply for all
direct clinical care. Although a cutaneous lesion
will be sterile after 24 hours’ treatment, dressings
soiled with discharges from lesions should be
burned and reusable surgical equipment
sterilised.

43. Treatment
 The case should be under the care of an infectious
diseases physician.
 Penicillin is the drug of choice for cutaneous
anthrax and is given for 5–7 days.
 Tetracyclines, erythromycin and chloramphenicol
are also effective.
 The U.S. military recommends parenteral
ciprofloxacin or doxycycline for inhalation anthrax
though the duration of treatment is not well defined.

44.  Counselling
Advise the case and their caregivers of the
nature of the infection and its mode of
transmission.
 Management of contacts

45. Vaccination
 Cell-free filtrate
 At risk groups
 Veterinarians
 Lab workers
 Livestock handlers
 Military personnel
 Immunization series
 Five IM injections over 18-week period
 Annual booster
9/19/2015

46. Methods of control—
 A. Preventive measures:
Immunize high-risk persons , Educate employees ,
Control dust, wash, disinfect or sterilize, immunize and
annually reimmunize all domestic animals at risk….etc.
 B. Control of patient, contacts and the immediate
environment
Report to local health authority, Isolation,
Concurrent disinfection, Investigation of contacts,
Specific treatment….etc.

47.  C. Epidemic measures
 D. Disaster implications
 E. International measures; Sterilize imported
bone meal before use as animal feed. Disinfect
wool, hair and other products when indicated and
feasible.

48. Prevention
 Control in animals. Annual vaccination protects.
 Disposal of animal carcasses: disinfect with oil,
burn, bury deep, covered with quicklime.
 Spores will NOT form inside the carcass, and
putrefaction kills the Bacillus. Flies feeding on
incoagulable blood may be a problem.

49. An anthrax death. Notice flies
feeding on blood and secretions

50. Burning a carcass in a hole... Not deep enough

51. Question
The most common naturally occurring form of
anthrax is:
a. Cutaneous
b. Gastrointestinal
c. Inhalational
d. Ocular
e. Mediastinal

52. Question
After low-level germination at the site of entry
to the body, anthrax may be taken up by:
a. Basophils
b. Eosinophils
c. Lymphocytes
d. Macrophages
e. Neutrophils

54. Thank
you…