Anthrax
Medical Author: Michael C. Fishbein, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
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Anthrax - From Russia with Love
Medical Author: Michael C. Fishbein, MD
Previous Medical Editor: Leslie J. Schoenfield, MD, PhD
Medical Editor: Melissa Conrad Stöppler, MD
 This article recounts the chilling, yet fascinating story of the deadliest outbreak of anthrax in recorded history. Anthrax is a bacterium (germ) that can cause a serious, sometimes fatal infection. Anthrax can be used as a weapon. In 2001, anthrax was spread through the mail in a powder. Twenty-two people were infected. The events that occurred in Sverdlovsk, Russia, in 1979 demonstrate what can happen when anthrax is released into the air.
The Outbreak
This was the ninth day of the mysterious, fatal epidemic that
struck Sverdlovsk in early April of 1979. Autopsies already had been performed
on 37 victims who died of an unknown disease. Yet neither the clinicians nor the
pathologists had identified the cause of the epidemic. Moreover, as you can
imagine, the members of the pathology
department were frustrated and overburdened with work. So, on this day, Dr.
Faina Abramova, who had been chief of pathology at hospital #40, returned from retirement to help perform the
autopsies.
The first autopsy Dr. Abramova performed was number 38 of the 42 ultimately
performed by the local pathologists. The patient was a 43-year-old man who had
had weakness and fever for two days. He was admitted to the hospital where he
died four days later.
At the autopsy table, Dr. Abramova was struck by the crimson color of the
membranes (meninges)
covering the man's brain. In her description, she referred to this covering as
the "cardinal's cap" because of its color and location. Astonishingly, she
recognized this finding as characteristic of anthrax infection. (Few doctors
have ever seen the disease anthrax.) In fact, her diagnosis was based on her recollection of a brain specimen from a patient
with anthrax on display in a museum at her medical school.
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What is anthrax?
Anthrax is a life-threatening infectious disease that normally affects animals, especially ruminants (such as goats, cattle, sheep, and horses). Anthrax can be transmitted to humans by contact with infected animals or their products. In recent years, anthrax has received a great deal of attention as it has become clear that the infection can also be spread by a bioterrorist attack or by biological warfare. Anthrax does not spread from person to person.
What causes anthrax?
The agent of anthrax is a bacterium called Bacillus anthracis. While other investigators discovered the anthrax bacillus, it was a German physician and scientist, Dr. Robert Koch, who proved that the anthrax bacterium was the cause of a disease that affected farm animals in his community. Under the microscope, the bacteria look like large rods. However, in the soil, where they live, anthrax organisms exist in a dormant form called spores. These spores are very hardy and difficult to destroy. The spores have been known to survive in the soil for as long as 48 years.
How is anthrax contracted?
Anthrax can infect humans in three ways. The most common is infection through the skin, which causes an ugly sore that usually goes away without treatment. Humans and animals can ingest anthrax from carcasses of dead animals that have been contaminated with anthrax. Ingestion of anthrax can cause serious, sometimes fatal disease. The most deadly form is inhalation anthrax. If the spores of anthrax are inhaled, they migrate to lymph glands in the chest where they proliferate, spread, and produce toxins
that often cause death.
How common is anthrax?
Anthrax is now rare in humans in the United States and developed countries. It still occurs today, largely in countries lacking public-health regulations that prevent exposure to infected goats, cattle, sheep, and horses and their products. In the last few years, there have been rare cases of anthrax in people exposed to imported animal hides used to make drums. Drum players, drum makers, and their family members have been infected in this way. The major concern for those of us in western countries (who don't play drums) is the use of anthrax as an agent of biological warfare.
How long is the incubation period with
anthrax?
The incubation period (the period between contact with anthrax and the start of symptoms) may be relatively short, from one to five days. Like other infectious diseases, the incubation period for anthrax is quite variable and it may be weeks before an infected individual feels sick.
What kinds of diseases does anthrax cause?
There are three forms of disease caused by anthrax: cutaneous (skin) anthrax, inhalation anthrax, and gastrointestinal (bowel) anthrax.
CUTANEOUS ANTHRAX
The cutaneous (skin) form of anthrax
starts as a red-brown raised spot that enlarges with
considerable redness around it, blistering, and hardening.
The center of the spot then shows an ulcer crater with
blood-tinged drainage and the formation of a black crust
called an eschar. There are swollen glands (lymph nodes) in
the area. Symptoms include muscle aches and pain,
headache, fever, nausea, and vomiting. The illness usually resolves in about six weeks, but deaths may occur if patients do not receive appropriate antibiotics.
INHALATION ANTHRAX
The first symptoms are subtle, gradual and
flu-like (influenza). In a few days, however, the illness worsens and there may be severe respiratory distress.
Shock, coma, and death follow. Inhalation anthrax does not cause a true pneumonia. In fact, the spores get picked in the lungs up by scavenger cells called macrophages. Most of the spores are killed. Unfortunately, some survive and are transported
to glands in the chest called lymph nodes. In the lymph nodes, the spores that survive multiply, produce deadly toxins, and spread throughout the body. Severe hemorrhage and tissue death (necrosis) occurs in these lymph nodes in the chest. From there, the disease spreads to the adjacent lungs and the rest of the body. Inhalation anthrax is a very serious disease, and unfortunately, most affected individuals will die even if they get appropriate antibiotics. Why is this so? The antibiotics are effective in killing the bacteria, but they do not destroy the deadly toxins that have already been released by the anthrax bacteria.
GASTROINTESTINAL ANTHRAX
Now rare, anthrax of the bowels (gastrointestinal anthrax) is the result of eating undercooked, contaminated meat. The symptoms of this form of anthrax include nausea, loss of appetite, bloody diarrhea and fever followed by abdominal pain. The bacteria invade through the bowel wall. Then the infection spreads throughout the body through the bloodstream (septicemia) with deadly toxicity.
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