ANTHRAX

Synonyms
• Woolsorter's disease (pneumonic anthrax or pulmonary anthrax), Rag-picker's
disease, Knacker's disease, Hide-porter’s disease (cutaneous anthrax), Malignant
edema, Malignant carbuncle, Malignant pustule, Charbon, Milz brand disease, Splenic
fever and Sang de rate.
Etiology
• Bacillus anthracis, is a Gram-positive, endospore-forming, rod-shaped (square-
ended), non-motile and facultatively aerobic bacteria.
• Pathogenecity of anthrax bacilli depends on three factors, are
– Factor I: Edema factor - Inflammatory property
– Fator II: Protective antigen (PA) - Antiphagocytic and immunogenic factor.
– Factor III: Lethal factor - Inflammatory property
– There are two forms: (a). Vegetative form (capsular form) within the host and
(b). Spore form in the environment.
• Spores are formed through sporulation, when exposed to oxygen in the air.
• Spores are resistant against cold, heat, chemicals and drying. They are viable for
many years (>60 years) in the soil and in bone marrow of dead : 200-250 Yrs.
• Acidic soil reduces the survivability of spores.
• Spores can be destroyed by heating at 100°C for 10 minutes, 5% sodium hydroxide,
10% formalin at 40°C for 15 minutes and 3% peracetic acid.
• Vegetative form can be killed at 60°C for 30 minutes.
• Anthrax spores are considered to be one of a number of potential agents for use
in biological terrorism.

Reservoir and incidence

• Soil is the reservoir for the infectious agents.
• For man, the source of infection is always infected animals, contaminated animal
products (leather, belts, wool, fur, hairs, skin and bone meal) or environmental
contamination by anthrax spores.
• It is distributed worldwide, except Antarctica. It is common in agricultural regions
where it occurs in animas.
• Globally it has been estimated that as many as 20000 to 100000 human cases of
anthrax occur annually.
• Many regions in India are still enzootic for animal anthrax and sporadic cases of
human anthrax have been reported, especially from South India (Tamil Nadu,
Puducherry, Andhra Pradesh and Karnataka).
Host range:
• Herbivores including domestic animals like cattle, sheep, goat and buffalo.
• Wild animals also highly susceptible to this disease.
• Pigs, equines, dogs and camels are moderately susceptible.
• However carnivores and birds are highly resistance.
 • Some species like algerian sheep and dwarf pigs are naturally resistance to anthrax.
• Man is moderately susceptible to this disease.
Transmission
In Animals
• Herbivorous animals infected by ingestion of spores which are viable in soil for years
and contaminated fodder/improperly processed feed (meat meal, bone meal) or water.
• In carnivores and omnivores the diseases results from infected carcasss/contaminated
meat.
• Disease also spread through direct contact with secretions of diseased / dead animal or
with contaminated fomites like soil, water, wool, hide etc..
• Indirect transmission is due to regular animal husbandry/agricultural works,
accidental inoculation of pathogen or by mechanical vectors.
• Biting flies like blow flies and horse flies (tabinadae) acts as mechanical vectors.
In Man
– Cutaneous route: contact with contaminated carcasses, wool, hide or hair.
– Ingestion (Oral route): ingestion of under-cooked infected meat and
contaminated water.
– Inhalation (Respiratory route): during wool sorting. It needs higher dose
(LD50) of 8000 to 10000 viable spores.
• Inhalation of spores along with ingestion of under-cooked infected meat is highly fatal
than cutaneous route of infection.
• Mortality may be 20%, 25-60% and 100% respectively in cutaneous, oral and
pulmonary route of infection.
Clinical signs in animals
• It primarily affects all warm-blooded animals, especially cattle, sheep, goats, horses
and pigs.
• The morbidity and mortality are 70% to 80% and 1% to 5% in highly susceptible and
less susceptible animals, respectively.
• Incubation period 1-5 days. It occurs as peracute, acute, subacute and rarely chronic
form. In swine, it may be pharyngeal form, intestinal form and septicemic form.
• General symptoms of anthrax in animals includes severe mucosal congestion leading
to haemorrhages from mouth, anus and nares, elevated body temperature (40-41.6oC),
dyspnoea, oedema, excitement or depression, anorexia, convulsions, staggering gait,
diarrhoea/dysentery, abortion, blood stained milk and absence of rigor mortis.
• In herbivores the disease is mostly hyperacute with high fatality rate. Sudden death
occurs with in 10-24 hours due to septicaemia and toxiaemia. The gastrointestinal
form is most common. Cutaneous anthrax can occur through bite of mechanical
vectors or wound contamination.
• In carnivores and in swine the disease outcome may be fatal or recovery takes place.
Intestinal form is occasional but ingested pathogen localized in pharyngeal
lymphnode causing oedematous swelling which may lead to death by the occlusion of
air passage. Carbuncular lesions may develop on tongue or oropharynx.
Clinical signs in Man
Cutaneous form (Malignant pustule, Hide-porter's disease)
– Most common form of anthrax in humans.
– Incubation period ranges from 1 to 7 days, an erythematous papule appears on
an exposed area of skin and becomes vesicular, with a purple to black centre.
The center of the lesion finally forms a necrotic eschar and sloughs.
– Regional adenopathy, fever, malaise, headache, and nausea and vomiting may
be present.
– After the eschar sloughs, haematogenous spread and sepsis may occur,
resulting in shock, cyanosis, sweating and collapse.
– Haemorrhagic meningitis may also occur.
– Case fatality may be 20% if not treated.
Pulmonary form (Woolsorter's disease)
– It occurs following the inhalation of spores from hides, bristles or wool.
– Incubation period ranges from 1 to 5 days.
– It is characterized by fever, cough, dyspnea, pneumonia, emphysema, cardiac
and respiratory failure and death in 24 hours.
– Case fatality may reach upto 100%.
Intestinal form
– Less common form of anthrax. It is caused by ingestion of spores present in
infected meat, milk or other food products.
– Incubation period ranges from 12 hours to 5 days.
– The characteristic eschar or malignant carbuncle mostly occurs on the
oropharynx, stomach, duodenum and upper ileum.
– Common symptoms are anorexia, vomiting, watery to bloody diarrhoea, fever
and abdominal pain.
– Case fatality may be 50% if untreated.
– Anthrax sepsis and anthrax meningitis can be developed in severe cases
DIAGNOSIS
On the basis of history & pathognomonic lesions
• McFadyean's reaction: Staining and identification of anthrax bacilli from the
vesicular fluid or skin lesions, exudates of respiratory tract, blood by polychrome
methylene blue stain.The capsule appears in purple or in pink colour and bacilli in
deep blue colour.
• Polychrome methylene blue staining with blood smear from ear vein (in suspected
cases of anthrax in animals).
• Culture and identification.
– On nutrient agar or blood agar with aerobic condition, it produces colonies
of bacilli with "medusa-head appearance“.
– On gelatin stab culture, it grows like "inverted-fir tree" (becasue, it is
facultatively anaerobic)
• Animal inoculation (in guinea pigs or mice).
• Ascoli's thermoprecipitation test to detect antigen in the suspected.
• ELISA and PCR
Treatment
• Penicillin V or G given for 5-7 days by oral i/m or i/v route
• Other drugs like tetracycline, gentamicin, streptomycin, erythromycin and
chloramphenicol are also used.
Prevention and Control
• Carcass suspected for anthrax SHOULD NOT OPEN it contaminate the
surroundings.
• Carcass disposal involves incineration or deep burial. Barns and fences should be
disinfected with 10% sodium hydroxide or 3% peracetic acid.
• Protective measures to be taken while handling of infected wool and hide. Disinfect
wool or hair from animals in endemic areas with 10% formalin or 3% peracetic acid.
• Prevent the contact and ingestion of infected animal products.
• People handling dead carcasses suspected for anthrax must not have skin abrasions,
should wear face mask, gum boots and protective clothing.
Disposal of anthrax infected carcass
• Carcass suspected for anthrax should not open.
• The natural orifices should be plugged with disinfected cotton.
• Best method of disposal is burning or incineration. If it is not possible, burial should
be done in a remote area. The area is declared protected from domestic and wild
animals. A 2-meter deep pit is suitable for burial of average sized animal. The carcass
should be covered with sufficient quantities of quick lime (caustic soda) and soil.
• The ground area where the carcass was lying should be disinfected with 3% peracetic
acid (8lit/ m2) or 3-5% formaldehyde (40lit/carcass).
Immunization
• Vaccination of animals in endemic areas with single dose of sterne spore vaccine
which is a attenuated live spore vaccine.