Bacillus anthracis, and has been documented as far back as 700 BC. Animals can become infected from spores in contaminated soil, plants, or water. People also can become sick with anthrax when spores get into their body. Learn about anthrax symptoms, causes, vaccine, and treatment.
Anthrax bacteria (green) being swallowed by an immune system cell
Image by Camenzind G. Robinson, Sarah Guilman and Arthur Friedlander, United States Army Medical Research Institute of Infectious Diseases
Anthrax is a disease caused by Bacillus anthracis, a germ that lives in soil. Many people know about it from the 2001 bioterror attacks. In the attacks, someone purposely spread anthrax through the U.S. mail. This killed five people and made 22 sick.
Anthrax is rare. It affects animals such as cattle, sheep, and goats more often than people. People can get anthrax from contact with infected animals, wool, meat, or hides. It can cause three forms of disease in people. They are:
Cutaneous, which affects the skin. People with cuts or open sores can get it if they touch the bacteria.
Inhalation, which affects the lungs. You can get this if you breathe in spores of the bacteria.
Gastrointestinal, which affects the digestive system. You can get it by eating infected meat.
Antibiotics often cure anthrax if it is diagnosed early. But many people don't know they have anthrax until it is too late to treat. A vaccine to prevent anthrax is available for people in the military and others at high risk.
Source: National Institute of Allergy and Infectious Diseases (NIAID)
Additional Materials (16)
Anthrax
This illustration depicts a photomicrographic view of Bacillus anthracis bacteria taken from heart blood, and processed using a carbol-fuchsin stain.
Image by CDC
Diagnosis
This image depicts a view of a Petri dish culture plate, which was partitioned down its center, dividing the dish into two equal halves. In order to perform what is known as an encapsulation test. On the left was a bicarbonate agar growth medium, and on the right, a blood agar growth medium. Each half of the plate was inoculated with the bacterium, Bacillus anthracis. Note the different morphologic characteristics exhibited by the same microorganism, when grown on different growth media. In this case, this proved to result in a positive encapsulation test, with the colonies produced on the bicarbonate medium exhibiting a smooth appearance, while those cultivated on the blood agar medium exhibiting a rough appearance.
Image by CDC/ Dr. James Feeley
Bacillus
Under a magnification of 1000X, this photomicrograph of a malachite green spore stained sample, revealed the presence of numerous Bacillus sp. bacteria. Due to the use of the spore staining method, many emerald green endospore staged organisms are seen in this sample.
Image by CDC/ Courtesy of Larry Stauffer, Oregon State Public Health Laboratory
Bacillus anthracis bacterial colonies
Under a magnification of 20X, this image depicts a number of Gram-positive, Sterne-strain, Bacillus anthracis bacterial colonies, which had been cultivated on a blood agar plate (BAP), and incubated for a 24-hour time period at a temperature of 35 °C. Of particular note was the classic ground glass texture exhibited by the colonies, resembling a pile of glass shards. As they continued to grow, and their edges touched, you can see that these colonies had coalesced, destroying their originally well-demarcated borders.
Image by CDC/ J. Todd Parker; PhD; Photo credit: J. Todd Parker; PhD and Luis Lowe; MS; MPH
Anthrax
This illustration depicts a photomicrographic view of Bacillus anthracis bacteria taken from the peritoneum, and processed using a Hiss capsule stain.
Image by CDC
Anthrax
Anthrax color enhanced micrograph : Color-enhanced scanning electron micrograph shows splenic tissue from a monkey with inhalational anthrax; featured are rod-shaped bacilli (yellow) and an erythrocyte (red)
Image by Arthur Friedlander NIAID/NIH
Anthrax bacteria (green) being swallowed by an immune system cell
Multiple anthrax bacteria (green) being enveloped by an immune system cell (purple). Anthrax bacteria live in soil and form dormant spores that can survive for decades. When animals eat or inhale these spores, the bacteria activate and rapidly increase in number. Today, a highly effective and widely used vaccine has made the disease uncommon in domesticated animals and rare in humans.
This image is part of the Life: Magnified collection, which was displayed in the Gateway Gallery at Washington Dulles International Airport June 3, 2014, to January 21, 2015. To see all 46 images in this exhibit, go to https://www.nigms.nih.gov/education/life-magnified/Pages/default.aspx.
Image by Camenzind G. Robinson, Sarah Guilman and Arthur Friedlander, United States Army Medical Research Institute of Infectious Diseases
Anthrax and Antibiotics: Anthrax is Deadly. Antibiotics Could Save Your Life.
Video by Centers for Disease Control and Prevention (CDC)/YouTube
How Dangerous Is An Anthrax Letter?
Video by The Infographics Show/YouTube
Anthrax
Video by pirelliaward/YouTube
Anthrax - Causes, Symptoms, Treatments & More…
Video by Rehealthify/YouTube
Anthrax Vaccine Study
Video by Mayo Clinic/YouTube
Science Talk: Einstein Scientists Move Closer to a Safer Anthrax Vaccine
Video by Albert Einstein College of Medicine/YouTube
Anthrax and Bacillus anthracis
Video by Paul Cochrane/YouTube
Killer Strain: Anthrax
Video by Centers for Disease Control and Prevention (CDC)/YouTube
Anthrax | Microbiology | Med Vids Made Simple
Video by Med Vids Made Simple/YouTube
Anthrax
CDC
Diagnosis
CDC/ Dr. James Feeley
Bacillus
CDC/ Courtesy of Larry Stauffer, Oregon State Public Health Laboratory
Bacillus anthracis bacterial colonies
CDC/ J. Todd Parker; PhD; Photo credit: J. Todd Parker; PhD and Luis Lowe; MS; MPH
Anthrax
CDC
Anthrax
Arthur Friedlander NIAID/NIH
Anthrax bacteria (green) being swallowed by an immune system cell
Camenzind G. Robinson, Sarah Guilman and Arthur Friedlander, United States Army Medical Research Institute of Infectious Diseases
3:01
Anthrax and Antibiotics: Anthrax is Deadly. Antibiotics Could Save Your Life.
Centers for Disease Control and Prevention (CDC)/YouTube
8:21
How Dangerous Is An Anthrax Letter?
The Infographics Show/YouTube
3:13
Anthrax
pirelliaward/YouTube
1:55
Anthrax - Causes, Symptoms, Treatments & More…
Rehealthify/YouTube
5:31
Anthrax Vaccine Study
Mayo Clinic/YouTube
1:55
Science Talk: Einstein Scientists Move Closer to a Safer Anthrax Vaccine
Albert Einstein College of Medicine/YouTube
3:11
Anthrax and Bacillus anthracis
Paul Cochrane/YouTube
4:27
Killer Strain: Anthrax
Centers for Disease Control and Prevention (CDC)/YouTube
11:31
Anthrax | Microbiology | Med Vids Made Simple
Med Vids Made Simple/YouTube
Anthrax Basics
Anthrax Life Cycle
Image by CDC
Anthrax Life Cycle
Illustration of the process by which a dormant anthrax spore becomes active after entering a body, in this case a cow eating grass.
Image by CDC
What Is Anthrax?
Anthrax is a serious infectious disease caused by gram-positive, rod-shaped bacteria known as Bacillus anthracis. It occurs naturally in soil and commonly affects domestic and wild animals around the world. People can get sick with anthrax if they come in contact with infected animals or contaminated animal products. Anthrax can cause severe illness in both humans and animals.
Anthrax is not contagious, which means you can’t catch it from another person like the cold or flu.
How people get infected with anthrax
People get infected with anthrax when spores get into the body. When anthrax spores get inside the body, they can be “activated.” The bacteria can then multiply, spread out in the body, produce toxins, and cause severe illness.
This can happen when people breathe in spores, eat food or drink water contaminated with spores, or get spores in a cut or scrape in the skin. It is very uncommon for people in the United States to get infected with anthrax.
Certain activities can also increase a person’s chances of getting infected.
How animals get infected with anthrax
Domestic and wild animals can become infected when they breathe in or ingest spores in contaminated soil, plants, or water. These animals can include cattle, sheep, goats, antelope, and deer. In areas where domestic animals have had anthrax in the past, routine vaccination can help prevent outbreaks.
Where anthrax is found
Anthrax is most common in agricultural regions of
Central and South America,
sub-Saharan Africa,
central and southwestern Asia,
southern and eastern Europe, and
the Caribbean.
Anthrax is rare in the United States. However, sporadic outbreaks do occur in wild and domestic grazing animals such as cattle or deer. Anthrax is more common in countries that do not have programs that routinely vaccinate animals against anthrax. In the United States, veterinarians recommend yearly vaccination of livestock in areas where animals have had anthrax in the past.
Source: Centers for Disease Control and Prevention (CDC)
Additional Materials (1)
Anthrax - Causes, Symptoms, Treatments & More…
Video by Rehealthify/YouTube
1:55
Anthrax - Causes, Symptoms, Treatments & More…
Rehealthify/YouTube
Types of Anthrax
Ancestral Ames Strain and Types of Morphs Found in the Evidence from the 2001 Anthrax Attack
Image by U.S. GAO
Ancestral Ames Strain and Types of Morphs Found in the Evidence from the 2001 Anthrax Attack
Ancestral Ames Strain and Types of Morphs Found in the Evidence from the 2001 Anthrax Attack
Image by U.S. GAO
Types of Anthrax
The type of illness a person develops depends on how anthrax enters the body. Typically, anthrax gets into the body through the skin, lungs, or gastrointestinal system. All types of anthrax can eventually spread throughout the body and cause death if they are not treated with antibiotics.
Cutaneous anthrax
Cutaneous anthrax is the most common form of anthrax infection, and it is also considered to be the least dangerous. Infection usually develops from 1 to 7 days after exposure.
When anthrax spores get into the skin, usually through a cut or scrape, a person can develop cutaneous anthrax. This can happen when a person handles infected animals or contaminated animal products like wool, hides, or hair. Cutaneous anthrax is most common on the head, neck, forearms, and hands. It affects the skin and tissue around the site of infection.
Without treatment, up to 20% of people with cutaneous anthrax die. However, with proper treatment, almost all patients with cutaneous anthrax survive.
Inhalation anthrax
Inhalation anthrax is considered to be the most deadly form of anthrax. Infection usually develops within a week after exposure, but it can take up to 2 months.
When a person breathes in anthrax spores, they can develop inhalation anthrax. People who work in places such as wool mills, slaughterhouses, and tanneries may breathe in the spores when working with infected animals or contaminated animal products from infected animals. Inhalation anthrax starts primarily in the lymph nodes in the chest before spreading throughout the rest of the body, ultimately causing severe breathing problems and shock.
Without treatment, inhalation anthrax is almost always fatal. However, with aggressive treatment, about 55% of patients survive.
Gastrointestinal anthrax
Gastrointestinal anthrax has rarely been reported in the United States. Infection usually develops from 1 to 7 days after exposure.
When a person eats raw or undercooked meat from an animal infected with anthrax, they can develop gastrointestinal anthrax. Once ingested, anthrax spores can affect the upper gastrointestinal tract (throat and esophagus), stomach, and intestines, causing a wide variety of symptoms.
Without treatment, more than half of patients with gastrointestinal anthrax die. However, with proper treatment, 60% of patients survive.
Injection anthrax
This type of infection has never been reported in the United States.
Recently, another type of anthrax infection has been identified in heroin-injecting drug users in northern Europe.
Symptoms may be similar to those of cutaneous anthrax, but there may be infection deep under the skin or in the muscle where the drug was injected. Injection anthrax can spread throughout the body faster and be harder to recognize and treat. Lots of other more common bacteria can cause skin and injection site infections, so a skin or injection site infection in a drug user does not necessarily mean the person has anthrax.
Source: Centers for Disease Control and Prevention (CDC)
Additional Materials (2)
Simple diagram of the lungs during inhalation
Simple diagram of the lungs during inhalation
Image by LadyofHats
Killer Strain: Anthrax
Video by Centers for Disease Control and Prevention (CDC)/YouTube
Simple diagram of the lungs during inhalation
LadyofHats
4:27
Killer Strain: Anthrax
Centers for Disease Control and Prevention (CDC)/YouTube
History of Anthrax
Anthrax
Image by Center for Disease Control and Prevention
Anthrax
Image by Center for Disease Control and Prevention
History of Anthrax
Throughout history, from biblical times to modern day, many sicknesses have been described with symptoms that resemble anthrax. Although we cannot know for sure whether these earliest reports of illness were, in fact, anthrax, many researchers believe that they were.
Naturally Occurring Anthrax
700 BC - Ancient origins of anthrax
Anthrax is thought to have originated in Egypt and Mesopotamia. Many scholars think that in Moses’ time, during the 10 plagues of Egypt, anthrax may have caused what was known as the fifth plague, described as a sickness affecting horses, cattle, sheep, camels and oxen.
Ancient Greece and Rome were also well acquainted with anthrax, and this is illustrated in many of the ancient writings of the most famous scholars from those times. For example, many scholars think anthrax was depicted by Homer in The Iliad, written around 700 BC, and in poems by Virgil, who lived from 70-19 BC. Some even suggest that anthrax may have contributed to the fall of Rome.
Moschophoros (Calf Bearer), a statue by Phaidimos
1700s - First clinical descriptions of anthrax
The first clinical descriptions of cutaneous anthrax were given by Maret in 1752 and Fournier in 1769. Before this, anthrax had only been described through historical accounts.
1877 - Robert Koch uses anthrax to develop his famous Koch Postulates
Scientist Robert Koch studied Bacillus anthracis, the bacterium that causes anthrax. He discovered that the bacteria formed spores and were able to survive for very long periods of time and in many different environments. Koch decided to use anthrax bacteria in one of his most important historical experiments, in which he isolated and grew Bacillus anthracis in pure culture and injected animals with the bacteria. Using what he observed in this study, he described how the microbe he injected into the animals caused the disease. From these studies, he was also able to determine the life cycle of the anthrax bacteria, and was able to demonstrate what became known as Koch’s postulates, which demonstrate a causal relationship between a specific microorganism and a disease.
Bacteriologist Robert Koch in his laboratory
1800s - Many significant scientific discoveries
During the 1800s, doctors saw cases of anthrax but did not yet have a diagnosis for the disease. During this time, the organism that causes anthrax had not yet been discovered, but doctors had noticed a link between the disease and the animal hair industry. Because of this, the disease became known as “wool sorters disease.” By the middle of the century, early researchers had associated the disease with the presence of rod-shaped bodies that were seen in the blood of infected animals. These bodies were eventually identified as bacteria and given the name Bacillus anthracis.
Art depicting sequence of wool production
1881 - Louis Pasteur creates the first vaccine for anthrax
Louis Pasteur, another prominent scientist, took Koch’s work a step further, trying to fully prove how anthrax was spread and how it made people or animals sick. Pasteur also worked to create a vaccine for anthrax. In his experiment, Pasteur gave 25 animals two shots of an anthrax vaccine he had created with weakened anthrax bacteria. After he gave both rounds of the vaccine to these animals, he injected them with live anthrax bacteria. He also injected live bacteria into 25 other animals that had not been vaccinated. Each of the vaccinated animals survived, while the 25 that were not vaccinated died.
French Chemist Louis Pasteur
1900s - Anthrax well documented in the U.S., but undocumented in other countries
Much knowledge was gained about anthrax in the 1800s. As a result, animal and human cases of anthrax in the United States, Britain, and Germany were well documented in the early 1900s. However, there were still places where anthrax cases hadn’t been documented, such as Russia, Asia, India and Africa. Because of the high number of contaminated animal products imported from these countries, however, it was known that anthrax had to be widespread in these regions.
1937 - Anthrax vaccine for animals reduces anthrax cases in humans
Max Sterne successfully created the anthrax live spore vaccine for animals. This vaccine is still used in animals in most countries. Because of the introduction of routine vaccination of animals against anthrax and the improvements in animal product processing procedures, the number of cases of anthrax in humans declined. This decline was so significant that during the entire 20th century there were only 18 cases of inhalation anthrax in the United States.
1944 - Penicillin used to treat anthrax
Penicillin had been discovered in 1928, but it wasn’t until 1944 when it was first used to treat anthrax. Penicillin became the drug of choice for treating anthrax, and it replaced all previous therapies, such as serum therapies and chemotherapies.
1950s - The first anthrax vaccine for humans is created
The first anthrax vaccine for humans was created. This anthrax vaccine was tested in a group of goat hair mill workers. Volunteers were given either the vaccine or a placebo (a shot that does not have the vaccine in it). The volunteers were then followed over a 2-year period. This study determined that the vaccine was 92.5% effective in preventing cutaneous anthrax. After the study, the vaccine was made available to people working in goat hair processing mills in the United States.
1970 - New human vaccine released
An updated human anthrax vaccine was released, replacing the 1950s vaccine. This is essentially the same vaccine used today.
2006 - New York City drum maker diagnosed with inhalation anthrax
A drum-maker from New York City got sick while on tour with a dance troupe in Pennsylvania. He had just returned from Africa with four goat skins that he planned to use to make drums. He said that when he processed the goat skins to remove the hair, he did not use chemicals on the skins to kill germs or wear protection while handling the skins. He also reported that while he processed the skins, hair and dust particles floated into the air. Four days after he last had contact with the goat skins, he began having breathing problems and was hospitalized. Five days later he was diagnosed with inhalation anthrax. Public health investigators determined he had been exposed to anthrax while processing the goat skins he brought home from Africa. When he scraped the hair from the skins, the anthrax spores were released into the air and he breathed them in. The spores got into his lungs and caused him to become ill. It was the first time in 30 years that a case of naturally acquired anthrax was reported in the United States.
2009 - A woman in Connecticut was diagnosed with Gastrointestinal anthrax
A woman in Connecticut was diagnosed with gastrointestinal anthrax. Public health investigators learned that the woman had participated in a drumming event the day before she became ill. The drums used at the event and the event space were all tested for contamination with anthrax spores. Two animal skin drums were found to have anthrax spores on them, and spores were also found in the room where the drumming took place, and in other rooms in the building. Investigators determined that the spores were released into the air while the contaminated drums were played. After 2 months in the hospital, the woman recovered and was released from the hospital.
2010 - A new form of anthrax
Early in 2010, a small outbreak of anthrax occurred in the United Kingdom and Germany. All of the patients who came to the hospital were illicit drug users who had used heroin before having symptoms. Anthrax in these patients did not look like typical cutaneous anthrax. Many had swelling and infection of the deeper layers of skin but they didn’t have a raised sore with a black center – the tell-tale sign of cutaneous anthrax. Doctors recognized this anthrax as a new type of anthrax, calling it injection anthrax. Doctors wondered where the anthrax spores came from and how they were injected into the drug users. While no anthrax was found in the heroin itself, the evidence gathered by epidemiologists strongly suggested there was anthrax in the heroin. Public health officials believe that the anthrax spores were in the heroin and that when the patients injected the drug into their bodies, they also injected anthrax spores.
2011 - A medical victory remains a medical mystery
Dan Anders had a close-call with inhalation anthrax. His wife, Anne (in the background) calls him “Miracle Man.” Photo courtesy of the Star Tribune/Minneapolis-St. Paul, 2013
A retired Florida man and his wife traveled for 3 weeks on a cross-country trip that took them through Wyoming, Montana and the Dakotas. They visited many state parks. The man got sick when they arrived in Minnesota. He went to the emergency room complaining of flu-like symptoms and was originally diagnosed with community-acquired pneumonia. A doctor, who had grown up on a cattle farm and was familiar with anthrax, felt that this diagnosis was not right and ordered more tests. The tests found bacteria in his blood that looked like anthrax bacteria. The samples of his blood were then sent to the Minnesota Public Health laboratory, where his anthrax illness was confirmed.
Because the doctors at the hospital were able to quickly diagnose anthrax, the patient got treatment immediately, including a specialized antitoxin (anthrax immunoglobulin) rushed in by the Centers for Disease Control and Prevention. After 3 weeks in the hospital, the patient fully recovered and was sent home.
A case of naturally occurring inhalation anthrax is very rare in the United States, so to rule out any possible bioterrorism threats, the FBI was called in to investigate the case. The FBI determined that the man had inhaled the anthrax spores in a natural environment and there was no threat to anyone else.
Anthrax Used as a Biological Weapon
1800s - Scientific discoveries led to more knowledge of how to grow specific germs
The work of scientist Robert Koch in the 1800s led to the development of more modern microbiology experiments. This increase in more sophisticated experiments also created the knowledge of how to grow and produce large stocks of specific germs.
Portrait of Robert Koch
1900s - First deliberate use of anthrax as an act of aggression
The first deliberate uses of anthrax as an act of aggression were recorded in the early decades of the 1900s, during World War I.
1914-1918 Anthrax used during the first World War
There is evidence that the German army used anthrax to secretly infect livestock and animal feed traded to the Allied Nations by neutral partners. An example of this undercover biological warfare was the infection of Argentinian livestock intended for trade with the allied forces, resulting in the death of 200 mules in 1917 and 1918.
1925 - A diplomatic approach to limit the use and creation of germ and chemical warfare
After the many chemical and biological horrors of WWI, a diplomatic attempt was made to limit the use and creation of this kind of warfare. The Geneva Protocol for the Prevention of the Use in War of Asphyxiating, Poisonous or other Gases and Bacteriological Methods of Warfare was created. This treaty was a great step in trying to stop the use of biologic agents during war. However, it did not specifically outlaw the research or production of biologic agents. Many countries agreed to the treaty but then created amendments to allow for use of biologic weapons during retaliation. After the Geneva Convention, interest in anthrax mostly focused on preventing disease in livestock and on improving the Pasteur vaccine.
1932 - Japan experimenting with anthrax as a weapon
Japan began producing anthrax to be used as a weapon and conducted research with biological weapons in Japanese-occupied Manchuria. During this time, prisoners were infected with anthrax and other deadly diseases. It was later discovered that during this program, the Japanese attacked at least 11 Chinese cities with anthrax and other biological agents by spraying them directly onto homes from aircraft.
1942 - United States and Great Britain experiment with bioweapons
A bioweapons program was started in the United States. The United States conducted experiments with anthrax, among other biologic agents, at testing sites in Mississippi and Utah. More than 5,000 bombs were filled with anthrax in preparation for a response to any possible attacks from Germany.
Great Britain also began to experiment with anthrax for bioweapons on a small island off the coast of Scotland called Gruinard Island. They tested the widespread release of anthrax by releasing bombs containing the germ over the island, where 80 sheep had been placed. All of the sheep died from anthrax. One of the most important findings from this experiment was how long anthrax stays in the environment after a release. The island remained uninhabitable until 1986, when Great Britain decided to decontaminate it by killing all of the anthrax spores. After a year of soaking the island in a mixture of formaldehyde and seawater, the island was considered disinfected.
Gruinard Bay, Scotland
1950 - U.S. bioweapon programs are expanded
During the Korean War, U.S. bioweapon programs were expanded. This expansion included the creation of a program to develop vaccines and treatments to protect troops against biological agents.
1960s - Growing international concern about the use of bioweapons
By 1960, the United States possessed a large collection of bioweapons, including many types of bacteria, fungi, and toxins. During the late 1960s, there was growing concern, internationally, about the use of biological weapons and the ineffectiveness of the Geneva Protocol. In July of 1968, Great Britain submitted a proposal to the Committee on Disarmament of the United Nations, which would prohibit the development, production, and stockpiling of biological agents. This proposal also outlined the need for inspections for alleged violators. Several months later, The Warsaw Pact nations submitted a similar proposal. In 1969, President Nixon terminated the U.S. bioweapons program through an executive order. This executive order stopped offensive bioweapon research and production of the weapons, and it also called for destruction of the arsenal. The United States also adopted the policy to never use any biological or toxic weapons under any circumstances. After this, research efforts in the United States became solely directed toward the creation of defensive methods like vaccines, treatments, and diagnostic tests for potential biologic threats.
1972 - Treaty signed to prohibit biological and toxic weapons
The 1972 Convention on the Prohibition of the Development, Production, and Stockpiling of Biological and Toxin Weapons and on Their Destruction was later created after the proposals of Great Britain and the Warsaw Pact nations. This treaty prohibited the development, possession, and stockpiling of pathogens or toxins. The treaty also required parties to destroy stockpiles of bioweapons within 9 months of signing the treaty. The treaty was ratified in April of 1972, with more than 100 nations signing it, including Iraq, the United States, and the Soviet Union.
Between 1971 and 1972, the United States destroyed pathogens and stockpiles of biologic weapons. Small amounts of certain pathogens were kept so they could be used to test new treatments and vaccines.
1979 - Deadly anthrax outbreak in Sverdlovsk, USSR
In April and May of 1979, an unusual outbreak of anthrax was reported in the city of Sverdlovsk, USSR. However, reports of this outbreak did not begin to surface in Western news until early 1980. Later that year, articles in Soviet medical, veterinary, and legal journals described the outbreak as naturally occurring in livestock, causing 96 cases of anthrax in humans. Of these cases, 79 were described as gastrointestinal anthrax, and 17 of them were cutaneous anthrax. Soviet officials reported that 64 of these 96 people died from gastrointestinal anthrax.
Internationally, there was a great debate about the data presented from this outbreak and its accuracy. Some speculated that the outbreak was not naturally occurring among livestock, but that it resulted from activities banned by the Biological Weapons Convention of 1972 (Convention on the Prohibition of the Development, Production, and Stockpiling of Biological and Toxin Weapons and on Their Destruction). All of the cases occurred within 4 kilometers (about 2½ miles) downwind from a Soviet military microbiology facility, and it was suspected that the cases were from the accidental airborne release of anthrax spores. Years later, Western analysts were permitted to review the outbreak to address the speculation. These analysts used data to determine that the anthrax outbreak did occur from the microbiology facility and was the largest outbreak of inhalation anthrax in history. Despite these findings, the Soviet Union maintained that the outbreak was from meat contaminated with anthrax spores. In 1992, then-president of Russia, Boris Yeltsin, admitted that the outbreak was exactly what Western analysts had determined. He stated that the air filters at the biologic facility had not been properly installed the morning of the release, allowing anthrax spores to spew out of the facility.
2001 - Anthrax attack on America
Before 2001, the last case of inhalation anthrax reported in the United States was in 1976. After the September 11 attacks on the World Trade Center and Pentagon, letters filled with a white powder containing anthrax spores were mailed to two U.S. Senators’ offices and news media agencies along the East Coast. Authorities recovered four letters, postmarked September 18, 2001, and October 9, 2001. The powder form allowed the anthrax to float in the air and for it to be breathed in. The powder from these letters contaminated the postal facilities they were processed through as well as the buildings where they were opened.
Until the first few people became ill with anthrax, Americans were unaware of this attack. The first case of inhalation anthrax was diagnosed on October 4, 2001. During October and November of 2001, there were a total of 11 confirmed cases of inhalation anthrax and 11 confirmed cases of cutaneous anthrax. Of the 11 cases of inhalation anthrax, seven of the cases were postal workers who handled the letters or worked in a postal facility where the letters were processed. Two cases were from the AMI Publishing Company, where a photo editor received a contaminated letter. The last two cases were the hardest in which to determine exposure: a 94-year old Connecticut woman and a New York City hospital employee. Investigators thought that the Connecticut women’s mail may have been cross-contaminated in a mail facility; however, no anthrax spores were ever found in her home. The exposure source of the New York City hospital employee is still unknown.
Of the 22 people who got sick with anthrax in 2001, five of them died. All of the people who died had inhalation anthrax, the most serious form of the disease. In all, 43 people tested positive for exposure to anthrax, and 10,000 more people were considered at risk of possible exposure to anthrax.
Before this event, there had never been an intentional release of anthrax in the United States. The FBI conducted an intense 7-year investigation into who may have sent the contaminated letters. Many years after the attacks, advancements in genetic testing allowed the FBI to conduct more complex testing of the spores used in the attack. Once the spores were analyzed, it was determined they came from a strain called the Ames strain and from a single spore batch known as RMR-1029, from a specific research lab. The attack and the subsequent investigation came to be known as Amerithrax. The FBI officially concluded the Amerithrax investigation on February 19, 2010.
Source: Centers for Disease Control and Prevention (CDC)
Additional Materials (2)
Anthrax
Using the India ink capsule staining technique on this sample enabled improved visualization of these encapsulated, Bacillus anthracis bacteria. In clinical samples including as blood, blood culture bottles, or cerebrospinal fluid (CSF), this India ink works well to reveal the presence of these organisms.
Image by CDC/ Courtesy of Larry Stauffer, Oregon State Public Health Laboratory
Anthrax
This image depicts a view of a Petri dish culture plate, which contained a growth medium of sheep blood agar (SBA), and which had been inoculated with Bacillus anthracis. In this case, what you’re seeing is a positive result of what is known as a phage test, whereupon, you’ll note the diminished growth (arrowhead) contained within the confluent colonial growth, known as oval-shaped macroplaque, where a gamma phage suspension had been applied atop the blood agar medium. This particular culture was incubated in a carbon dioxide-free environment, at a temperature of 35?C.
Image by CDC/ Courtesy of Larry Stauffer, Oregon State Public Health Laboratory
Anthrax
CDC/ Courtesy of Larry Stauffer, Oregon State Public Health Laboratory
Anthrax
CDC/ Courtesy of Larry Stauffer, Oregon State Public Health Laboratory
Transmission
Anthrax Infection
Image by CDC
Anthrax Infection
Image by CDC
How Do People Get Anthrax?
People get infected with anthrax when spores get into the body. When this happens, the spores can be activated and become anthrax bacteria. Then the bacteria can multiply, spread out in the body, produce toxins (poisons), and cause severe illness.
People get anthrax by:
Breathing in spores,
Eating food or drinking water that is contaminated with spores, or
Getting spores in a cut or scrape in the skin.
Anthrax is NOT contagious. You cannot catch anthrax from another person the way you might catch a cold or the flu. In rare cases, person-to-person transmission has been reported with cutaneous anthrax, where discharges from skin lesions might be infectious.
Certain activities can increase the chances of getting anthrax
Working with infected animals or animal products
Most people who get sick from anthrax are exposed while working with infected animals or animal products such as wool, hides, or hair.
Inhalation anthrax can occur when a person inhales spores that are in the air (aerosolized) during the industrial processing of contaminated materials, such as wool, hides, or hair.
Cutaneous anthrax can occur when workers who handle contaminated animal products get spores in a cut or scrape on their skin.
Eating raw or undercooked meat from infected animals
People who eat raw or undercooked meat from infected animals may get sick with gastrointestinal anthrax. This usually occurs in countries where livestock are not routinely vaccinated against anthrax and food animals are not inspected prior to slaughter.
In the United States, gastrointestinal anthrax has rarely been reported. This is because yearly vaccination of livestock is recommended in areas of the United States where animals have had anthrax in the past, and because of the examination of all food animals, which ensures that they are healthy at the time of slaughter.
A newly discovered type of anthrax is injection anthrax. This type of anthrax has been seen in northern Europe in people injecting heroin. So far, no cases of injection anthrax have been reported in the United States.
Source: Centers for Disease Control and Prevention (CDC)
Who Is At Risk?
Anthrax
Image by CDC/ Courtesy of Larry Stauffer, Oregon State Public Health Laboratory
Anthrax
Using contrast microscopy, this photomicrograph highlights the endospores found amongst a number of Bacillus anthracis bacteria. Endospores are seen under phase contrast microscopy as lighter areas, i.e. "points of light", due to the fact that they are dehydrated, and therefore, more refractile.
Image by CDC/ Courtesy of Larry Stauffer, Oregon State Public Health Laboratory
Who Is At Risk of Anthrax?
Most people will never be exposed to anthrax. However, there are activities that can put some people at greater risk of exposure than others.
Anthrax is not contagious, which means you can’t catch it from another person like the cold or flu.
Laboratory professionals
Laboratory workers who handle anthrax may be at risk for being exposed if proper safety precautions aren’t followed.
People who handle animal products
Although rare, people can get anthrax after having contact with infected animals or their products, such as wool, hides, or hair. For this reason, people in certain occupations, like veterinarians, farmers, livestock producers, and others who handle animals and animal products may have an increased risk of exposure.
Mail handlers, military personnel, and response workers
Certain workers could be exposed to anthrax in the event of a bioterrorist attack, either during the attack or when responding to the emergency. Workers who could be at risk include mail handlers (if spores are sent through the mail), law enforcement personnel, healthcare workers, decontamination workers, and critical infrastructure workers who could be exposed to airborne (aerosolized) spores, depending on how the spores were spread.
Travelers
Anthrax can be found naturally in soil and commonly affects domestic and wild animals around the world, but it is most common in agricultural regions of Central and South America, Sub-Saharan Africa, Central and southwestern Asia, Southern and eastern Europe, and the Caribbean. Travelers should be mindful of what they eat and handle, as well as the souvenirs they bring home. Avoid eating raw or undercooked meat, and avoid contact with livestock, animal products and animal carcasses. Vaccination against anthrax is not recommended for travelers and is not available for civilian travelers.
Source: Centers for Disease Control and Prevention (CDC)
Additional Materials (3)
Anthrax
This photomicrograph reveals some of the ultrastructural morphology depicted by Bacillus anthracis bacteria, which had been processed using M'Fadyean capsule stain, and grown at 35?C, on a growth medium of defibrinated horse blood.
Image by CDC/ Courtesy of Larry Stauffer, Oregon State Public Health Laboratory
Sensitive content
This media may include sensitive content
This image depicts an anthrax skin lesion on neck of a male patient, caused by the bacterium, Bacillus anthracis.
This image depicts an anthrax skin lesion on neck of a male patient, caused by the bacterium, Bacillus anthracis. This form of the disease is referred to as cutaneous anthrax.
Image by CDC
Sensitive content
This media may include sensitive content
Cutaneous anthrax
Cutaneous anthrax lesion on the neck : Cutaneous anthrax lesion on the neck.
Image by CDC
Anthrax
CDC/ Courtesy of Larry Stauffer, Oregon State Public Health Laboratory
Sensitive content
This media may include sensitive content
This image depicts an anthrax skin lesion on neck of a male patient, caused by the bacterium, Bacillus anthracis.
CDC
Sensitive content
This media may include sensitive content
Cutaneous anthrax
CDC
Symptoms
scanning electron microscopic (SEM) image depicts spores from the Sterne strain of Bacillus anthracis bacteria
Image by Janice Haney Carr - Center for Disease Control and Prevention
scanning electron microscopic (SEM) image depicts spores from the Sterne strain of Bacillus anthracis bacteria
Under a high magnification of 12,483X, this digitally-colorized, scanning electron microscopic (SEM) image depicts spores from the Sterne strain of Bacillus anthracis bacteria. For a black and white version of this image, see PHIL 2267. A key characteristic of the Sterne strain of B. anthracis, is the wrinkled surface of the protein coat of these bacterial spores. These endospores can live for many years, which enables these bacteria to survive in a dormant state, under environmentally-stressful circumstances.
Image by Janice Haney Carr - Center for Disease Control and Prevention
What Are the Signs and Symptoms of Anthrax?
The symptoms of anthrax depend on the type of infection and can take anywhere from 1 day to more than 2 months to appear. All types of anthrax have the potential, if untreated, to spread throughout the body and cause severe illness and even death.
Cutaneous anthrax symptoms can include:
A group of small blisters or bumps that may itch
Swelling can occur around the sore
A painless skin sore (ulcer) with a black center that appears after the small blisters or bumps
Most often the sore will be on the face, neck, arms, or hand
Inhalation anthrax symptoms can include:
Fever and chills
Chest Discomfort
Shortness of breath
Confusion or dizziness
Cough
Nausea, vomiting, or stomach pains
Headache
Sweats (often drenching)
Extreme tiredness
Body aches
Gastrointestinal anthrax symptoms can include:
Fever and chills
Swelling of neck or neck glands
Sore throat
Painful swallowing
Hoarseness
Nausea and vomiting, especially bloody vomiting
Diarrhea or bloody diarrhea
Headache
Flushing (red face) and red eyes
Stomach pain
Fainting
Swelling of abdomen (stomach)
Injection anthrax symptoms can include:
Fever and chills
A group of small blisters or bumps that may itch, appearing where the drug was injected
A painless skin sore with a black center that appears after the blisters or bumps
Swelling around the sore
Abscesses deep under the skin or in the muscle where the drug was injected
Injection anthrax symptoms are similar to those of cutaneous anthrax, but injection anthrax can spread throughout the body faster and be harder to recognize and treat than cutaneous anthrax. Skin and injection site infections associated with injection drug use are common and do not necessarily mean the person has anthrax.
Source: Centers for Disease Control and Prevention (CDC)
Additional Materials (1)
Sensitive content
This media may include sensitive content
This image depicts a superior view of a human brain, which had been excised from a patient, who’d succumbed to anthrax, caused by the bacterium, Bacillus anthracis.
This image depicts a superior view of a human brain, which had been excised from a patient, who’d succumbed to anthrax, caused by the bacterium, Bacillus anthracis. The brain had been divided into sections, with cuts running perpendicular to the anteroposterior axis, revealing the brain’s light beige interior, and its darkly colored exterior, caused by a condition known as hemorrhagic meningitis, due to inhalation anthrax.
Image by CDC
Sensitive content
This media may include sensitive content
This image depicts a superior view of a human brain, which had been excised from a patient, who’d succumbed to anthrax, caused by the bacterium, Bacillus anthracis.
CDC
Diagnosis
Anthrax - Diagnosis
Image by US GOV
Anthrax - Diagnosis
Anthrax - inhalational
Image by US GOV
How Is Anthrax Diagnosed?
Doctors in the United States rarely see a patient with anthrax. CDC guidance and case definitions are available to help doctors diagnose anthrax, take patient histories to determine how exposure may have occurred, and order necessary diagnostic tests.
If inhalation anthrax is suspected, chest X-rays or CT scans can confirm if the patient has mediastinal widening or pleural effusion, which are X-ray findings typically seen in patients with inhalation anthrax.
The only ways to confirm an anthrax diagnosis are:
To measure antibodies or toxin in blood
To test directly for Bacillus anthracis in a sample
blood
skin lesion swab
spinal fluid
respiratory secretions
Samples must be taken before the patient begins taking antibiotics for treatment.
Source: Centers for Disease Control and Prevention (CDC)
If You've Been Exposed
Radiography, Thoracic
Image by CDC
Radiography, Thoracic
This posteroanterior (PA) chest x-ray was captured on the 4th day of a case of inhalation anthrax, caused by the bacterium, Bacillus anthracis. Note the presence of a widened mediastinum, and pleural effusion, radiographic characteristics found in the case of inhalation anthrax.
Image by CDC
If You Think You Have Been Exposed to Anthrax
If you think you may have been exposed to anthrax, you need to go to a doctor right away and explain why you think you may have been exposed. Doctors can prescribe antibiotics to prevent you from getting sick. There is no test a doctor can give you that determines if you have been exposed to anthrax. The only way exposures can be determined is through a public health investigation.
If you already have symptoms of anthrax, it’s important to get medical care as quickly as possible to have the best chances for a full recovery.
Anthrax is NOT contagious. You cannot catch anthrax from another person the way you might catch a cold or the flu. In rare cases, person-to-person transmission has been reported with cutaneous anthrax, where discharges from skin lesions might be infectious.
Source: Centers for Disease Control and Prevention (CDC)
Treatment
Pasteur inoculating sheep against anthrax.
Image by /Wikimedia
Pasteur inoculating sheep against anthrax.
Pasteur inoculating a sheep against anthrax.
Rare Books
Keywords: Louis Pasteur; Charles Edouard Chamberland
Image by /Wikimedia
How Is Anthrax Infection Treated?
Doctors have several options for treating patients with anthrax, including antibiotics and antitoxin. Patients with serious cases of anthrax need to be hospitalized. They may require aggressive treatment, such as continuous fluid drainage and help breathing through mechanical ventilation.
For people who have been exposed to anthrax but do not yet have symptoms, certain antibiotics can be used to prevent illness from developing.
Antibiotics
All types of anthrax infection can be treated with antibiotics, including intravenous antibiotics (medicine given through the vein). If someone has symptoms of anthrax, it’s important to get medical care as quickly as possible to have the best chances of a full recovery. Doctors will select antibiotics that are best for treating anthrax and that are best for the patient based on their medical history.
Antitoxin
When anthrax spores get inside the body, they can be “activated.” When they become active, anthrax bacteria can multiply, spread out in the body, and produce toxins—or poisons. Anthrax toxins in the body cause severe illness.
After anthrax toxins have been released in the body, one possible treatment is antitoxin. Antitoxins target anthrax toxins in the body. Doctors must use antitoxin together with other treatment options.
Currently, there are a few types of antitoxins that can be used for treating anthrax.
Source: Centers for Disease Control and Prevention (CDC)
Additional Materials (2)
Antibiotics
Image by Memed_Nurrohmad
Anthrax and Antibiotics: Anthrax is Deadly. Antibiotics Could Save Your Life.
Video by Centers for Disease Control and Prevention (CDC)/YouTube
Antibiotics
Memed_Nurrohmad
3:01
Anthrax and Antibiotics: Anthrax is Deadly. Antibiotics Could Save Your Life.
Centers for Disease Control and Prevention (CDC)/YouTube
Prevention
Bottle of Doxycycline
Image by NIAID
Bottle of Doxycycline
Capsules of the antibiotic doxycycline spill from a medication bottle. Oral antibiotics, such as doxycycline or amoxicillin, are often prescribed after exposure to tickborne Lyme disease.
Image by NIAID
How to Prevent Anthrax
Anthrax is rare, and most people will never be exposed to it. There is a vaccine licensed to prevent anthrax, but it is only recommended for routine use in certain groups of at-risk adults (for example, some members of the military and laboratory workers).
For people who have been exposed to anthrax but do not yet have symptoms, certain antibiotics can be used to prevent illness from developing.
Preventing anthrax during travel
Visitors to areas where anthrax is common or where an outbreak is occurring in animals can get sick with anthrax if they have contact with infected animal carcasses or eat meat from animals that were sick when slaughtered. They can also get sick if they handle animal parts, such as hides, or products made from those animal parts, such as animal hide drums. If you are visiting these areas, do not eat raw or undercooked meat and avoid contact with livestock, animal products, and animal carcasses.
International travelers should be aware of regulations concerning (and restrictions against) the importation of prohibited animal products, trophies, and souvenirs. For more information, see CDC’s Yellow Book.
Preventing anthrax from animal hides
Imported animal hides have been associated with a number of anthrax cases in the United States. Cases have occurred in drum makers using these hides. Cases have also occurred in people who have handled or been near the drums or in the environment where they were made. Some imported hides may contain anthrax spores, and although this is rare, there is no way to test for the presence of spores on hides.
To protect against anthrax spores, be sure to use hides that came from:
Animals from the United States
Animals that were imported with an international veterinary certificate showing that they have undergone the appropriate government inspection
Source: Centers for Disease Control and Prevention (CDC)
Additional Materials (1)
Anthrax
Video by pirelliaward/YouTube
3:13
Anthrax
pirelliaward/YouTube
Antibiotics
Ciprofloxacin
Image by Myself/Wikimedia
Ciprofloxacin
Eight 500 mg ciprofloxacin tablets, manufactured by Bayer, against a black background.
Image by Myself/Wikimedia
Antibiotics to Prevent Anthrax After Exposure
Antibiotics can prevent anthrax from developing in people who have been exposed but have not developed symptoms. Antibiotics work in two main ways, by killing the anthrax or by stopping the anthrax from growing. When the anthrax can’t grow anymore, it dies. Two of the antibiotics that could be used to prevent anthrax are:
Ciprofloxacin
Doxycycline
Each of these antibiotics offers the same protection against anthrax. Anthrax spores typically take 1 to 7 days to be activated, but some spores can remain inside the body and take up to 60 days or more before they are activated. Activated spores release toxins—or poisons—that attack the body, causing the person to become sick. That’s why people who have been exposed to anthrax must take antibiotics for 60 days. This will protect them from any anthrax spores in their body when the spores are activated.
Anthrax spores can take up to 60 days or more to be activated in the body
Source: Centers for Disease Control and Prevention (CDC)
Vaccine
A person is being injected with a vaccine
Image by Ed Us/Unsplash
A person is being injected with a vaccine
Image by Ed Us/Unsplash
Vaccine to Prevent Anthrax
Anthrax Vaccine Adsorbed (AVA) protects against anthrax. It does not contain any anthrax bacteria and cannot give people anthrax. It is not typically available to the general public. The vaccine is approved by the Food and Drug Administration (FDA) for two different situations: routine occupational use (before possible exposure) and post-event emergency use (after possible exposure).
Routine occupational use (before possible exposure)
Anthrax vaccine is approved for use in three groups of adults 18 to 65 years of age who may be at risk of coming in contact with anthrax because of their job.
These at-risk adults will receive the vaccine before exposure:
Certain laboratory workers who work with anthrax
Some people who handle animals or animal products, such as some veterinarians
Some members of the United States military
To build up protection against anthrax, these groups should get 5 shots of anthrax vaccine over 18 months. To stay protected, they should get annual boosters. The shots are injected into a muscle (intramuscular).
People who should NOT get the anthrax vaccine for routine occupational use include:
Pregnant women.
Anyone who has had a serious allergic reaction to a previous dose of anthrax vaccine.
Anyone who has a severe allergy to any component of the anthrax vaccine.
Anyone with severe allergies, including allergy to latex, should tell their doctor.
Anyone with a moderate or severe illness might be asked by their doctor to wait until they recover to get the vaccine. People with mild illness can usually be vaccinated.
Post-event emergency use (after possible exposure)
In November 2015, FDA also approved the vaccine for use after exposure to anthrax for people 18 through 65 years of age. In certain situations, such as a bioterrorist attack involving anthrax, anthrax vaccine might be recommended to prevent the disease in people after they have been exposed to the anthrax germs.
If this were to happen, people who were exposed would get 3 shots of anthrax vaccine over 4 weeks plus a 60-day course of antibiotics.
During an emergency, the only people who should not get the anthrax vaccine after possible exposure are those who have had a serious allergic reaction to a previous dose of anthrax vaccine. These people would receive the 60-day course of antibiotics only.
Source: Centers for Disease Control and Prevention (CDC)
Send this HealthJournal to your friends or across your social medias.
Anthrax
Bacillus anthracis, and has been documented as far back as 700 BC. Animals can become infected from spores in contaminated soil, plants, or water. People also can become sick with anthrax when spores get into their body. Learn about anthrax symptoms, causes, vaccine, and treatment.