Communicable Disease Epidemiology

“ANTHRAX”
Supporting Lecturer: dr. Arulita Ika Fibriana, M. Kes.

Arranged by:

Name : Ika Fadillah

SIN : 6411420054

Class : 3E (IUP)

Public Health Department, Faculty of Sport Science,

Semarang State University 2021

A. Overview of Anthrax

Anthrax is a serious infectious disease caused by gram-positive, rod-shaped bacteria

known as Bacillus anthracis. Anthrax can be found naturally in soil and commonly affects
domestic and wild animals around the world. In fall 2001, anthrax bacteria were distributed
intentionally through the United States mail system causing twenty-one cases of illness.

Anthrax has been reported from nearly every continent and is most common in
agricultural regions with neutral or alkaline, calcareous soils. In these regions, anthrax
periodically emerges as epizootics are usually associated with drought, flooding, or soil
disturbance, and many years may pass between outbreaks.

Humans get infected with anthrax when spores get into the body. When anthrax
spores get inside the body, they can be activated. When bacteria are active, they can multiply
and then spread in the body and produce toxins that cause severe illness. While in animals,
domestic and wild animals such as cattle, sheep, goats, antelope, and deer can become
infected when they breathe in or ingest spores in contaminated soil, plants, or water.

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.
Cutaneous anthrax occurs when anthrax spores get into the skin, usually through a cut or
scrape, and develop to be cutaneous anthrax. Inhalation anthrax occurs when human breathes
in anthrax spores, it can develop inhalation anthrax. Gastrointestinal anthrax occurs when
human eats raw or undercooked meat from an animal infected with anthrax. Injection anthrax
occurs to drug users that do drug-injecting that infected by the disease.
 All types of anthrax can eventually spread throughout the body and cause death if
they are not treated with antibiotics. In areas where domestic animals have had anthrax in the
past, routine vaccination can help prevent outbreaks. The incubation period ranges from a
few hours to 3 weeks, most often 2 to 6 days.

The ways to confirm an anthrax diagnosis are: (1) to measure antibodies or toxin in
blood; (2) to test directly for Bacillus anthracis in a sample (blood, skin lesion swab, spinal
fluid, respiratory secretions).

B. Etiology and ecology

Bacillus anthracis ground glass colonies

Bacillus anthracis, medusa head morphology

Bacillus anthracis, methylene blue stain

 Anthrax is a bacterial disease caused by the spore–forming Bacillus anthracis, a Gram-
positive, rodshaped bacterium, the only obligatepathogen in the large genus Bacillus.

The infected host sheds the vegetative bacilli onto the ground and these sporulate on
exposure to the air. The spores, which can persist in soil for decades, wait to be taken up by
another host, when germination and multiplication can again take place upon infection. Flies
appear to play an important role in large outbreaks in endemic areas. Humans acquire anthrax
from handling carcasses, hides, bones, etc. from animals that died of the disease.

The cycle of infection is influenced by (i) factors that affect sporulation and germination,
such as pH, temperature, water activity and cation levels; and (ii) factors related to the
season, such as available grazing, the health of the host, insect populations and human
activities.

C. Anthrax in Animals

LD50s range from < 10 spores in susceptible herbivores to > 107 spores in more resistant
species when administered parenterally. However, B. anthracis is not an invasive organism
and by inhalational or ingestion routes, LD50s are in the order of tens of thousands, even in
species regarded as susceptible. The relationship between experimentally determined LD50s
and doses encountered by animals acquiring the disease naturally is poorly defined.

National programmes have resulted in a global reduction of anthrax, although this is

counteracted by the failure of more recent generations of veterinarians, farmers, etc., through
lack of experience, to recognize and report the disease, and the abandonment of vaccination.
The disease is still common in some Mediterranean countries, in small pockets in Canada and
the USA, certain countries of central and South America and central Asia, several sub-
Saharan African countries and western China. Sporadic cases and outbreaks continue to occur
elsewhere.

In animals, generally acquire anthrax by ingestion of spores while grazing or browsing.

However, anomalies in the epizootiology of the disease often arise that are hard to explain in
terms of simple ingestion of spore. Flies appear to play an important role in explosive
outbreaks. Inhalation within dust may be important on occasion. Direct animal-to-animal
transmission is believed to occur to an insignificant extent, excluding carnivores feeding on
other victims of the disease. Human activities in the form of trade have long been responsible
for the spread of the disease globally. The age, sex and condition of animals may all influence
the incidence of the disease at any one site. Carriage or latent infection are unproven states
but have not been disproved either. Many anomalies and unknowns remain in our
understanding of how animals acquire anthrax and how it is transmitted.

D. Anthrax in humans

Human anthrax infection generally results from contact with infected animals, or
occupational exposure to infected or contaminated animal products. The incidence of the
natural disease depends on the level of exposure to affected animals. Reported animal:human
case ratios in a country or region reflect the economic conditions, quality of surveillance,
social traditions, dietary behaviour, etc. in that country or region. In contrast to animals, age-
or sex-related bias is generally not apparent in humans, though males generally have higher
occupational risk rates in many countries.

The evidence is that humans are moderately resistant to anthrax but that outbreaks occur.
Infectious doses are difficult to assess but in individuals in good health and in the absence of
lesions through which the organism can gain ready access, ID 50s are generally in the
thousands or tens of thousands and anthrax is not considered a contagious disease.

Anthrax in humans is traditionally classified in two ways: (1) based on how the
occupation of the individual led to exposure differentiates between nonindustrial anthrax,
occurring in farmers, butchers, knackers/renderers, veterinarians, etc., and industrial anthrax,
occurring in those employed in the processing of bones, hides, wool and other animal
products; (2) reflecting the route by which the disease was acquired. This distinguishes
between cutaneous anthrax, acquired through a skin lesion, ingestion (oral route) anthrax,
contracted following ingestion of contaminated food, primarily meat from an animal that died
of the disease, and inhalational anthrax, from breathing in airborne anthrax spores.

Anthrax has type on illness develops, and it depends on how anthrax enters the body.
Typically, anthrax gets into the body through the skin, lungs, or gastrointestinal system. The
type of anthrax including:

a. Cutaneous anthrax
 This type occurs 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. Cutaneous anthrax is the most common form of anthrax
infection, and it is also considered to be the least dangerous.
b. Inhalation anthrax

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. Inhalation anthrax is considered to be the most deadly form of
anthrax.
c. Gastrointestinal anthrax
 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. Gastrointestinal
anthrax has rarely been reported in the United States.
d. Injection anthrax

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.
E. Symptoms

Symptoms of anthrax is depend the type of infection.

a. Cutaneous anthrax symptoms can include: (1) a group of small blisters or bumps that
may itch; (2) swelling around the sore; (3) a painless skin sore (ulcer) with a black
 center that appears after the smallblisters or bumps. Most often the sore will be on the
face, neck, arms, or hands.
Small cutaneous anthrax ulcer just below a patient’s wrist :

b. Inhalation anthrax symptoms can include: (1) fever and chills; (2) chest discomfort;
(3) shortness of breath; (4) confusion or dizziness; (5) cough; (6) nausea, vomiting, or
stomach pains; (7) headache; (8) sweats (often drenching); (9) extreme tiredness; (10)
body aches.
c. Gastrointestinal anthrax symptoms can include: (1) fever and chills; (2) swelling of
neck or neck glands; (3) sore throat; (4) painful swallowing (5) hoarseness; (6) nausea
and vomiting, especially bloodyvomiting; (7) diarrhea or bloody diarrhea; (8)
headache; (9) flushing (red face) and red eyes (10) stomach pain; (11) fainting; (12)
swelling of abdomen (stomach).
d. Injection anthrax symptoms can include: (1) fever and chills; (2) agroup of small
blisters or bumps that may itch, appearing where the drug was injected; (3) apainless
skin sore with a black center that appears after the blisters or bumps; (4) swelling
around the sore; (5) abscesses deep under the skin or in the muscle where the drug
was injected.
F. Diagnose, Treatment and Prevention

Diagnose of anthrax is depend on the symptoms and anthrax type. The healthcare
provider may conduct one or more tests, including: (1) biopsy of skin lesion; (2) blood tests;
(3) chest X-ray; (4) computed tomography (CT) scan; (5) lab tests on stool or mucus; (6)
lumbar puncture (spinal tap). And the ways to confirm an anthrax diagnosis are: (1) to
measure antibodies or toxin in blood; (2) to test directly for Bacillus anthracis in a sample
(blood, skin lesion swab, spinal fluid, respiratory secretions).

The treatment of anthrax can through by antibiotics. Fast treatment with antibiotics can
stop the infection from developing. Oral, injectable or intravenous antibiotics fight infection.
Commonly used antibiotics include ciprofloxacin and doxycycline. Treatment also can use
antitoxins and vaccine. Antitoxin is injectable antibody medications neutralize anthrax toxins
in the body. The treatment use antitoxins, typically includes antibiotics, too. Vaccine to
prevent anthrax infection also treats infected people. Treatment involves three doses of the
vaccine over four weeks. Antibiotics also received at the same time.

To prevent anthrax, vaccination is the good choice. The anthrax vaccine is 90% effective
at preventing infection. The vaccine, also stop the infection if humans have knowingly been
exposed to anthrax. In areas where domestic animals have had anthrax in the past, routine
vaccination can help prevent outbreaks.

G. Bibliography

Overview of Anthrax - Generalized Conditions. (n.d.). Retrieved from Veterinary Manual

website: https://www.msdvetmanual.com/generalized-conditions/anthrax/overview-
of-anthrax
How to Prevent Anthrax | CDC. (2020, December 14). Retrieved from www.cdc.gov website:
https://www.cdc.gov/anthrax/prevention/index.html
Anthrax: Bacillus anthracis, Symptoms, Types, Causes, Treatment. (n.d.). Retrieved from
Cleveland Clinic website: https://my.clevelandclinic.org/health/diseases/10853-
anthrax
Basic Information. (2019). Retrieved from CDC website:
https://www.cdc.gov/anthrax/basics/index.html
CDC. (2019, March 4). Centers for Disease Control and Prevention. Retrieved from Centers
for Disease Control and Prevention website: https://www.cdc.gov
World Health Organization. (2018). Home. Retrieved from Who.int website:
https://www.who.int
Friis, R. H. (2018). Epidemiology 101. Burlington, Massachusetts: Jones & Bartlett Learning.