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Bacillus anthracis, the causative agent of anthrax, is a Gram-positive bacterium naturally occurring in the environment worldwide where it forms resilient, dormant spores capable of surviving for extended periods of time [3, 4].

Gram-positive

Rod-shaped

Spore-forming

Nonmotile

Found in the earths soil

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How do endospores contribute to pathogenicity?

Highly resistant to various forms of microbial control methods such as high temperatures, radiation, desiccation, and chemicals.

Germinate vegetative cells which are metabolically active and produce exotoxins PA, LF, and EF. When the three exotoxins combine they produce LT and ET. LT and ET inhibit the host innate immune system allowing for survival.

Provide protection allowing for survival in soil. The ability of spores to persist for years and even decades in the environment is well-documented, including several reports of spore survival lasting >50 years [1,4,7,16–18]

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Anthrax infection occurs when spores enter the hosts body.

Spores -> vegetative cells -> toxins -> illness

Breathing in aerosolized spores from contaminated animal hides, wool, or hair.

Ingesting spores by eating meat from infected animal or drinking spore contaminated water.

Spores enter a cut or scrape on the skin of host by petting or handling infected animal or products.

Spores enter through use of spore contaminated needles.

Anthrax is not contagious. It is very rare for anthrax to spread from person to person.

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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.

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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.

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Bacillus anthracis, the causative agent of anthrax, affects humans, livestock, and wildlife in multiple regions around the world. It is a gram-positive, rod-shaped, and spore-forming bacterium that primarily affects wild and domestic herbivores, resulting in high mortality rates, while also posing an important human health risk [1].

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All forms of anthrax cause fever and chills. However other symptoms vary depending on the type of anthrax.

Inhalation anthrax
Chest pain
Cough
Shortness of breath
Severe respiratory distress
Shock

Gastrointestinal anthrax
Excessive sweating
Painful swallowing
Stomach pain
Nausea and vomiting with blood
Bloody diarrhea
Swelling of abdomen

Cutaneous anthrax
Small, itchy blisters
Swelling
Painless ulcers with black center in locations such as arms, hands and face.

Injection anthrax
Abscesses occur deep under skin or in the muscle location of the injection.

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Anthrax Infection Diagnosis & Testing | CDC

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Anthrax can be diagnosed in two ways.

1. Measuring the amount of antibodies or toxins in the blood.

2. Directly testing for bacillus anthracis through samples such as mucus, blood, and spinal fluid (Lumbar Puncture).

X-Rays and CT scans may also be used to diagnose anthrax infections.

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How anthrax is 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.

Laboratory testing for anthrax

Laboratory systems are set up in the United States to quickly confirm or rule out whether a patient has anthrax or whether the environment is contaminated with Bacillus anthracis, the type of bacteria that causes anthrax. These labs are vital to the early identification of anthrax, especially in the case of a bioterrorism attack using anthrax.

However, the labs at CDC are always hard at work, not just during a bioterrorism event. They are working every day to conduct research that enhances the scientific understanding of anthrax. Laboratory scientists at CDC routinely strive to provide accurate information and efficient testing.

Labs at CDC work to:

Study and describe Bacillus anthracis

Provide anthrax reference diagnostics

Create new tests (including assays and diagnostics) to quickly identify anthrax

Test prevention and treatment options for anthrax

Provide epidemiological support and training to other labs and partners

All research with Bacillus anthracis is conducted in laboratories with the appropriate degree of containment to ensure public safety. The design of the secure laboratory facilities protects both scientists and the surrounding environment.

Laboratory Response Network (LRN)

Laboratory testing plays the largest role in diagnosing patients with anthrax. That's why the Laboratory Response Network (LRN) would be essential to help hospitals, doctors, and public health officials quickly confirm a diagnosis of anthrax.

The LRN was created through a partnership with the Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC), the Federal Bureau of Investigation (FBI), and the Association of Public Health Laboratories (APHL). This network links state and local public health laboratories in all states with clinical, military, veterinary, and agricultural labs as well as labs that test water and food. Together, these labs can quickly identify biological threats, including anthrax.

Laboratories that are a part of the LRN can test patient specimens for Bacillus anthracis, the type of bacteria that causes anthrax. LRN labs are strategically located across the United States and abroad, each playing a role in their state's or territory's overall emergency response plan. If anthrax was intentionally released, quietly and without anyone knowing, it might be difficult for hospitals, doctors, and public health officials to diagnose anthrax in the first few patients. That's why the Laboratory Response Network (LRN) would be essential during an anthrax emergency. Its purpose is to help hospitals, doctors, and public health officials quickly confirm a diagnosis of anthrax.

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Anthrax Infection Diagnosis & Testing | CDC

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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.

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Antibiotics are some of the medications effective in treating anthrax.
Ciprofloxacin (Cipro) is an antibiotic that must be taken twice a day for the full 60 days prescribed. It is effective in killing anthrax and inhibiting growth.

Mode of action includes inhibiting bacterial DNA gyrase. DNA gyrase is
essential in bacterial DNA replication, transcription and repair. Inhibition of DNA gyrase leads to double stranded breakage in the DNA strands. Ultimately killing Bacillus anthracis and inhibiting growth.

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Anthrax causes various physical and psychological long term effects.

Scarring

Fatigue

Joint pain

Problems of the respiratory tract

Chronic cough

Memory impairment

Depression

Anxiety

Post-traumatic stress disorder

Individuals who survive inhalation anthrax are more likely to suffer from more severe long term effects.

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Anthrax Vaccine Adsorbed (AVA) builds protection against forms of anthrax. AVA is a series of 5 shots over 18 months along with boosters. It is not available to the general public.

Avoid handling infected livestock

While traveling avoid handling animal hides.

If exposed to anthrax seek medical attention immediately.

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Where? It is endemic in Sub-Saharan Africa, the Middle East, Central and Southwest Asia, and Central and South America. Sporadic cases occur in North America and Europe, with most occurring in Eastern and Southern Europe [8].
Why?  The agricultural regions listed unfortunately do not have veterinary programs available that routinely vaccinate animals against anthrax.

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10. Facts, Historical relevance and features🧪

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10. Facts, Historical relevance and features🧪

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Facts

Anthrax is most like to be used as a biological weapon.

History

Used in 1914 during WW I

2001 Anthrax letters after 9/11

Anthrax was also likely the infamous “Black Bane” that swept through Europe in the 1600s, causing over 60,000 deaths in humans and cattle [2].

Features

Anthrax spores are tasteless, orderless and have no color.

Netflix documentary “ The Anthrax Attacks”

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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

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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Read about the history of anthrax, both as naturally occurring bacteria and as a biological weapon.

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