Anthrax Infection             

      Dr Sampurna Roy MD

Anthrax is of great historical interest for it was the first human disease of proved bacterial origin. It was described in Homer's Iliad.

Anthrax is rare disease caused by Bacillus anthracis,  a large Gram-positive, spore-bearing  bacillus which normally causes disease in animals. Image

Highly resistant spores are formed in soil & dead animals (not in diseased animal or man).      Image1  ;  .

Man is rarely, infected by spores, through abrasion of skin, by inhalation or by ingestion of infected meat. Symptoms start within 1-2 days of infection. Once in man, spore germinates to vegetative form & produce lethal toxins.      

Anthrax is an occupational disease of farmers, butchers and dealers of hides, animal hair , wool etc.

 Four forms of the disease:

1. Malignant pustule (Hide porters’ disease):

This is the most common form (95%). Bacteria enters through abrasions of skin. It is commonly seen in head & neck. Initial papule is surrounded by edema & hyperemia. Papule becomes vesicle & ruptures with central necrosis forming ragged, black ulcer, surrounded by minute vesicles & papules. Lesion is associated with intense itching & heals within 1-2 weeks. Regional lymph nodes may be enlarged indicating progressive lesion leading to septicemia and death.   Image1  ;  Image2

Microscopic features:  Epithelium is edematous with loss of continuity. Sub-epidermal, chronic & acute infiltrates involving adipose tissue & capillaries, with areas of necrosis. Gram stain shows large solid and beaded gram-positive rods, particularly beneath the epithelium. The bacilli are not really visible on the H&E stain.

2. Pneumonic type: Pulmonary anthrax causes extensive serofibrinous exudate in large areas of the lung and sometimes consolidation of an entire lobe. It causes hemorrhagic bronchopneumonia, necrosis of alveolar septa & thrombi in alveolar capillaries leading to septicemia & death.

3.Gastrointestinal type:  This is due to ingestion of contaminated meat . Ulceration of the stomach or bowel  and invasion of regional lymphatics are usual features. The hemorrhagic gastroenteritis of anthrax may cause obstruction or perforation but death is commonly caused by electrolyte imbalance and hemoconcentration produced by fulminant diarrhea and massive ascites.

4. Septicemic type:  Septicemia usually follows pulmonary anthrax than malignant pustule. In pulmonary antrax bacilli are phagocytosed by alveolar macrophages and transported to regional lymph nodes and then to the blood by way of the thoracic duct.  Disseminated intravascular coagulation complicates septicemia. Bacterial toxin causes fatal depression of the respiratory center.  Death is the usual consequence following profound systemic manifestations.

Morphologic changes in Anthrax infection:   It is characterized principally by a bloody mucinous edema that affects many tissues and is found in most serous cavities.  Meningitis may be a prominent feature.   Image

 Laboratory diagnosis:

1. Smears from pustules, sputum, CSF. ;     2. Blood culture            

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