Anthrax (Splenic fever, Siberian ulcer, Charbon, Milzbrand)

Anthrax is a zoonotic disease caused by the spore forming bacterium Bacillus anthracis.
Anthrax is most common in wild and domestic herbivores (eg, cattle, sheep, goats, camels,
antelopes) but can also be seen in humans exposed to tissue from infected animals,
contaminated animal products or directly to B. anthracis spores under certain conditions.
Depending on the route of infection, host factors, and potentially strain-specific factors, anthrax
can have several different clinical presentations. In herbivores, anthrax commonly presents as
an acute septicemia with a high fatality rate, often accompanied by hemorrhagic lymphadenitis.
In dogs, humans, horses, and pigs, it is usually less acute.

B. anthracis spores can remain infective in soil for many years. During this time, they are a
potential source of infection for grazing livestock. Grazing animals may become infected when
they ingest sufficient quantities of these spores from the soil. In addition to direct transmission,
biting flies may mechanically transmit B. anthracis spores from one animal to another. The
relative importance of this mode of transmission during epizootics or epidemics has yet to be
quantified but is frequently suspected. Feed contaminated with bone or other meal from infected
animals can serve as a source of infection for livestock, as can hay that is heavily contaminated
with infected soil. Raw or poorly cooked contaminated meat is a source of infection for
carnivores and omnivores; anthrax resulting from contaminated meat consumption has been
reported in pigs, dogs, cats, mink, wild carnivores, and humans.

Epidemiology

Under diagnosis and unreliable reporting make it difficult to estimate the true incidence of
anthrax worldwide. However, 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 among susceptible domestic and wild animals. These
epizootics are usually associated with drought, flooding, or soil disturbance, and many years
may pass between outbreaks. During interepidemic periods, sporadic cases may help maintain
soil contamination.

Human cases may follow contact with contaminated animals or animal products. The risk of
human disease in these settings is comparatively small in developed countries, partly because
they are less likely to be exposed to virulent spores. However, in developing countries each
affected cow can result in up to 10 human cases because of home slaughter and sanitation
issues. In cases of natural transmission, humans exhibit primarily cutaneous disease (>95% of
all cases). GI anthrax (including pharyngeal anthrax) may be seen among human populations
following consumption of contaminated raw or undercooked meat. Under certain artificial
conditions (eg, laboratories, animal hair processing facilities, exposure to weaponized spore
products), humans may develop a highly fatal form of disease known as inhalational anthrax or
woolsorter's disease. Inhalational anthrax is an acute hemorrhagic lymphadenitis of the
mediastinal lymph nodes, often accompanied by hemorrhagic pleural effusions, severe
septicemia, meningitis, and a high mortality rate.

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Pathogenesis

After wound inoculation, ingestion, or inhalation, spores infect macrophages, germinate, and
proliferate. In cutaneous and GI infection, proliferation can occur at the site of infection and the
lymph nodes draining the site of infection. Lethal toxin and edema toxin are produced by B.
anthracis and respectively cause local necrosis and extensive edema, which is a frequent
characteristic of the disease. As the bacteria multiply in the lymph nodes, toxemia progresses
and bacteremia may ensue. With the increase in toxin production, the potential for disseminated
tissue destruction and organ failure increases. After vegetative bacilli are discharged from an
animal following death (by carcass bloating, scavengers, or postmortem examination), the
oxygen content of air induces sporulation. Spores are relatively resistant to extremes of
temperature, chemical disinfection, and dessication. Necropsy is discouraged because of the
potential for vegetative cells to be exposed to air, resulting in large numbers of spores being
produced. Because of the rapid pH change following death and decomposition, vegetative cells
in an unopened carcass quickly die without sporulating.

Clinical Findings

Typically, the incubation period is 3–7 days (range 1−14 days). The clinical course ranges from
peracute to chronic. The peracute form (common in cattle and sheep) is characterized by sudden
onset and a rapidly fatal course. Staggering, dyspnea, trembling, collapse, a few convulsive
movements, and death may occur in cattle, sheep, or goats with only a brief evidence of illness.

In acute anthrax of cattle and sheep, there is an abrupt fever and a period of excitement followed
by depression, stupor, respiratory or cardiac distress, staggering, convulsions, and death. Often,
the course of disease is so rapid that illness is not observed and animals are found dead. The
body temperature may reach 107°F (41.5°C), rumination ceases, milk production is materially
reduced, and pregnant animals may abort. There may be bloody discharges from the natural
body openings. Some infections are characterized by localized, subcutaneous, edematous
swelling that can be quite extensive. Areas most frequently involved are the ventral neck,
thorax, and shoulders.

The disease in horses may be acute. Signs may include fever, chills, severe colic, anorexia,
depression, weakness, bloody diarrhea, and swellings of the neck, sternum, lower abdomen, and
external genitalia. Death usually occurs within 2–3 days of onset.

Although relatively resistant, pigs may develop an acute septicemia following ingestion of B.
anthracis, characterized by sudden death, oropharyngitis, or more usually a mild chronic form.
Oropharyngeal anthrax is characterized by rapidly progressive swelling of the throat, which
may cause death by suffocation. In the chronic form, pigs show systemic signs of illness and
gradually recover with treatment. Some later show evidence of anthrax infection in the cervical
lymph nodes and tonsils when slaughtered (as apparently healthy animals). Intestinal
involvement is seldom recognized and has nonspecific clinical characteristics of anorexia,
vomiting, diarrhea (sometimes bloody), or constipation.

In dogs, cats, and wild carnivores, the disease resembles that seen in pigs. In wild herbivorous
animals, the expected course of illness and lesions varies by species but resembles, for the most
part, anthrax in cattle.
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Lesions

Rigor mortis is frequently absent or incomplete. Dark blood may ooze from the mouth, nostrils,
and anus with marked bloating and rapid body decomposition. If the carcass is inadvertently
opened, septicemic lesions are seen. The blood is dark and thickened and fails to clot readily.
Hemorrhages of various sizes are common on the serosal surfaces of the abdomen and thorax as
well as on the epicardium and endocardium. Edematous, red-tinged effusions commonly are
present under the serosa of various organs, between skeletal muscle groups, and in the subcutis.
Hemorrhages frequently occur along the GI tract mucosa, and ulcers, particularly over Peyer's
patches, may be present. An enlarged, dark red or black, soft, semifluid spleen is common. The
liver, kidneys, and lymph nodes usually are congested and enlarged. Meningitis may be found if
the skull is opened.

In pigs with chronic anthrax, the lesions usually are restricted to the tonsils, cervical lymph
nodes, and surrounding tissues. The lymphatic tissues of the area are enlarged and are a mottled
salmon to brick-red color on cut surface. Diphtheritic membranes or ulcers may be present over
the surface of the tonsils. The area around involved lymphatic tissues generally is gelatinous
and edematous. A chronic intestinal form involving the mesenteric lymph nodes is also
recognized.

Diagnosis

A diagnosis based on clinical signs alone is difficult. Confirmatory laboratory examination

should be attempted if anthrax is suspected. Because the vegetative cell is not robust and will
not survive 3 days in transit, the optimal sample is a cotton swab dipped in the blood and
allowed to dry. This results in sporulation and the death of other bacteria and contaminants. Pigs
with localized disease are rarely bacteremic, so a small piece of affected lymphatic tissue that
has been collected aseptically should be submitted. Before submission, the receiving reference
laboratory should be contacted regarding appropriate specimen labelling, handling, and shipping
procedures.

Specific diagnostic tests include bacterial culture, PCR tests, and fluorescent antibody stains to
demonstrate the agent in blood films or tissues. Western blot and ELISA tests for antibody
detection are available in some reference laboratories. Lacking other tests, fixed blood smears
stained with Loeffler's or MacFadean stains can be used and the capsule visualized; however,
this can result in some 20% false positives.

Differential diagnosis

In livestock, anthrax must be differentiated from other conditions that cause sudden death. In
cattle and sheep, clostridial infections, bloat, and lightning strike (or any cause of sudden death)
may be confused with anthrax. Also, acute leptospirosis, bacillary hemoglobinuria,
anaplasmosis, and acute poisonings by bracken fern, sweet clover, and lead must be considered
in cattle. In horses, acute infectious anemia, purpura, colic, lead poisoning, lightning strike, and
sunstroke may resemble anthrax. In pigs, acute classical swine fever, African swine fever, and
pharyngeal malignant edema are diagnostic considerations. In dogs, acute systemic infections
and pharyngeal swellings due to other causes must be considered.

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Treatment
Severely ill animals are unlikely to recover but in the early stages, particularly when fever is
detected before other signs are evident, recovery can be anticipated if the correct treatment is
provided. Penicillin (20 000 IU/kg BW twice daily) has had considerable value, but
streptomycin (8-10g/d in two doses intramuscularly for cattle) is much more effective.
Oxytetracycline (5 mg/kg BW per day) parenterally has also proved superior to penicillin in the
treatment of clinical cases after vaccination in cattle and sheep. Antiserum, if available, should
also be administered for at least 5 days in doses of 100-250 mL daily but it is expensive.

It is desirable to prolong treatment to at least 5 days to avoid a recrudescence of the disease.

Other antibacterials, including amoxicillin, chloramphenicol, ciprofloxacin, doxycycline,
erythromycin, gentamicin, streptomycin, and sulfonamides also can be used, but their
effectiveness in comparison with penicillin and the tetracyclines has not been evaluated under
field conditions

Control
When an outbreak occurs, place the farm in quarantine, destruct discharges and cadavers, and
vaccinate survivors, to control the disease and indirectly reduce human exposure. Prohibition of
movement of milk and meat from the farm during the quarantine period should prevent entry of
the infection into the human food chain.

Infected carcasses should not be opened but immediately burned in situ or buried, together with
bedding and soil contaminated by discharges. If this cannot be done immediately, a liberal
application of 5% formaldehyde on the carcass and its immediate surroundings will discourage
scavengers. Burning is the preferred method of disposal.

Burial should be at least 2 m deep with an ample supply of quicklime added.

Prevention
Prophylactic administration of a single dose of long acting tetracycline or penicillin is a much
commoner tactic.

Immunization
– In livestock, anthrax can be controlled largely by annual vaccination of all grazing animals
in the endemic area and by implementation of control measures during epizootics.
– The nonencapsulated Sterne-strain vaccine is used almost universally for livestock
immunization.
– Vaccination should be done 2–4 wk before the season when outbreaks may be expected.
– Because this is a live vaccine, antibiotics should not be administered within 1 wk of
vaccination