Practice Updates for Doctors: Anthrax
This article provides a brief
overview of anthrax, its recent spread in northern Bangladesh, and key
considerations for clinicians based on current information.
Introduction
Anthrax is an acute, zoonotic bacterial disease caused by the
spore-forming bacterium Bacillus anthracis. It primarily affects
herbivores like cattle, sheep, and goats, and can be transmitted to humans. The
spores of B. anthracis can persist in soil for years to decades. Animals
typically become infected by ingesting these spores while grazing.
Human infection usually occurs in
three forms: cutaneous (skin), gastrointestinal (ingestion), and inhalation
(lungs). Cutaneous anthrax accounts for over 95% of naturally occurring human
cases.
Recently, cases have been
detected in the Rangpur (Pirgacha, Kaunia, Mithapukur) and Gaibandha
(Sundarganj) districts of northern Bangladesh.
Outbreaks occur mostly during monsoon (April–September) following heavy rains, which activate spores in low-lying, alkaline soils.
Risk Factors
- Direct exposure to sick/infected animals or
their by-products (e.g., during slaughtering).
- Prior cut injuries, abrasions, or fissures on
exposed body parts, which serve as entry points for the bacteria,
significantly increasing the risk of cutaneous anthrax.
- Slaughtering and processing meat from sick or
dead livestock.
- Ingestion of raw or undercooked meat salvaged
from infected animals (risk for gastrointestinal anthrax).
- Inhalation of aerosolized spores during the processing of contaminated hides, bones, hair, or wool (risk for inhalation anthrax, which is rare naturally).
Clinical Features
Cutaneous anthrax with black eschar
Cutaneous anthrax
Cutaneous anthrax with black eschar and edema
- Cutaneous anthrax: Painless papule → vesicle →
black eschar; local edema, fever, lymphadenopathy
- Gastrointestinal anthrax: Severe abdominal
pain, vomiting, bloody diarrhea, oropharyngeal ulcer
- Inhalational anthrax: Fever, dyspnea, chest
pain, rapid progression to respiratory failure
- Injectional anthrax (rare): Severe soft tissue
infection at injection site
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- Avoid slaughtering or consuming meat of sick
livestock
- Ensure livestock vaccination in endemic areas
- Use gloves and protective gear when handling
carcasses
- Handwashing with soap after contact with animals or
animal products
- Deep burial or burning of dead animals
- Cutaneous anthrax:
Ciprofloxacin
500 mg orally every 12 hours for 7–10 days
or Doxycycline 100 mg orally every 12 hours for 7–10 days
- Severe/systemic disease (IV therapy):
Ciprofloxacin
400 mg IV every 12 hours + Clindamycin 900 mg IV every 8 hours
or Doxycycline
100 mg IV every 12 hours + supportive therapy
- Post-exposure prophylaxis:
Ciprofloxacin
500 mg orally every 12 hours for 60 days
(Anthrax vaccine
not available in Bangladesh)
Cutaneous anthrax responds well
to early antibiotic therapy. Gastrointestinal and inhalational forms carry high
mortality if untreated. Rapid recognition and treatment significantly improve
outcomes.
Key Prescribing Points
Endemic in
northern Bangladesh; outbreaks follow monsoon
Infection not
transmitted person-to-person
Hand hygiene, safe
slaughtering practices and livestock vaccination are crucial for prevention
Anthrax is fatal if untreated;
start antibiotics immediately upon high clinical suspicion
Early
antibiotic therapy prevents complications and mortality
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