Clinically, it appears as a papule that progresses to form a large vesicle. Similarly, cutaneous anthrax has an incubation period of 1 to 5 days. However, there are 1 to 2 cases annually of cutaneous anthrax. In the United States, GI anthrax has not been reported. Survival provides patients with some natural immunity. While others may develop fulminant upper and lower GI bleeding, septicemia, and death. In a minority of patients, they may be entirely asymptomatic. However, vegetative cells can migrate into the bloodstream from these superficial ulcerations where they can rapidly multiply creating septicemia and progression to severe symptoms. This differs from hematogenously disseminated inhalation anthrax where the ulcerations begin submucosally. Anthrax then adheres to the gastrointestinal epithelium where it germinates and creates superficial ulcerations visible on endoscopic examination. In GI anthrax, the spore is consumed, and symptoms emerge after 1 to 6 days of incubation. The 3 forms of the disease emerge based on the organism’s mode of entry into the host. ![]() There are 3 types of anthrax infections which include inhalational, GI, and cutaneous. This may all lead to poor identification of the causative organism and the ultimate failure to diagnose gastrointestinal anthrax. Mild and self-limiting symptoms may be under-reported. However, the low reported incidence of gastrointestinal anthrax may be secondary to the fact that it most commonly occurs in under-served areas with poor access to healthcare and diagnostic testing, and that symptoms can vary immensely in clinical presentation. It is reported that cases of anthrax infections are 95% cutaneous, 5% respiratory, and 1% gastrointestinal. Anthrax is rarely seen in developed countries due to animal and human vaccination programs. The organism is found within the environment with herbivores like sheep, cattle, and goats the most commonly infected after they consume spores in contaminated soil where they can survive for years. Human-to-human transmission has not been reported, and researchers do not believe it occurs. ![]() Occupations such as veterinarians, farmers, wool sorters are at higher risk. ![]() ![]() Exposure to livestock, infected meat, and infected soil increase risk for the development of the disease. Populations at risk for infection from anthrax are those who ingest under-cooked meat contaminated with spores, and those living in rural and agricultural areas. Eleven additional patients were diagnosed with cutaneous anthrax, all of whom survived. Eleven people who came in contact with the infected mail were later diagnosed with inhalational anthrax, and 5 died from their illnesses. In September 2001, a government employee of the US Army Research Institute for Infectious Disease intentionally distributed anthrax spores through the US Postal Service. Of those infected 66 died within 1 to 4 days following the onset of symptoms. In 1979, an accidental release of anthrax spores from a Soviet Union bioweapons facility in Sverdlovsk, Russia infected 77 people with diagnostic certainty. In recent history, anthrax has been used as an agent of biologic warfare in both the United States and abroad. Anthrax has many desired features that make it an optimal biologic weapon because it has the following features including high morbidity and mortality rates, low infective dose, lack of rapid available diagnostic tests, lack of universally available effective vaccine, potential to cause anxiety and fear, wide availability of pathogen, feasibility of production, environmental stability, and potential to be weaponized. Anthrax is a spore-forming rod that is readily found in soil in tropical environments.
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