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Anthrax The CDC has issued advisories for the handling of suspicious packages or letters.
Anthrax can infect the skin, GI system or lungs. Cutaneous anthrax is the most common naturally occurring form, with an estimated 2000 cases reported annually. In order for the organism to invade the skin, it must be rubbed into an abraded area or enter through an open area. The disease can be prevented by early treatment with appropriate antibiotics. Anthrax can also be swallowed or inhaled. In order to be inhaled it must be aerosolized into very small particles which is very difficult to do. One of the major problems with anthrax spores is the potentially long incubation period of subsequent infections. Exposure to an aerosol of anthrax spores could cause symptoms as soon as 2 days after exposure. Illness could also develop as late as 6-8 weeks after exposure. It has been estimated that for humans the lethal dose sufficient to kill 50% of persons exposed to it is 2500 to 55,000 inhaled anthrax spores. It is not spread from person to person. Signs and Symptoms of Anthrax Infection Inhalation anthrax: This is the most lethal form of anthrax. It begins with symptoms resembling a viral respiratory illness (sore throat, muscle aches, mild fever, and malaise) followed by development of dyspnea and hypoxia, leading to respiratory failure and shock. This is accompanied by mediastinal widening visual on xray. Meningitis often will develop. The fatality is extremely high, even with all possible supportive care including appropriate antibiotics. With antibiotic treatment the fatality rate is estimated to be at least 75%. It is believed that in each day of delay in initiating treatment after exposure, the fatality rate increases by 5 to 10%. Cutaneous anthrax: Cutaneous anthrax can cause a painless boil-like lesion that eventually makes an area with a blackened escharatic center. A small papule, advances to a vesicle (1-2 days) and then progresses an ulcer with a necrotic center. It can be accompanied by malaise, lymphadenopathy, fever and headache. This is the most common naturally occurring type of infection and usually occurs after skin contact with contaminated materials. Incubation period ranges from 1-12 days. The fatality rate for cutaneous anthrax is 20% with a substantial decrease in risk (1%) with antibiotic treatment. Gastrointestinal anthrax: Signs of gastrointestinal anthrax ingestion are severe abdominal distress (loss of appetite, nausea/vomiting and fever, progressing to abdominal pain, bloody diarrhea, and hematemesis). These are followed by fever and signs of septicemia. Lower bowel inflammation usually causes It usually follows the consumption of raw or undercooked contaminated meat. It can be accompanied by fever, lesions at the base of the tongue, sore throat, difficulty swallowing, and lymphadenopathy. Symptoms usually occur in one to seven days after exposure. The fatality rate is between 25-60%. The effect of early antibiotic treatment is not clearly established. According to JAMA, antibiotics used are Cipro (Adults 500mg q12hr, Children 20-30mg/kg in 2 divided doses not to exceed 1g/d), Penicillin and Doxycycline. Doxycycline is in the tetracycline family and should not be given to children less than 9yo, pregnant or breast feeding women. Antibiotics are to be given for 60 days due to the risk for recurrence that remains for at least 60 days because of the possibility of delayed germination of spores. Some characteristics which may help you identify a suspicious package are:
Some excellent articles on Anthrax are: http://www.hopkins-biodefense.org/pages/agents/agentanthrax.html http://www.mdch.state.mi.us/anthrax/Hospital.htm
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