AN ANCIENT DISEASE IN A DIFFERENT AVATAR..

Introduction
A "Gram positive" bacterium means it has the type of
cell walls which are harmless, unlike the cell walls of "Gram
negative" bacteia, which attack tissue. Therefore, anthrax can
only attack tissue by producing a special toxin that it excretes.
A few cells or spores do not produce enough toxin to start an
infection. Studies have apparently determined that, typically,
ten thousand anthrax spores must be inhaled to start an Dr kedar karki.
infection. Anthrax normally attacks the lungs, because (M.V.St. Preventive Medicine)
it must lodge in vulnerable tissue.

Transmission

Naturally occurring anthrax is a disease acquired following contact with

anthrax-infected animals or anthrax-contaminated animal products. Infection
gains entrance in the body by ingestion, inhalation or through the skin. The
disease most commonly occurs in herbivores, which are infected by ingesting
spores from the soil. Biting flies and other insects have often been found to
harbour anthrax organisms but the transmission is mechanical only.

Anthrax in Humans
Anthrax infection can occur in three forms: cutaneous (skin), inhalation
and gastrointestinal. The clinical picture varies depending on how the disease
was contracted, but symptoms usually occur within seven days.

CUTANEOUS ANTHEAX: The bacterium enters a cut or abrasion on

the skin, the infection begins as a papule resembling an insect bite but within 1-
2 days develops into a vesicle and then a painless ulcer, usually 1-3 cm in
diameter, with a characteristic blank necrotic area in the centre. Lymph glands
in the adjacent area may swell. Deaths are rare with appropriate antimicrobial
therapy.

INHALATION ANTHRAX: After initial respiratory trouble, the

symptoms may progress to severe breathing problems and shock. Inhalation
anthrax usually results in death in 1-2 days after onset of the acute symptoms.
On entry of the spores, macrophages try to engulf many of them. Surviving
spores are transported via lymphatica to mediastinal lymph nodes, where
germination may occur up to 60 days later. The process responsible for the
delayed transformation of spores to vegetative cells is poorly understood but
well documented. The toxins are released by the colonizing bacteria leading to
haemorrhage, oedema, and necrosis.
Production of the anthrax toxin is mediated by a temperature-sensitive
plasmid. The toxin consists of three distinct antigenic components. They are-the
oedema factor, which is necessary for the oedema producing activity of the
toxin: Factor-II is the protective antigen (PA), because it induces protective
antitoxic antibodies in guinea pigs: Factor-III is known as the lethal factor
because it is essential for the lethal effects of the anthrax toxin. Once toxin
production has reached critical threshold, death occurs even if sterility of the
bloodstream is achieved with antibiotics. Based on primate data, it has been
estimated that for humans the LD 50 (lethal dose sufficient to kill 50% of
persons exposed to it) is 2500 to 55,000 inhaled anthrax spores.

GASTROINTESTINAL ANTHRAX: This is analogous to cutaneous

anthrax but occurs on the intestinal mucosa. As in cutaneous anthrax, the
organisms probably invade the mucosa through a pre-existing lesion. The
bacteria spread from the mucosal lesion to the lymphatic system. Intestinal
anthrax results from the ingestion of poorly cooked meat from infected animals.
Intestinal anthrax, although extremely rare in developed countries, has an
extremely high mortality rate.

Meningitis due to B. anthracis is a very rare complication that may result

from a primary infection elsewhere.

EPIDEMIOLOGY

Anthrax is worldwide in distribution although the incidence varies with

the soil, climate and the efforts put forward to suppress it. The characteristic
epidemiology of anthrax in developed countries shows the simultaneous
occurrence of multicentric foci of infection. In many areas where the disease
has not been recorded in last few years or eve for a few decades, many sudden
deaths occur without observed illness under favourable climatic conditions. In
tropical and subtropical countries with high annual rainfall the infection persists
in the soil and frequent anthrax outbreaks are commonly encountered.

In some African countries the disease occurs every summer and reaches
its peak severity in years with heavy rainfall. Wild fauna, including hippos,
elephants etc. die in large numbers. It is probable that the predators act as inert
carriers of the infection.

Large anthrax epizootics in herbivores have been reported: during a 1945

outbreak in Iran, one million sheep died. Animal vaccination programs have
reduced drastically the animal mortality from the disease. However, anthrax
spores continue to be documented in soil samples from throughout the world.

Anthrax is most common in agricultural regions where it occurs in

animals. These include South and Central America, Southern and Eastern
Europe, Asia, Africa, the Caribbean, and the Middle East. When anthrax affects
humans, it is usually due to an occupational exposure to infected animals or
their products. Workers who are exposed to dead animals and animal products
(industrial anthrax) from other countries where anthrax is more common may
become infected with B. anthracis. Anthrax in animal infection are received
from Texas, Louisiana, Mississippi, Oklahoma and South Dakota.

ANTHRAX AS A BIOLOGICAL WEAPON

The recent publicity surrounding the cases of anthrax in the USA has
caused alarm among the general public about the potential terrorist use of
biological warfare. Some other pathogens, identified in Western defense circles
among the top 10 biological agents, are highly infectious. These, such as
smallpox and plague, are highly dangerous if used as weapons since, once
released, they risk potentially becoming a global problem and can find their
way back into the perpetrators' camp.

Anthrax is a preferred biological warfare agent because it is highly lethal.

One hundred million lethal doses could be prepared per gram of anthrax
material (100,000 times deadlier than the deadliest chemical warfare agent).
Inhalational anthrax is virtually always fatal with heavy inhalation and late
diagnosis. There are low barriers to production low cost of producing the
anthrax material and simpler technology. The knowledge is widely available
and it is easy to produce in large quantities. It is easy to weaponize. It is
extremely stable and can be stored almost indefinitely as a dry powder. It can be
loaded, in a freeze-dried condition, in munitions or disseminated as an aerosol
with crude sprayers.

However, others opine that anthrax will never be used successfully as a

terrorist weapon, and probably never as a military weapon. It has to be
converted to spores suspended in the air, which is technically very difficult; and
the lethality is nowhere near the terror that it is made out to be. It is not 100%
lethal as often claimed. Wool-sorters inhale anthrax spores in small quantities
continually (150-700 per hour), and only if they get a large dose, dose an
infection begin. Studies have apparently determined that, typically, ten thousand
anthrax spores must be inhaled to start an infection. Hence, sending anthrax
spores in powder form by post appears to be a weapon for spreading fear rather
than killing the population.

Anthrax figured in every known bio-arsenal of the last century, including

those of Britain, the USA, Japan, the Soviet Union and Iraq. However, no one
ever used them in battle, although Japan did conduct tests on humans. Britain
infected a Scottish inland, Gruinard, while testing anthrax weapons, and only
succeeded in cleaning it up with massive formalin treatments decades later. No
successful terrorist use of anthrax is known, unless that was the intent in the
USA - in which case, it was the first to work.

The Aum Shinrikyo cult in Japan tried spraying anthrax, but used only a
harmless, vaccine strain, either by mistake, or for a trial run. Foul play has long
been suspected, but never proved, in an economically devastating outbreak of
anthrax in Zimbabwe in 1979 which helped tip the political balance. The Soviet
Union had anthrax missiles shells and cluster bombs, antibiotic and vaccine
resistant strains, highly infectious strains, and recipes for reliable aerosols. The
largest release of anthrax spores was an accidental one. In Sverdlovsk, Russia in
April 1979, 68 people died after a small amount of anthrax powder was released
through the ventilation system of a nearby secret military base. Like every other
known bioweapons state in the world, Russia is supposed to have destroyed its
stocks.

Although a vaccine for anthrax exists, it is used almost exclusively on

American military personnel. People who work with the bacteria in laboratories,
people who handle furs, hides, and other products from overseas are also
vaccinated.