Anthrax: Bacillus Anthracis

Outline I. Introduction II. Definitions and Symptoms A. Bacillus anthracis B. Zoonosis C. Transmission: spores 1. Three types of entry 2. Three main types of anthrax D. Classified as a biological weapon 1. Biosafety level three 2. Anthrax not contagious between humans E. Cutaneous anthrax Symptoms F. Inhalation anthrax. G. Gastrointestinal anthrax. II. Origins of the Disease A. Ancient Mesopotamia B. Mention in The Iliad III. Ancient Manifestations, Views, and Causes IV. Ancient Treatments of Disease Symptoms A. Figs B. Anthrax control 1. Burning in Ancient Athens 2. Burning in 1600s 3. Burning Laws in Late 1600s V. Social Effects on Victims and Socioeconomic Impact on Society A. 2001 U.S. Postal Service anthrax incident B. Projected economic impact of a bioterrorist attack VI. Epidemic Outbreaks A. 1500 B.C. -- Fifth Egyptian plague B. 1600s -- "Black Bane" C. 1770 -- Haiti D. 1978-80 Human anthrax epidemic in Zimbabwe VII. Modern Causes of the Disease VIII. Current Treatments A. Historical Development of Modern Treatment Methods 1. 1877 Robert Koch 2. 1881 Louis Pasteur 3. 1937 Max Sterne 4. 1944 First use of penicillin to treat anthrax 5. 1979 Modern vaccine developed B. Treatment of Today
IX. Anthrax as a Biomedical Weapon A. Modern threat B. 1916-1918 Mesopotamia and Russia. C. 1942 Anthrax Island D. 1979 Russian Town of Sverdlovsk E. 2001 Anthrax Letters
Introduction
Bacillus anthracis a deadly disease that kills man and beast. This paper will explore the disease from its ancient origins, ancient treatments, social effects, modern outbreaks, modern causes of the disease, and current treatments.
Definitions and Symptoms Anthrax’s scientific name or genesis and species is Bacillus anthracis. This is a serious infectious disease caused by a non-motile gram-positive, rod-shaped bacteria (Centers for Disease Control and Prevention, 2014). It is considered a zoonosis, which means that it can be transmitted from animals to humans. Transmission from animals to humans is caused by spores, which have three types of entry: inhalation, ingestion and sublingual. These correspond to the three main types of anthrax: inhalation, gastrointestinal, and cutaneous. Anthrax has also been classified as a biological weapon by the Department of Defense, Department of Health and Humans Services, and Centers for Disease Control. It is a biosafety level three, due to the fact that it causes death in humans. Infection is rare in humans and usually happens only by handling infected animal skins or by eating infected undercooked meat. Anthrax is not contagious in humans--it cannot be spread human to human.
According to the Ohio Department of Health,
“Cutaneous anthrax is the most common form. The mortality rate is 5% -20% in untreated patients. Inhalation anthrax can present as respiratory distress with fever and shock. The mortality rate in inhalation anthrax is 80%-100%. Intestinal anthrax rarely occurs, but when it does, it usually manifests as explosive outbreaks of violent gastroenteritis with vomiting and bloody stools. The mortality rate is 25%- 75%”
(Ohio State University, n.d.).
Symptoms
Symptoms of Anthrax vary according to the type of anthrax that is acquired. According to the Centers for Disease Control, symptoms may include:
Cutaneous anthrax. A group of small blisters or bumps that may itch. A painless skin sore (ulcer) with a black center appears after the small blisters or bumps. Most often the sore will be on the face, neck, arms, or hands. Swelling can occur around the sore. (See Attachment 1)
Inhalation anthrax. Symptoms can include fever and chills, chest discomfort, shortness of breath, confusion or dizziness, cough, nausea, vomiting or stomach pain, headache, sweats (often drenching), extreme tiredness, and body aches. (See Attachment 1)
Gastrointestinal anthrax. Symptoms include fever and chills, swelling of neck or neck glands, sore throat, painful swallowing, hoarseness, nausea and vomiting, especially bloody vomiting, diarrhea or bloody diarrhea, headache, flushing (red face) and red eyes, stomach pain, fainting, and swelling of abdomen (Centers for Disease Control and Prevention, 2014, Jan.17).
Ancient Origins of the Disease
1250 B.C.
According to Turnbull as well as others, the first probable mention of anthrax in ancient literature comes from ancient Mesopotamia, especially the Old Testament scripture which tells about the fifth plague in Egypt (Turnbull, 1998).
1230 B.C.
Many believe that anthrax was described by Homer in his epic poem The Iliad. Homer’s Iliad begins with Apollo’s “burning wind of plague” in response to Achilles’ prayer. “Pack animals were his target first, and dogs / but soldiers, too, soon felt transfixing pain from his hard shots, / and pyres burned night and day” (The Iliad of Homer, Book I, quoted by Knights, n.d.).
Ancient Views of Causes
The ancient Hebrews believed that God caused the disease. Exodus 9:8-10 states,
“Then the Lord said to Moses and Aaron, ‘Take handfuls of soot from the kiln, and let Moses throw it in the air in the sight of Pharaoh. 9It shall become fine dust all over the land of Egypt, and shall cause festering boils on humans and animals throughout the whole land of Egypt.’ 10 So they took soot from the kiln, and stood before Pharaoh, and Moses threw it in the air, and it caused festering boils on humans” (Holy Bible, NRSV).
In The Iliad, Homer likewise attributes Achilles’ prayer to the sun god, Apollo. “What god was it then set them together in bitter collision? / Zeus' son and Leto's, Apollo, who in anger at the king drove / the soul pestilence along the host, and the people perished--” (The Iliad of Homer, Book I, lines 1.7-1.10).
Ancient Treatments of the Disease’s Symptoms
Little is known about ancient treatment methods for anthrax, most likely because little or no treatment existed.
Possible biblical mention of treatment
However, Ann Pharmacother, writing in The Annals of Pharmacotherapy, states that “Figs may very well have been the first treatment for anthrax. Biblical passages reveal that figs gave healing properties, "Take a cluster of figs. And they took and laid it on the boil [anthrax], and he recovered." According to Pharmacother, these passages “convincingly indicate that figs have healing properties in cutaneous anthrax lesions” (Pharmacother, 2003).
Preventive Measures
With no real treatment known, ancient approaches to anthrax control centered around prevention rather than cure. Since biblical times, open-air burning of carcasses has been practiced. Ancient Athenians completely burned human plague victims in open-air pyres to incinerate human plague victims, and by the 1600s, European nation-states were making the burning of infected carcasses a matter of official policy. By the late Seventeenth Century, it had become a capital crime in Holland and Prussia to neglect to either burn or bury infected carcasses (Kastner & Phebus, 2004).
Social Effects on Victims and Socioeconomic Impact on Society
Socioeconomic Impact of Anthrax Attack on America
According to Dori Reissman, writing on webM.D., there have been reports of lasting physiological and psychological effects from the 2001 U.S. Postal Service anthrax incident. These physiological effects also have an economic impact; many of the victims of the bioterrorism exposure are still not capable of returning back to work. The article states that “Researchers found that more than half of the victims had not returned to work more than a year after the attacks, all were under psychiatric care, and most reported symptoms ranging from chronic cough, fatigue, and memory problems to depression, anxiety, and hostility.” Many of these symptoms could also be related from the trauma or stress from the event. Reissman also noted that the physiological symptoms victims suffer from include “chronic cough, fatigue, joint swelling, pain, and memory problems” (Reissman, n.d.).
Even a small outbreak can be costly in terms of dollar amounts. The small-scale 2001 anthrax attack in the United States resulted in a cost of over $200 million to decontaminate anthrax-infected facilities. This raises the question of the economic ramifications of a large-scale bioterrorist attack. A study by the CDC estimates that “the economic impact of a bioterrorist attack could range from an estimated $477.7 million per 100,000 persons exposed (brucellosis scenario) to $26.2 billion per 100,000 persons exposed (anthrax scenario)” (Buzby & Detwiler, 2002).
Impact of Anthrax in Animals
Anthrax is a severe problem in many parts of the developing world, particularly in southern and eastern India, where many humans still acquire it because the disease is so poorly controlled in wildlife there. There is a natural risk to humans and animals due to the constant presence of anthrax in the environment, usually located in the soil. Animals are usually not affected unless contaminated soil is disturbed and spores are released into ground or air. Then animals can become infected from the spores. Humans are affected in the same way animals are. However, they are also at risk for eating infected or diseased animals (World Health Organization, n.d.). According to the Athena Project, the prevalence or risk of infections in humans “is about 1/100,000 and only possible when humans have been brought into contact with the flesh, bones, hides, hair, and excrement of diseased animals. In the United States, cases of naturally occurring anthrax are generally restricted to areas of Arkansas, Texas, Nebraska, South Dakota, Mississippi, and California. Anthrax can also be found globally. It is more common in developing countries or countries without veterinary public health programs and can be found in certain regions South and, Southern and Eastern Europe, Asia, Central America Africa, the Caribbean, and the Middle East” (Athena Project, n.d.).
Epidemic Outbreaks
Epidemic outbreaks of anthrax have occurred throughout history. Here are some of the most notable.
1500 B.C. -- Fifth Egyptian plague
As previously mentioned, the fifth Egyptian plague, recorded in the Bible, is thought by many to be the earliest recorded anthrax epidemic.
1600s -- "Black Bane"
Black Bane, thought to be anthrax, ripped through Europe in the early 1600s, killing 60,000 cattle (EMPRES, n.d.).
1770 -- Haiti
A devastating earthquake hit Haiti in 1770, and in the confusion that followed, thousands of slaves made a break for freedom, leaving no one to transport food to the island’s inhabitants. At the same time, a terrible epizootic of anthrax attacked the livestock. Starving islanders ate the infected corpses, and approximately 15,000 died. An additional 15,000 eventually died of starvation. The cause of the epizootic is still not understood (Morens, 2002).
1978-80 Human anthrax epidemic strikes Zimbabwe In one of the largest historically recorded anthrax outbreaks, 10,738 human cases of anthrax were registered in Zimbabwe between January of 1979 and December of 1980. Of these, 182 proved fatal. By way of comparison, the normal human incidence of the disease worldwide is 7,000 cases. The epidemic was accompanied by an epizootic and a dreadful guerilla war. The cause of the epidemic is still unclear (Nass, n.d.).
Causes of Anthrax Today
The main cause of anthrax today is human contact with infected animals. In the following diagram from the National World Health organization, you can see the predominant route of animal infection. This chart illustrates the different possibilities of infection, such as contaminated imports, tanneries, and research laboratories. This diagram (see additional attachments) shows all types of routes of entry and the three types of infection anthrax: cutaneous, inhalation, and gastrointestinal. The diagram does not, however, cover transmission of the disease from continent to continent. In humans, the predominant cause of anthrax is contact with infected animals.
Current Treatments
Today’s treatments have followed a long path of development, beginning in 1877 with Robert Koch. Here are the highlights of that development.
Historical Development of Modern Treatment Methods
1877 Robert Koch. The father of modern microbiology studied anthrax in his lab; he discovered the bacterial spores and eventually used anthrax to lay the foundation for Koch Postulates.
1881 Louis Pasteur. Pasteur used Koch Postulates, discovered the epidemiology of anthrax, and developed the first vaccine.
1937 Max Sterne. Sterne created the first successful animal vaccine, which is attributed to decreasing the spread across to humans. (Alper, 1994)
1944 First use of penicillin to treat anthrax. “Penicillin had been discovered in 1928, but it wasn’t until 1944 when it was first used to treat anthrax. Penicillin became the drug of choice for treating anthrax, and it replaced all previous therapies, such as serum therapies and chemotherapies.” (Centers for Disease Control, n.d.)
1950 The first-ever mass-produced anthrax vaccine for humans. This was tested and produced in the United States. It proved to be 92.5% effective in preventing the outbreak of the disease. (Centers for Disease Control, n.d.)
1979 Modern vaccine developed. Our modern vaccine was developed and is now in use. This replaces the previous vaccine that was mass-produced in 1950.The new vaccine is now the prime preventive treatment against anthrax. However, it is still unavailable to US civilians.

Treatment of Today
Just as it was in 1877 with Robert Koch, the preferred method of treatment and golden standard of care is good old-fashioned antibiotics. The antibiotic of choice, according to new research by the CDC, is “intravenous ciprofloxacin. This is based on its preferred efficacy in NHP infection models and recent use for anthrax cases. Levofloxacin and moxifloxacin are considered equivalent alternatives to ciprofloxacin.” (Centers for Disease Control and Prevention, n.d.)
Anthrax as a Biological Weapon
Anthrax has for centuries been used as a weapon, and today the danger posed by such weaponry is greater than ever before. A 1993 analysis by the Office of Technology Assessment of the U.S. Congress estimated that “130,000 to 3 million deaths could occur following the release of 100 kilograms of aerosolized B. anthracis over Washington, DC, making such an attack as lethal as a hydrogen bomb. (See The History of Bioterrorism: Anthrax, a short video from the Centers for Disease Control and Prevention [CDC])
Historical Anthrax Bioweaponry Attacks Here are some of the most prominent bio-weaponry attacks recorded.
1916-1918 Mesopotamia and Russia. British intelligence from 1916 through 1918 shows that the Germans infected nearly 5,000 mules and horses being used in Mesopotamia and that in August 1916 agents sent anthrax to Romania, the aim being to infect sheep that were on their way to Russia (Abarelli, 2001).
1942 Anthrax Island. During WWII British Government microbiologists decided to test anthrax as a biomedical weapon by testing its effectiveness on sheep. They bombed with anthrax an island located off the coast of Scotland. All sheep died, and scientists decided that using anthrax as a weapon against the Germans in WWII would not only be devastating to Germany, but they would not be able to control the spread of the disease to just Nazi troops. The little island laid dormant for 50 years until the government could decontaminate the island. (BBC News, 2001)
1944 Japanese use of anthrax for bio-weaponry. Japan fed POWs food containing anthrax and later launched 250 balloons thought to contain anthrax over the US. Apparently, the contents of the balloons did not release. (World Health Organization, n.d.)
1979 Russian Town of Sverdlovsk. The Russian town of Sverdlovsk was experiencing what seemed to be a terrible outbreak of influenza in 1979. When villagers began to die, the Soviet Government tried to cover up the epidemic, claiming all the deaths were caused by tainted meat, and began to vaccinate thousands of people with no explanation. In 1992 researcher Jeanne Guillemin uncovered the fact that this had been an epidemic outbreak of anthrax and concluded that deadly spores from the Soviet Army's’ biological research facility had been carried into the village by high winds. According to Guillemin, “[The Soviets] had perfected methods of keeping the miniscule spores separated so they would not clump and could be widely disseminated in by biological warfare weaponry. It is now known that tons of anthrax spores were at one time in secure storage.” (Guillemin, 2005)
2001 Attack against Americans. In 2001, shortly after the attacks on 9-11, there was a bioterrorism attack against the US. Using the U.S. postal system in October of 2001, an army bioweapons scientist mailed several letters containing anthrax spores to various news and media outlets. The scientist, acting alone, was responsible for killing five individuals and injuring seventeen people. According to the Justice Department, from October 4 to November 20, 2001, 22 cases of anthrax (11 inhalation, 11 cutaneous) were identified; five of the inhalation cases were fatal. Twenty (91%) case-patients were either mail handlers or were exposed to worksites where contaminated mail was processed. (Michels, 2008)
Conclusion
Anthrax has wreaked endless havoc throughout recorded history, and continues to do so today. With increased medical knowledge has come improved medical treatment, and in much of today’s world anthrax is no longer the problem it once was. The threat of anthrax bio-weaponry remains, however.

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Attachment 1:
Cutaneous anthrax

Inhalation anthrax

Attachment 2
Routes of Infection and Transmission Diagram