Anthrax

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Abstract
Anthrax is an often fatal bacterial infection that occurs when Bacillus anthracis endospores enter the body through abrasions in the skin or by inhalation or ingestion.1 It is a zoonosis to which most mammals, especially grazing herbivores, are considered susceptible. Human infections result from contact with contaminated animals or animal products, and there are no known cases of human-to-human transmission. Human anthrax is not common, and only one of us has seen a case. Cutaneous anthrax, the most common form, is usually curable. A small percentage of cutaneous infections become systemic, and these can be fatal. Systemic infection resulting from inhalation of the organism has a mortality rate approaching 100 percent, with death usually occurring within a few days after the onset of symptoms.2 The rate of mortality among persons with infection resulting from ingestion is variable, depending on the outbreak, but it may also approach 100 percent. Whatever the portal of entry, systemic anthrax involves massive bacteremia and toxemia with nondescript initial symptoms until the onset of hypotension, shock, and sudden death. Manifestations of advanced disease, including shock and sudden death, are believed to result from the action of the exotoxin complex secreted by anthrax bacilli.1,3 The efficacy of therapy, if initiated during the incubation period, and the rapid course of the disease once symptoms appear make early intervention an absolute necessity. Inglesby et al. have provided a description of the policies and strategies for dealing with anthrax as a biologic weapon.4 The goal of this article is to familiarize physicians with the current understanding of the pathogenesis, diagnosis, prevention, and treatment of anthrax.

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