View source for Anthrax

{{Short description|Infection caused by Bacillus anthracis bacteria}}
{{Other uses}}
{{Cs1 config|name-list-style=vanc|display-authors=6}}
{{Globalize|1=article|date=October 2021}}
{{Use dmy dates|date=January 2020}}
{{Infobox medical condition (new)
| name            = Anthrax
| image           = Anthrax PHIL 2033.png
| caption         = A skin lesion with black [[eschar]] characteristic of anthrax
| field           = [[Infectious disease (medical specialty)|Infectious disease]]
| symptoms        = '''Skin form''': small blister with surrounding swelling<br />'''Inhalational form''': fever, chest pain, [[shortness of breath]]<br />'''Intestinal form''': nausea, vomiting, diarrhea, abdominal pain<br />'''Injection form''': fever, [[abscess]]<ref name=CDC2014Sym/>
| complications   =
| onset           = 1 day to 2 months post contact<ref name=CDC2014Sym/>
| duration        =
| causes          = ''[[Bacillus anthracis]]''<ref name=CDC2015Bas/>
| risks           = Working with animals; travelers, postal workers, military personnel<ref name=CDC2015Risk/>
| diagnosis       = Based on [[antibodies]] or toxin in the blood, [[microbial culture]]<ref name=CDC2015Diag/>
| differential    =
| prevention      = [[anthrax vaccine|Anthrax vaccination]], [[antibiotics]]<ref name=CDC2015Risk/><ref name=Hend2014/>
| treatment       = Antibiotics, [[antitoxin]]<ref name=CDC2016Tx/>
| medication      =
| prognosis       = 20–80% die without treatment<ref name=Hend2014/><ref name=FDA2015/>
| frequency       = >2,000 cases per year<ref name=Glob2016/>
| deaths          =
}}

'''Anthrax''' is an infection caused by the [[bacterium]] ''[[Bacillus anthracis]]'' or [[Bacillus cereus biovar anthracis|''Bacillus cereus'' biovar ''anthracis'']].<ref name=CDC2015Bas>{{cite web|title=Basic Information What is anthrax?|url=https://www.cdc.gov/anthrax/basics/index.html|website=CDC|access-date=14 May 2016|date=1 September 2015|url-status=live|archive-url=https://web.archive.org/web/20160517175036/http://www.cdc.gov/anthrax/basics/index.html|archive-date=17 May 2016}}</ref> Infection typically occurs by [[cutaneous anthrax|contact with the skin]], inhalation, or intestinal absorption.<ref name=":4">{{cite web|title=Types of Anthrax|url=https://www.cdc.gov/anthrax/basics/types/index.html|website=CDC|access-date=14 May 2016|date=21 July 2024|url-status=live|archive-url=https://web.archive.org/web/20160511091519/http://www.cdc.gov/anthrax/basics/types/index.html|archive-date=11 May 2016}}</ref> Symptom onset occurs between one day and more than two months after the infection is contracted.<ref name="CDC2014Sym">{{cite web |date=23 July 2014 |title=Symptoms |url=https://www.cdc.gov/anthrax/basics/symptoms.html |url-status=live |archive-url=https://web.archive.org/web/20160511071331/http://www.cdc.gov/anthrax/basics/symptoms.html |archive-date=11 May 2016 |access-date=14 May 2016 |website=CDC}}</ref> The skin form presents with a small blister with surrounding swelling that often turns into a painless [[skin ulcer|ulcer]] with a black center.<ref name=CDC2014Sym/> The inhalation form presents with fever, chest pain, and [[shortness of breath]].<ref name=CDC2014Sym/> The intestinal form presents with diarrhea (which may contain blood), abdominal pains, nausea, and vomiting.<ref name=CDC2014Sym/>

According to the U.S. [[Centers for Disease Control and Prevention]], the first clinical descriptions of [[cutaneous anthrax]] were given by Maret in 1752 and Fournier in 1769.<ref name=":11">{{Cite journal |last1=Mikesell |first1=P. |last2=Ivins |first2=B. E. |last3=Ristroph |first3=J. D. |last4=Vodkin |first4=M. H. |last5=Dreier |first5=T. M. |last6=Leppla |first6=S. H. |date=1983 |title=Plasmids, Pasteur, and anthrax |url=https://www.researchgate.net/publication/237280309 |journal=ASM News |volume=49 |issue=7}}</ref> Before that, anthrax had been described only in historical accounts. The German scientist [[Robert Koch]] was the first to identify ''Bacillus anthracis'' as the bacterium that causes anthrax.<ref name=":11" />

Anthrax is spread by contact with the bacterium's [[endospore|spore]]s, which often appear in infectious animal products.<ref name=CDC2015Tran/> Contact is by breathing or eating or through an area of broken skin.<ref name=CDC2015Tran/> It does not typically spread directly between people.<ref name=CDC2015Tran>{{cite web|title=How People Are Infected|url=https://www.cdc.gov/anthrax/basics/how-people-are-infected.html|website=CDC|access-date=14 May 2016|date=1 September 2015|url-status=live|archive-url=https://web.archive.org/web/20161226203338/https://www.cdc.gov/anthrax/basics/how-people-are-infected.html|archive-date=26 December 2016}}</ref> Risk factors include people who work with animals or animal products, and military personnel.<ref name=CDC2015Risk/> Diagnosis can be confirmed by finding antibodies or the toxin in the blood or by [[microbial culture|culture]] of a sample from the infected site.<ref name=CDC2015Diag>{{cite web |title=Diagnosis |url=https://www.cdc.gov/anthrax/basics/diagnosis.html |website=CDC |access-date=14 May 2016 |date=1 September 2015 |url-status=live |archive-url=https://web.archive.org/web/20160511091531/http://www.cdc.gov/anthrax/basics/diagnosis.html |archive-date=11 May 2016 }}</ref>

[[anthrax vaccine|Anthrax vaccination]] is recommended for people at high risk of infection.<ref name=CDC2015Risk>{{cite web|title=Who Is at Risk|url=https://www.cdc.gov/anthrax/risk/index.html|website=CDC|access-date=14 May 2016|date=1 September 2015|url-status=live|archive-url=https://web.archive.org/web/20160511091534/http://www.cdc.gov/anthrax/risk/index.html|archive-date=11 May 2016}}</ref> Immunizing animals against anthrax is recommended in areas where previous infections have occurred.<ref name=CDC2015Tran/> A two-month course of antibiotics such as [[ciprofloxacin]], [[levofloxacin]] and [[doxycycline]] after exposure can also prevent infection.<ref name=Hend2014>{{cite journal | vauthors = Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT, Rubinstein E, Holty JE, Messonnier NE, Smith TL, Pesik N, Treadwell TA, Bower WA | title = Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults | journal = Emerging Infectious Diseases | volume = 20 | issue = 2 | date = February 2014 | pmid = 24447897 | pmc = 3901462 | doi = 10.3201/eid2002.130687 }}</ref> If infection occurs, treatment is with [[antibiotic]]s and possibly [[antitoxin]].<ref name=CDC2016Tx>{{cite web |title=Treatment |url=https://www.cdc.gov/anthrax/medical-care/treatment.html |publisher=CDC|access-date=14 May 2016|date=14 January 2016|url-status=live|archive-url=https://web.archive.org/web/20160511232958/http://www.cdc.gov/anthrax/medical-care/treatment.html|archive-date=11 May 2016}}</ref> The type and number of antibiotics used depend on the type of infection.<ref name=Hend2014/> Antitoxin is recommended for those with widespread infection.<ref name=Hend2014/>

A rare disease, human anthrax is most common in Africa and central and southern Asia.<ref name=WHOBook2008>{{cite book | vauthors = Turnbull P |title=Anthrax in humans and animals |date=2008 |publisher=World Health Organization |location=Geneva |isbn=978-92-4-154753-6 |pages=20, 36 |edition=4th |url=https://www.who.int/csr/resources/publications/anthrax_web.pdf |url-status=live |archive-url=https://web.archive.org/web/20161130153732/http://www.who.int/csr/resources/publications/anthrax_web.pdf |archive-date=30 November 2016 }}</ref> It also occurs more regularly in [[Southern Europe]] than elsewhere on the continent and is uncommon in [[Northern Europe]] and North America.<ref>{{cite book| vauthors = Schlossberg D |title=Clinical Infectious Disease |date=2008 |publisher=Cambridge University Press |isbn=978-1-139-57665-9 |page=897 |url=https://books.google.com/books?id=-wWY1_mSeq0C&pg=PA897|url-status=live |archive-url=https://web.archive.org/web/20170910162238/https://books.google.com/books?id=-wWY1_mSeq0C&pg=PA897|archive-date=10 September 2017}}</ref> Globally, at least 2,000 cases occur a year, with about two cases a year in the United States.<ref name=Glob2016>{{cite book |title=Anthrax: Global Status |date=2016 |publisher=Gideon Informatics Inc |isbn=978-1-4988-0861-3 |page=12 |url=https://books.google.com/books?id=ZmmwCwAAQBAJ&pg=PA12 |url-status=live |archive-url=https://web.archive.org/web/20170910162238/https://books.google.com/books?id=ZmmwCwAAQBAJ&pg=PA12 |archive-date=10 September 2017 }}</ref><ref name=":5">{{cite web |date=26 August 2009 |title=Anthrax |url=https://www.cdc.gov/nczved/divisions/dfbmd/diseases/anthrax/technical.html |archive-url=https://web.archive.org/web/20161226203133/https://www.cdc.gov/nczved/divisions/dfbmd/diseases/anthrax/technical.html |archive-date=26 December 2016 |access-date=14 May 2016 |website=CDC |publisher=[[National Center for Emerging and Zoonotic Infectious Diseases]]}}</ref> Skin infections represent more than 95% of cases.<ref name=FDA2015/> Without treatment the risk of death from skin anthrax is 23.7%.<ref name=Hend2014/> For intestinal infection the risk of death is 25 to 75%, while respiratory anthrax has a mortality of 50 to 80%, even with treatment.<ref name=Hend2014/><ref name=FDA2015/> Until the 20th century anthrax infections killed hundreds of thousands of people and animals each year.<ref name="Cherkasskiy1999">{{cite journal | vauthors = Cherkasskiy BL | title = A national register of historic and contemporary anthrax foci | journal = Journal of Applied Microbiology | volume = 87 | issue = 2 | pages = 192–95 | date = August 1999 | pmid = 10475946 | doi = 10.1046/j.1365-2672.1999.00868.x | s2cid = 6157235 | doi-access = free }}</ref> In herbivorous animals infection occurs when they eat or breathe in the spores while grazing.<ref name=WHOBook2008/> Humans may become infected by killing and/or eating infected animals.<ref name=WHOBook2008/>

Several countries have [[Anthrax weaponization|developed anthrax as a weapon]].<ref name=FDA2015>{{cite web|title=Anthrax|url=https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ucm061751.htm|website=FDA|access-date=14 May 2016|date=17 June 2015|archive-url=https://web.archive.org/web/20160507025037/https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ucm061751.htm|archive-date=7 May 2016}}</ref> It has been used in [[biowarfare]] and [[bioterrorism]] since 1914. In 1975, the [[Biological Weapons Convention]] prohibited the "development, production and stockpiling" of biological weapons. It has since been used in bioterrorism. Likely delivery methods of weaponized anthrax include aerial dispersal or dispersal through livestock; notable bioterrorism uses include the [[2001 anthrax attacks]] in the United States and an incident in [[Aum Shinrikyo#Incidents before 1995|1993 by the Aum Shinrikyo group]] in Japan.

== Etymology ==
The English name comes from ''anthrax'' ({{lang|grc|ἄνθραξ}}), the [[Greek language|Greek]] word for coal,<ref>{{LSJ|a)/nqrac|ἄνθραξ|ref}}.</ref><ref>{{OEtymD|anthrax}}</ref> possibly having [[Egyptian language|Egyptian]] etymology,<ref>{{cite book|url=https://books.google.com/books?id=fV3dCQAAQBAJ|title=Wool Economy in the Ancient Near East | vauthors = Breniquet C, Michel C |year=2014|publisher=Oxbow Books|via=Google Books|url-status=live|archive-url=https://web.archive.org/web/20160827170707/https://books.google.com/books?id=fV3dCQAAQBAJ|archive-date=27 August 2016|isbn=978-1-78297-634-9}}</ref> because of the characteristic black skin [[lesion]]s people with a cutaneous anthrax infection develop. The central black [[eschar]] surrounded by vivid red skin has long been recognised as typical of the disease. The first recorded use of the word "anthrax" in English is in a 1398 translation of [[Bartholomaeus Anglicus]]'s work ''{{lang|la|De proprietatibus rerum}}'' (''On the Properties of Things'', 1240).<ref name="de Trevisa 1398">{{cite book| vauthors = de Trevisa J |title=Bartholomaeus Anglicus' De Proprietatibus Rerum|date=1398}}</ref>

Anthrax was historically known by a wide variety of names, indicating its symptoms, location, and groups considered most vulnerable to infection. They include Siberian plague, [[Cumberland County, New South Wales|Cumberland disease]], charbon, splenic fever, malignant edema, woolsorter's disease and ''{{lang|fr|[[Bradford|la maladie de Bradford]]}}''.<ref name="Stark 2013">{{cite book| vauthors = Stark J |title=The Making of Modern Anthrax, 1875–1920: Uniting Local, National and Global Histories of Disease|date=2013|publisher=Pickering & Chatto|location=London}}</ref>

== Signs and symptoms ==
=== Skin ===
[[Image:Skin reaction to anthrax.jpg|thumb|Skin lesion from anthrax]]
[[File:Cutaneous anthrax lesion on the neck. PHIL 1934 lores.jpg|thumb|Anthrax skin lesion on the neck]]
[[File:Riehl Zumbusch Tafel IV (2).jpg|thumb|Anthrax skin lesion on the face]]
Cutaneous anthrax, also known as hide-porter's disease, is when anthrax occurs on the skin. It is the most common (>90% of cases) and least dangerous form (low mortality with treatment, 23.7% mortality without).<ref>{{cite web|title=Cutaneous Anthrax|url=https://www.cdc.gov/anthrax/basics/types/cutaneous.html|website=CDC|access-date=16 February 2018|language=en-us|date=21 July 2014|archive-date=21 January 2018|archive-url=https://web.archive.org/web/20180121184541/https://www.cdc.gov/anthrax/basics/types/cutaneous.html|url-status=live}}</ref><ref name=Hend2014/> Cutaneous anthrax presents as a [[boil]]-like [[skin lesion]] that eventually forms an [[ulcer]] with a black center ([[eschar]]). The black eschar often shows up as a large, painless, [[necrotic]] ulcer (beginning as an irritating and itchy skin lesion or blister that is dark and usually concentrated as a black dot, (somewhat resembling bread mold) at the site of infection. In general, cutaneous infections form within the site of spore penetration two to five days after exposure. Unlike [[bruise]]s or most other lesions, cutaneous anthrax infections normally do not cause pain. Nearby lymph nodes may become infected, reddened, swollen, and painful. A scab forms over the lesion soon, and falls off in a few weeks. Complete recovery may take longer.<ref name="CDC-Anthrax">{{cite web|title=Anthrax Q & A: Signs and Symptoms |work=Emergency Preparedness and Response |publisher=Centers for Disease Control and Prevention |year=2003 |url=http://www.bt.cdc.gov/agent/anthrax/faq/signs.asp |access-date=19 April 2007 |archive-url=https://web.archive.org/web/20070405150014/http://www.bt.cdc.gov/agent/anthrax/faq/signs.asp |archive-date=5 April 2007 }}</ref> Cutaneous anthrax is typically caused when ''B. anthracis'' spores enter through cuts on the skin. This form is found most commonly when humans handle infected animals and/or animal products.<ref>{{cite journal | vauthors = Akbayram S, Doğan M, Akgün C, Peker E, Bektaş MS, Kaya A, Caksen H, Oner AF | title = Clinical findings in children with cutaneous anthrax in eastern Turkey | journal = Pediatric Dermatology | volume = 27 | issue = 6 | pages = 600–06 | date = 2010 | pmid = 21083757 | doi = 10.1111/j.1525-1470.2010.01214.x | s2cid = 37958515 }}</ref>

=== Injection ===
In December 2009, an outbreak of anthrax occurred among injecting heroin users in the [[Glasgow]] and [[Stirling]] areas of Scotland, resulting in 14&nbsp;deaths.<ref name=":2" /> It was the first documented non-occupational human anthrax outbreak in the UK since 1960.<ref name=":2" /> The source of the anthrax is believed to have been dilution of the heroin with [[bone meal]] in Afghanistan.<ref name=":3" /> Injected anthrax may have symptoms similar to cutaneous anthrax, with the exception of black areas,<ref>{{Cite web |title=Anthrax – Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/anthrax/symptoms-causes/syc-20356203 |access-date=2023-01-25 |website=Mayo Clinic |language=en |archive-date=25 January 2023 |archive-url=https://web.archive.org/web/20230125224358/https://www.mayoclinic.org/diseases-conditions/anthrax/symptoms-causes/syc-20356203 |url-status=live }}</ref> and may also cause infection deep into the muscle and spread faster.<ref>{{Cite web|date=2019-01-28|title=Injection Anthrax {{!}} Anthrax {{!}} CDC|url=https://www.cdc.gov/anthrax/basics/types/injection.html|access-date=2020-09-16|website=www.cdc.gov|language=en-us|archive-date=16 September 2020|archive-url=https://web.archive.org/web/20200916162345/https://www.cdc.gov/anthrax/basics/types/injection.html|url-status=live}}</ref> This can make it harder to recognise and treat.

=== Lungs ===
Inhalation anthrax usually develops within a week after exposure, but may take up to 2 months.<ref name="Yellow2020" /><!-- <ref name=Yellow2020/> --> During the first few days of illness, most people have fever, chills, and fatigue.<ref name="Yellow2020" /><!-- <ref name=Yellow2020/> --> These symptoms may be accompanied by cough, shortness of breath, chest pain, and nausea or vomiting, making inhalation anthrax difficult to distinguish from [[influenza]] and [[community-acquired pneumonia]].<ref name="Yellow2020" /><!-- <ref name=Yellow2020/> --> This is often described as the prodromal period.<ref name="Yellow2020">{{cite book|url=https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/anthrax|title=Anthrax – Chapter 4 – 2020 Yellow Book {{!}} Travelers' Health |publisher=CDC|access-date=14 March 2020|archive-date=6 June 2020|archive-url=https://web.archive.org/web/20200606130135/https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/anthrax|url-status=live}}</ref>

Over the next day or so, shortness of breath, cough, and chest pain become more common, and complaints not involving the chest such as nausea, vomiting, altered mental status, sweats, and headache develop in one-third or more of people.<ref name="Yellow2020" /><!-- <ref name=Yellow2020/> --> Upper respiratory tract symptoms occur in only a quarter of people, and muscle pains are rare.<ref name="Yellow2020" /><!-- <ref name=Yellow2020/> --> Altered mental status or shortness of breath generally brings people to healthcare and marks the fulminant phase of illness.<!-- <ref name=Yellow2020/> --><ref name="Yellow2020" />

It infects the lymph nodes in the chest first, rather than the lungs themselves, a condition called hemorrhagic [[mediastinitis]], causing bloody fluid to accumulate in the chest cavity, thereby causing shortness of breath. The second (pneumonia) stage occurs when the infection spreads from the lymph nodes to the lungs. Symptoms of the second stage develop suddenly within hours or days after the first stage. Symptoms include high fever, extreme shortness of breath, shock, and rapid death within 48 hours in fatal cases.<ref name=":0">{{Cite book|url = http://www.usamriid.army.mil/education/bluebookpdf/USAMRIID%20BlueBook%207th%20Edition%20-%20Sep%202011.pdf|title = USAMRIID's Medical Management of Biological Casualties Handbook|last = [[USAMRIID]]|date = 2011|isbn = 978-0-16-090015-0|edition = 7th|publisher = [[US Government Printing Office]]|quote = For the attacks of 2001, CFR was only 45%, while before this time CFRs for IA were >85% (p. 37)|archive-url = https://web.archive.org/web/20150209044622/http://www.usamriid.army.mil/education/bluebookpdf/USAMRIID%20BlueBook%207th%20Edition%20-%20Sep%202011.pdf|archive-date = 9 February 2015}}</ref>

=== Gastrointestinal ===
[[Human gastrointestinal tract|Gastrointestinal]] (GI) infection is most often caused by consuming anthrax-infected meat and is characterized by diarrhea, potentially with blood, abdominal pains, acute inflammation of the intestinal tract, and loss of appetite.<ref>{{cite web | url=https://www.cdc.gov/anthrax/types/gastrointestinal.html | title=Gastrointestinal Anthrax | work=Centers for Disease Control and Prevention | date=23 August 2013 | access-date=10 February 2015 | url-status=live | archive-url=https://web.archive.org/web/20150211034003/http://www.cdc.gov/anthrax/types/gastrointestinal.html | archive-date=11 February 2015 }}</ref> Occasional [[hematemesis|vomiting of blood]] can occur. Lesions have been found in the intestines and in the mouth and throat. After the bacterium invades the gastrointestinal system, it spreads to the bloodstream and throughout the body, while continuing to make toxins.<ref>{{cite journal | vauthors = Frankel AE, Kuo SR, Dostal D, Watson L, Duesbery NS, Cheng CP, Cheng HJ, Leppla SH | title = Pathophysiology of anthrax | journal = Frontiers in Bioscience | volume = 14 | issue = 12 | pages = 4516–24 | date = January 2009 | pmid = 19273366 | pmc = 4109055 | doi = 10.2741/3544 }}</ref>

== Cause ==
=== Bacteria ===
{{Main|Bacillus anthracis}}
[[Image:Bacillus anthracis Gram.jpg|thumb|[[Photomicrograph]] of a [[Gram stain]] of the bacterium ''Bacillus anthracis'', the cause of the anthrax disease]]

''Bacillus anthracis'' is a rod-shaped, [[Gram-positive]], facultative anaerobe<ref>{{cite journal | vauthors = Koehler TM | title = Bacillus anthracis physiology and genetics | journal = Molecular Aspects of Medicine | volume = 30 | issue = 6 | pages = 386–396 | date = December 2009 | pmid = 19654018 | pmc = 2784286 | doi = 10.1016/j.mam.2009.07.004 }}</ref> bacterium about 1 by 9&nbsp;μm in size.<ref name=CDC2015Bas /> It was shown to cause disease by [[Robert Koch]] in 1876 when he took a blood sample from an infected cow, isolated the bacteria, and put them into a mouse.<ref name="pages 277-310">{{cite journal | vauthors = Koch R |title=Untersuchungen über Bakterien: V. Die Ätiologie der Milzbrand-Krankheit, begründet auf die Entwicklungsgeschichte des ''Bacillus anthracis'' |trans-title=Investigations into bacteria: V. The etiology of anthrax, based on the ontogenesis of ''Bacillus anthracis'' [Cohns] |journal=Beiträge zur Biologie der Pflanzen |volume=2 |issue=2 |pages=277–310 |year=1876 |url=http://edoc.rki.de/documents/rk/508-5-26/PDF/5-26.pdf |url-status=live |archive-url=https://web.archive.org/web/20110718171133/http://edoc.rki.de/documents/rk/508-5-26/PDF/5-26.pdf |archive-date=18 July 2011 }}</ref> The bacterium normally rests in spore form in the soil, and can survive for decades in this state. Herbivores are often infected while grazing, especially when eating rough, irritant, or spiky vegetation; the vegetation has been hypothesized to cause wounds within the gastrointestinal tract, permitting entry of the bacterial spores into the tissues. Once ingested or placed in an open wound, the bacteria begin multiplying inside the animal or human and typically kill the host within a few days or weeks. The spores germinate at the site of entry into the tissues and then spread by the circulation to the lymphatics, where the bacteria multiply.<ref name="Widdicombe">{{cite journal | vauthors = Hughes R, May AJ, Widdicombe JG | title = The role of the lymphatic system in the pathogenesis of anthrax | journal = British Journal of Experimental Pathology | volume = 37 | issue = 4 | pages = 343–49 | date = August 1956 | pmid = 13364144 | pmc = 2082573 }}</ref>

The production of two powerful exotoxins and lethal toxin by the bacteria causes death. Veterinarians can often tell a possible anthrax-induced death by its sudden occurrence and the dark, nonclotting blood that oozes from the body orifices. Most anthrax bacteria inside the body after death are outcompeted and destroyed by anaerobic bacteria within minutes to hours post mortem, but anthrax vegetative bacteria that escape the body via oozing blood or opening the carcass may form hardy spores. These vegetative bacteria are not contagious.<ref name=Liu>{{cite journal | vauthors = Liu H, Bergman NH, Thomason B, Shallom S, Hazen A, Crossno J, Rasko DA, Ravel J, Read TD, Peterson SN, Yates J, Hanna PC | title = Formation and composition of the Bacillus anthracis endospore | journal = Journal of Bacteriology | volume = 186 | issue = 1 | pages = 164–78 | date = January 2004 | pmid = 14679236 | pmc = 303457 | doi = 10.1128/JB.186.1.164-178.2004 }}</ref> One spore forms per vegetative bacterium. The triggers for spore formation are not known, but oxygen tension and lack of nutrients may play roles. Once formed, these spores are very hard to eradicate.<ref>{{Citation |title=Disinfection, decontamination, fumigation, incineration |date=2008 |work=Anthrax in Humans and Animals. | edition = 4th |url= https://www.ncbi.nlm.nih.gov/books/NBK310477/ |access-date=2025-03-05 |publisher=World Health Organization |language=en}}</ref>

The infection of herbivores (and occasionally humans) by inhalation normally begins with inhaled spores being transported through the air passages into the tiny air sacs (alveoli) in the lungs. The spores are then picked up by scavenger cells ([[macrophage]]s) in the lungs and transported through small vessels ([[lymphatic system|lymphatics]]) to the [[lymph nodes]] in the central chest cavity ([[mediastinum]]). Damage caused by the anthrax spores and bacilli to the central chest cavity can cause chest pain and difficulty breathing. Once in the lymph nodes, the spores germinate into active bacilli that multiply and eventually burst the macrophages, releasing many more bacilli into the bloodstream to be transferred to the entire body. Once in the bloodstream, these bacilli release three proteins: [[Anthrax lethal factor endopeptidase|lethal factor]], edema factor, and protective antigen. The three are not toxic by themselves, but their combination is incredibly lethal to humans.<ref name=Pimental04>{{cite journal | vauthors = Pimental RA, Christensen KA, Krantz BA, Collier RJ | title = Anthrax toxin complexes: heptameric protective antigen can bind lethal factor and edema factor simultaneously | journal = Biochemical and Biophysical Research Communications | volume = 322 | issue = 1 | pages = 258–62 | date = September 2004 | pmid = 15313199 | doi = 10.1016/j.bbrc.2004.07.105 }}</ref> Protective antigen combines with these other two factors to form lethal toxin and edema toxin, respectively. These toxins are the primary agents of tissue destruction, bleeding, and death of the host. If antibiotics are administered too late, even if the antibiotics eradicate the bacteria, some hosts still die of toxemia because the toxins produced by the bacilli remain in their systems at lethal dose levels.<ref name="Sweeney">{{cite journal | vauthors = Sweeney DA, Hicks CW, Cui X, Li Y, Eichacker PQ | title = Anthrax infection | journal = American Journal of Respiratory and Critical Care Medicine | volume = 184 | issue = 12 | pages = 1333–41 | date = December 2011 | pmid = 21852539 | pmc = 3361358 | doi = 10.1164/rccm.201102-0209CI }}</ref>

<gallery>
File:Bacillus Anthracis.png|''Bacillus anthracis''
File:Anthrax color enhanced micrograph.JPG|Color-enhanced [[Scanning electron microscope|scanning electron micrograph]] shows [[spleen|splenic tissue]] from a [[monkey]] with inhalational anthrax; featured are rod-shaped [[bacilli]] (yellow) and an [[red blood cell|erythrocyte]] (red)
File:Gram Stain Anthrax.jpg|Gram-positive anthrax bacteria (purple rods) in [[cerebrospinal fluid]]: If present, a Gram-negative bacterial species would appear pink. (The other cells are [[white blood cell]]s.)
</gallery>

=== Exposure and transmission ===
Anthrax can enter the human body through the intestines (gastrointestinal), lungs (pulmonary), or skin (cutaneous), and causes distinct clinical symptoms based on its site of entry.<ref name=":5" /> Anthrax does not usually spread from an infected human to an uninfected human.<ref name=":5" /> If the disease is fatal to the person's body, its mass of anthrax bacilli becomes a potential source of infection to others and special precautions should be used to prevent further contamination.<ref name=":5" /> Pulmonary anthrax, if left untreated, is almost always fatal.<ref name=":5" /> Historically, pulmonary anthrax was called woolsorters' disease because it was an occupational hazard for [[Wool classing|people who sorted wool]].<ref name=":6">{{cite journal | vauthors = Metcalfe N | title = The history of woolsorters' disease: a Yorkshire beginning with an international future? | journal = Occupational Medicine | volume = 54 | issue = 7 | pages = 489–93 | date = October 2004 | pmid = 15486181 | doi = 10.1093/occmed/kqh115 }}</ref> Today, this form of infection is extremely rare in industrialized nations.<ref name=":6" /> Cutaneous anthrax is the most common form of transmission but also the least dangerous of the three transmissions.<ref name=":4" /> Gastrointestinal anthrax is likely fatal if left untreated, but very rare.<ref name=":4" />[[File:Anthrax - inhalational.jpg|thumb|Inhalational anthrax, [[mediastinum|mediastinal]] widening]]The spores of anthrax are able to survive in harsh conditions for decades or even centuries.<ref>{{Cite web | vauthors = Bloomfield R |date=2012-04-12 |title=Crossrail work stopped after human bones found on site |url=https://www.standard.co.uk/hp/front/crossrail-work-stopped-after-human-bones-found-on-site-6759649.html |access-date=2023-11-02 |website=Evening Standard |language=en |archive-date=25 October 2023 |archive-url=https://web.archive.org/web/20231025123650/https://www.standard.co.uk/hp/front/crossrail-work-stopped-after-human-bones-found-on-site-6759649.html |url-status=live }}</ref> Such spores can be found on all continents, including Antarctica.<ref>{{Cite journal | vauthors = Hudson JA, Daniel RM, Morgan HW |title=Acidophilic and thermophilic Bacillus strains from geothermally heated antarctic soil |journal=FEMS Microbiology Letters |volume=60 |issue=3 |date=August 1989 |pages=279–82 |doi=10.1111/j.1574-6968.1989.tb03486.x |doi-access=free }}</ref> Disturbed grave sites of infected animals have been known to cause infection after 70 years.<ref>{{Cite book | vauthors = Guillemin J |url=http://archive.org/details/anthraxinvestiga0000guil |title=Anthrax: the investigation of a deadly outbreak |date=1999 |publisher=Berkeley : University of California Press |others=Internet Archive |isbn=978-0-520-22204-5}}</ref> In one such event, a young boy died from gastrointestinal anthrax due to the thawing of reindeer corpses from 75 years before contact.<ref name=":7">{{Cite magazine | vauthors = Luhn A |date=August 8, 2016 |title=Siberian Child Dies After Climate Change Thaws an Anthrax-Infected Reindeer |url=https://www.wired.com/2016/08/child-dead-climate-change-thawed-anthrax-infected-reindeer/ |access-date=2023-11-02 |magazine=Wired |language=en-US |issn=1059-1028 |archive-date=17 August 2016 |archive-url=https://web.archive.org/web/20160817043745/http://www.wired.com/2016/08/child-dead-climate-change-thawed-anthrax-infected-reindeer/ |url-status=live }}</ref> Anthrax spores traveled through groundwater used for drinking and caused tens of people to be hospitalized, largely children.<ref name=":7" /> Occupational exposure to infected animals or their products (such as skin, wool, and meat) is the usual pathway of exposure for humans.<ref name=":8">{{Citation |title=Anthrax in humans |date=2008 |url=https://www.ncbi.nlm.nih.gov/books/NBK310487/ |work=Anthrax in Humans and Animals|edition=4th |access-date=2023-11-02 |publisher=World Health Organization |language=en |archive-date=18 June 2022 |archive-url=https://web.archive.org/web/20220618172116/https://www.ncbi.nlm.nih.gov/books/NBK310487/ |url-status=live }}</ref> Workers exposed to dead animals and animal products are at the highest risk, especially in countries where anthrax is more common.<ref name=":8" /> Anthrax in [[livestock]] grazing on open range where they mix with wild animals still occasionally occurs in the U.S. and elsewhere.<ref name=":8" />

Many workers who deal with wool and animal hides are routinely exposed to low levels of anthrax spores, but most exposure levels are not sufficient to produce infection.<ref name=":9">{{cite book |vauthors=Chambers J, Yarrarapu SN, Mathai JK |chapter=Anthrax Infection |date=2023 |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK535379/ |title=StatPearls |access-date=2023-11-02 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30571000 |archive-date=28 April 2022 |archive-url=https://web.archive.org/web/20220428091329/https://www.ncbi.nlm.nih.gov/books/NBK535379/ |url-status=live }}</ref> A lethal infection is reported to result from inhalation of about 10,000–20,000 spores, though this dose varies among host species.<ref name=":9" />

== Mechanism ==
The lethality of the anthrax disease is due to the bacterium's two principal virulence factors: the [[polyglutamic acid|poly-D-glutamic acid capsule]], which protects the bacterium from phagocytosis by host neutrophils; and the tripartite protein toxin, called [[anthrax toxin]], consisting of protective [[antigen]] (PA), [[edema]] factor (EF), and lethal factor (LF).<ref name=toxin>{{cite web |url=http://www.ks.uiuc.edu/Research/anthrax/ |title=Molecular Basis for Anthrax Intoxication | vauthors = Gao M |date=27 April 2006 |publisher=University of Illinois at Urbana-Champaign |access-date=26 December 2016 |archive-url=https://web.archive.org/web/20161226202812/http://www.ks.uiuc.edu/Research/anthrax/ |archive-date=26 December 2016 |url-status=live}}</ref> PA plus LF produces lethal toxin, and PA plus EF produces edema toxin. These toxins cause death and tissue swelling ([[edema]]), respectively.
To enter the cells, the edema and lethal factors use another protein produced by ''B. anthracis'' called protective antigen, which binds to two surface receptors on the host cell. A cell [[protease]] then cleaves PA into two fragments: PA<sub>20</sub> and PA<sub>63</sub>. PA<sub>20</sub> dissociates into the extracellular medium, playing no further role in the toxic cycle. PA<sub>63</sub> then oligomerizes with six other PA<sub>63</sub> fragments forming a heptameric ring-shaped structure named a prepore. Once in this shape, the complex can competitively bind up to three EFs or LFs, forming a resistant complex.<ref name="Pimental04"/> Receptor-mediated endocytosis occurs next, providing the newly formed toxic complex access to the interior of the host cell. The acidified environment within the endosome triggers the heptamer to release the LF and/or EF into the cytosol.<ref>{{cite journal | vauthors = Chvyrkova I, Zhang XC, Terzyan S | title = Lethal factor of anthrax toxin binds monomeric form of protective antigen | journal = Biochemical and Biophysical Research Communications | volume = 360 | issue = 3 | pages = 690–95 | date = August 2007 | pmid = 17617379 | pmc = 1986636 | doi = 10.1016/j.bbrc.2007.06.124 }}</ref> It is unknown how exactly the complex results in the death of the cell.

Edema factor is a [[calmodulin]]-dependent [[adenylate cyclase]]. Adenylate cyclase catalyzes the conversion of ATP into [[cyclic AMP]] (cAMP) and [[pyrophosphate]]. The complexation of adenylate cyclase with [[calmodulin]] removes calmodulin from stimulating calcium-triggered signaling, thus inhibiting the immune response.<ref name="Pimental04"/> To be specific, LF inactivates [[neutrophil]]s (a type of phagocytic cell) by the process just described so they cannot phagocytose bacteria. Throughout history, lethal factor was presumed to cause macrophages to make [[TNF-alpha]] and [[IL1B|interleukin 1 beta]] (IL1B). TNF-alpha is a [[cytokine]] whose primary role is to regulate immune cells, as well as to induce inflammation and [[apoptosis]] or programmed cell death. Interleukin 1 beta is another cytokine that also regulates inflammation and apoptosis. The overproduction of TNF-alpha and IL1B ultimately leads to [[septic shock]] and death. However, recent evidence indicates anthrax also targets endothelial cells that line serious cavities such as the [[pericardial cavity]], [[pleural cavity]], and [[peritoneal cavity]], lymph vessels, and blood vessels, causing vascular leakage of fluid and cells, and ultimately [[hypovolemic shock]] and septic shock.{{citation needed|date=May 2021}}

== Diagnosis ==
[[File:Septicaemic anthrax in a drug user.png|left|thumb|218x218px|Possible edema and necrosis in a case of injection anthrax.]]
Various techniques may be used for the direct identification of ''B. anthracis'' in clinical material. Firstly, specimens may be [[Gram stain]]ed. ''Bacillus'' spp. are quite large in size (3 to 4&nbsp;μm long), they may grow in long chains, and they stain Gram-positive. To confirm the organism is ''B. anthracis'', rapid diagnostic techniques such as [[polymerase chain reaction]]-based assays and [[Immunofluorescence|immunofluorescence microscopy]] may be used.<ref>{{cite book | vauthors = Levinson W |title=Review of Medical Microbiology and Immunology |year=2010 |edition=11th}}</ref>

All ''Bacillus'' species grow well on 5% sheep blood agar and other routine culture media. Polymyxin-lysozyme-EDTA-thallous acetate can be used to isolate ''B. anthracis'' from contaminated specimens, and bicarbonate agar is used as an identification method to induce capsule formation. ''Bacillus'' spp. usually grow within 24 hours of incubation at 35&nbsp;°C, in ambient air (room temperature) or in 5% CO<sub>2</sub>. If bicarbonate agar is used for identification, then the medium must be incubated in 5% CO<sub>2</sub>. ''B. anthracis'' colonies are medium-large, gray, flat, and irregular with swirling projections, often referred to as having a "[[Medusa|medusa head]]" appearance, and are not hemolytic on 5% sheep blood agar. The bacteria are not motile, susceptible to penicillin, and produce a wide zone of lecithinase on egg yolk agar. Confirmatory testing to identify ''B. anthracis'' includes gamma bacteriophage testing, indirect hemagglutination, and enzyme-linked immunosorbent assay to detect antibodies.<ref>{{cite book | vauthors = Forbes BA |title=Bailey & Scott's Diagnostic Microbiology |year=2002 |edition=11th}}</ref> The best confirmatory precipitation test for anthrax is the [[Alberto Ascoli|Ascoli]] test.

== Prevention ==
Precautions are taken to avoid contact with the skin and any fluids exuded through natural body openings of a deceased body that is suspected of harboring anthrax.<ref name=":1">{{Cite web|url=https://www.osha.gov/SLTC/emergencypreparedness/anthrax/controlandprevention.html|title=Safety and Health Topics {{!}} Anthrax – Control and Prevention {{!}} Occupational Safety and Health Administration|website=www.osha.gov|access-date=22 December 2019|archive-date=22 December 2019|archive-url=https://web.archive.org/web/20191222225809/https://www.osha.gov/SLTC/emergencypreparedness/anthrax/controlandprevention.html|url-status=live}}</ref> The body should be put in strict quarantine. A blood sample is collected and sealed in a container and analyzed in an approved laboratory to ascertain if anthrax is the cause of death. The body should be sealed in an airtight body bag and incinerated to prevent the transmission of anthrax spores. Microscopic visualization of the encapsulated bacilli, usually in very large numbers, in a blood smear stained with polychrome methylene blue (McFadyean stain) is fully diagnostic, though the culture of the organism is still the gold standard for diagnosis. Full isolation of the body is important to prevent possible contamination of others.<ref name=":1" />

Protective, impermeable clothing and equipment such as [[rubber glove]]s, rubber apron, and rubber boots with no perforations are used when handling the body. No skin, especially if it has any wounds or scratches, should be exposed. Disposable personal protective equipment is preferable, but if not available, decontamination can be achieved by autoclaving. Used disposable equipment is burned and/or buried after use. All contaminated bedding or clothing is isolated in double plastic bags and treated as biohazard waste.<ref name=":1" /> Respiratory equipment capable of filtering small particles, such the US [[National Institute for Occupational Safety and Health]]- and [[Mine Safety and Health Administration]]-approved high-efficiency respirator, is worn.<ref>{{cite web | work = National Personal Protective Technology Laboratory | url = https://www.cdc.gov/niosh/npptl/default.html | title = Respirators | archive-url = https://web.archive.org/web/20170731101026/https://www.cdc.gov/niosh/npptl/default.html | archive-date=31 July 2017 | publisher = National Institute for Occupational Safety and Health | date = 30 April 2009 }}</ref> Addressing Anthrax from a [[One Health]] perspective reduces risks of transmission and better protects both human and animal populations.<ref>{{Cite book |author1=World Health Organization |url=https://iris.who.int/handle/10665/325620 |title=Taking a multisectoral, one health approach: a tripartite guide to addressing zoonotic diseases in countries |author2=Food and Agriculture Organization of the United Nations |author3=World Organisation for Animal Health |date=2019 |publisher=IRIS  |isbn=978-92-4-151493-4 |language=en |access-date=8 October 2023 |archive-date=14 October 2023 |archive-url=https://web.archive.org/web/20231014150959/https://iris.who.int/handle/10665/325620 |url-status=live }}</ref>

=== Vaccines ===
{{Main|Anthrax vaccines}}
Vaccines against anthrax for use in livestock and humans have had a prominent place in the history of medicine. The French scientist [[Louis Pasteur]] developed the first effective veterinary [[Anthrax vaccines|vaccine]] in 1881.<ref>{{cite web|url=http://louisville.edu/library/ekstrom/special/pasteur/cohn.html|access-date=13 August 2008|title=Life and Times of Louis Pasteur|date=11 February 1996| vauthors = Cohn DV |publisher=School of Dentistry, [[University of Louisville]]|archive-url = https://web.archive.org/web/20080408070236/http://louisville.edu/library/ekstrom/special/pasteur/cohn.html |archive-date = 8 April 2008}}</ref><ref name="Mikesell1983">{{Cite journal | vauthors = Mikesell P, Ivins BE, Ristroph JD, Vodkin MH, Dreier TM, Leppla SH |title=Plasmids, Pasteur, and Anthrax |year=1983 |journal=ASM News |volume=49 |pages=320–22 |url=https://www.asm.org/ccLibraryFiles/FILENAME/0000000221/490783p320.pdf |access-date=8 June 2017 |archive-url=https://web.archive.org/web/20170808125915/https://www.asm.org/ccLibraryFiles/FILENAME/0000000221/490783p320.pdf |archive-date=8 August 2017 }}</ref><ref>{{cite web|url=http://german.about.com/library/blerf_koch.htm |title=Robert Koch (1843–1910) |publisher=About.com |access-date=13 August 2008| archive-url= https://web.archive.org/web/20080705230619/http://german.about.com/library/blerf_koch.htm| archive-date= 5 July 2008 | url-status= live}}</ref> Human anthrax vaccines were developed by the [[Soviet Union]] in the late 1930s and in the US and UK in the 1950s. The current FDA-approved US vaccine was formulated in the 1960s.<ref>{{cite book | collaboration = Institute of Medicine (US) Committee to Assess the Safety and Efficacy of the Anthrax Vaccine | chapter = Executive Summary |date=2002 | title = The Anthrax Vaccine: Is It Safe? Does It Work? | chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK220527/ |access-date=2024-05-19 |publisher=National Academies Press (US) |language=en | vauthors = Joellenbeck LM, Zwanziger LL, Durch JS, Strom BL  }}</ref>

Currently administered human anthrax vaccines include [[acellular vaccine|acellular]] [[subunit vaccine]] (United States) and [[live vaccine]] (Russia) varieties. All currently used anthrax vaccines show considerable local and general [[reactogenicity]] ([[erythema]], [[induration]], [[soreness]], [[fever]]) and serious adverse reactions occur in about 1% of recipients.<ref name="Splino_2005">{{cite journal | vauthors = Splino M, Patocka J, Prymula R, Chlibek R | title = Anthrax vaccines | journal = Annals of Saudi Medicine | volume = 25 | issue = 2 | pages = 143–149 | date = 2005 | pmid = 15977694 | pmc = 6147967 | doi = 10.5144/0256-4947.2005.143 | url = }}</ref> The American product, BioThrax, is licensed by the FDA and was formerly administered in a six-dose primary series at 0, 2, 4 weeks and 6, 12, 18 months, with annual boosters to maintain immunity. In 2008, the FDA approved omitting the week-2 dose, resulting in the currently recommended five-dose series.<ref>{{cite web |url=https://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm124462.htm |title=11 December 2008 Approval Letter |publisher=Food and Drug Administration |access-date=8 June 2017 |archive-url=https://web.archive.org/web/20170629030005/https://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm124462.htm |archive-date=29 June 2017 }}</ref> This five-dose series is available to military personnel, scientists who work with anthrax and members of the public who do jobs which cause them to be at-risk.<ref>{{Cite web |date=2020-11-18 |title=Vaccine to Prevent Anthrax {{!}} CDC |url=https://www.cdc.gov/anthrax/prevention/vaccine/index.html |access-date=2023-01-25 |website=www.cdc.gov |language=en-us |archive-date=25 January 2023 |archive-url=https://web.archive.org/web/20230125225025/https://www.cdc.gov/anthrax/prevention/vaccine/index.html |url-status=live }}</ref> New second-generation vaccines currently being researched include [[recombinant live vaccine]]s and [[recombinant subunit vaccine]]s. In the 20th century the use of a modern product ([[BioThrax]]) to protect American troops against the use of anthrax in [[biological warfare]] was controversial.<ref name=anthraxmilitary>{{cite news |url=https://www.latimes.com/archives/la-xpm-2003-dec-23-na-anthrax23-story.html |title=Military to Halt Anthrax Shots | vauthors = Schrader E |date=23 December 2003 |newspaper=Los Angeles Times |access-date=26 December 2016 |archive-url=https://web.archive.org/web/20161226203911/http://articles.latimes.com/2003/dec/23/nation/na-anthrax23 |archive-date=26 December 2016 |url-status=live}}</ref>

=== Antibiotics ===
Preventive antibiotics are recommended in those who have been exposed.<ref name=Hend2014/> Early detection of sources of anthrax infection can allow preventive measures to be taken. In response to the [[2001 anthrax attacks|anthrax attacks of October 2001]], the [[United States Postal Service]] (USPS) installed biodetection systems (BDSs) in their large-scale mail processing facilities. BDS response plans were formulated by the USPS in conjunction with local responders including fire, police, hospitals, and public health. Employees of these facilities have been educated about anthrax, response actions, and [[prophylaxis|prophylactic]] medication. Because of the time delay inherent in getting final verification that anthrax has been used, prophylactic antibiotic treatment of possibly exposed personnel must be started as soon as possible.{{citation needed|date=May 2021}}

== Treatment ==
[[File:Anthrax and Antibiotics - Anthrax is Deadly, Antibiotics Could Save Your Life.webm|thumb|Anthrax, and antibiotics]]
Anthrax cannot be spread from person to person, except in the rare case of skin exudates from cutaneous anthrax.<ref>{{Cite web|date=2019-01-09|title=How People Are Infected {{!}} Anthrax {{!}} CDC|url=https://www.cdc.gov/anthrax/basics/how-people-are-infected.html|access-date=2020-09-16|website=www.cdc.gov|language=en-us|archive-date=26 December 2016|archive-url=https://web.archive.org/web/20161226203338/https://www.cdc.gov/anthrax/basics/how-people-are-infected.html|url-status=live}}</ref> However, a person's clothing and body may be contaminated with anthrax spores. Effective decontamination of people can be accomplished by a thorough wash-down with [[antimicrobial]] soap and water. Wastewater is treated with bleach or another antimicrobial agent.<ref>{{cite web |url=https://www.osha.gov/SLTC/etools/anthrax/decon.html |title=How should I decontaminate during response actions? |publisher=Occupational Safety & Health Administration |access-date=26 December 2016 |archive-url=https://web.archive.org/web/20161226204204/https://www.osha.gov/SLTC/etools/anthrax/decon.html |archive-date=26 December 2016 }}</ref> Effective decontamination of articles can be accomplished by boiling them in water for 30 minutes or longer. Chlorine bleach is ineffective in destroying spores and vegetative cells on surfaces, though [[formaldehyde]] is effective. Burning clothing is very effective in destroying spores. After decontamination, there is no need to immunize, treat, or isolate contacts of persons ill with anthrax unless they were also exposed to the same source of infection.{{citation needed|date=May 2021}}

=== Antibiotics ===
Early antibiotic treatment of anthrax is essential; delay significantly lessens chances for survival. Treatment for anthrax infection and other bacterial infections includes large doses of intravenous and oral antibiotics, such as [[fluoroquinolone]]s ([[ciprofloxacin]]), [[doxycycline]], [[erythromycin]], [[vancomycin]], or [[penicillin]]. FDA-approved agents include ciprofloxacin, doxycycline, and penicillin.<ref name="urlCDC Anthrax Q & A: Treatment">{{cite web|url=http://emergency.cdc.gov/agent/anthrax/faq/treatment.asp|title=CDC Anthrax Q & A: Treatment|access-date=4 April 2011|archive-url=https://web.archive.org/web/20110505191339/http://emergency.cdc.gov/agent/anthrax/faq/treatment.asp|archive-date=5 May 2011}}</ref> In possible cases of pulmonary anthrax, early [[prophylaxis|antibiotic prophylaxis]] treatment is crucial to prevent possible death. Many attempts have been made to develop new drugs against anthrax, but existing drugs are effective if treatment is started soon enough.<ref>{{cite journal | vauthors = Doganay M, Dinc G, Kutmanova A, Baillie L | title = Human Anthrax: Update of the Diagnosis and Treatment | journal = Diagnostics | volume = 13 | issue = 6 | page = 1056 | date = March 2023 | pmid = 36980364 | pmc = 10046981 | doi = 10.3390/diagnostics13061056 | doi-access = free }}</ref>

=== Monoclonal antibodies ===
In May 2009, [[Human Genome Sciences]] submitted a [[biologic license application]] (BLA, permission to market) for its new drug, [[raxibacumab]] (brand name ABthrax) intended for emergency treatment of inhaled anthrax.<ref>{{cite news |title=HGSI asks for FDA approval of anthrax drug ABthrax |agency=[[Associated Press]] |newspaper=Forbes |date=21 May 2009 |url=http://www.pharmpro.com/news/2009/05/hgsi-asks-fda-approval-anthrax-drug-abthrax |url-status=live |archive-url=https://web.archive.org/web/20141018235213/http://www.pharmpro.com/news/2009/05/hgsi-asks-fda-approval-anthrax-drug-abthrax |archive-date=18 October 2014 }}</ref> On 14 December 2012, the US Food and Drug Administration approved raxibacumab injection to treat inhalational anthrax. Raxibacumab is a [[monoclonal antibody]] that neutralizes toxins produced by ''B. anthracis''.<ref name="urlFDA approves raxibacumab to treat inhalational anthrax">{{cite web|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm332341.htm|title=FDA approves raxibacumab to treat inhalational anthrax|website=[[Food and Drug Administration]]|access-date=14 December 2012|archive-url=https://web.archive.org/web/20121217061133/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm332341.htm|archive-date=17 December 2012}}</ref> In March 2016, FDA approved a second anthrax treatment using a monoclonal antibody which neutralizes the toxins produced by ''B. anthracis''. [[Obiltoxaximab]] is approved to treat inhalational anthrax in conjunction with appropriate [[antibacterial]] drugs, and for prevention when alternative therapies are not available or appropriate.<ref>{{cite web |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm491470.htm |archive-url=https://web.archive.org/web/20160324104441/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm491470.htm |archive-date=24 March 2016 |title=FDA approves new treatment for inhalation anthrax |author=News Release |publisher=FDA |date=21 March 2016}}</ref>

=== Biologic for Drug-, Antibody- or Vaccine-resistant Anthrax ===
Treatment of multi-drug resistant, antibody- or vaccine-resistant Anthrax is also possible.  Legler, et al.<ref>{{cite journal | vauthors = Legler PM, Little SF, Senft J, Schokman R, Carra JH, Compton JR, Chabot D, Tobery S, Fetterer DP, Siegel JB, Baker D, Friedlander AM | title = Treatment of experimental anthrax with pegylated circularly permuted capsule depolymerase | journal = Science Translational Medicine | volume = 13 | issue = 623 | article-number = eabh1682 | date = December 2021 | pmid = 34878819 | doi = 10.1126/scitranslmed.abh1682 }}</ref> showed that pegylated CapD (capsule depolymerase) could provide protection against 5 LD50 exposures to lethal [[Ames strain| Ames spores]] without the use of antibiotics, monoclonal antibodies, or vaccines.  The CapD enzyme removes the poly-D-glutamate (PDGA) capsular material from the bacteria, rendering it susceptible to the innate immune responses.  The unencapsulated bacteria can then be cleared.<ref>{{YouTube|id=QVSM2vaTFaE|title=Engineered enzyme against antibiotic resistant anthrax}}</ref>

[[File:CapD.jpg|thumb|center|400px|''B. anthracis'' Capsule Depolymerase (CapD) degrades the unusual PDGA capsule on the outer surface of the bacterium. The pegylated enzyme has been used in mice to protect against five LD50 challenges of lethal Ames spores.<ref name="pmid22257032">{{cite journal | vauthors = Hu X, Legler PM, Khavrutskii I, Scorpio A, Compton JR, Robertson KL, Friedlander AM, Wallqvist A | title = Probing the donor and acceptor substrate specificity of the γ-glutamyl transpeptidase | journal = Biochemistry | volume = 51 | issue = 6 | pages = 1199–1212 | date = February 2012 | pmid = 22257032 | doi = 10.1021/bi200987b }}</ref> The human enzyme (white surface) has been overlaid onto the bacterial CapD structure (PDB 3G9K,<ref name="Joachimiak">{{cite journal | vauthors = Wu R, Richter S, Zhang RG, Anderson VJ, Missiakas D, Joachimiak A | title = Crystal structure of Bacillus anthracis transpeptidase enzyme CapD | journal = The Journal of Biological Chemistry | volume = 284 | issue = 36 | pages = 24406–24414 | date = September 2009 | pmid = 19535342 | pmc = 2782033 | doi = 10.1074/jbc.M109.019034 | doi-access = free }}</ref> blue ribbon). In red is the substrate binding loop of HuGGT which CapD lacks. CapD binds polymers of D-glutamate. Original figure from Hu, Legler, et al.  Figure has been provided with permission of the author.<ref name="pmid22257032" />]]

== Prognosis ==
Cutaneous anthrax is rarely fatal if treated,<ref name="bravata">{{cite journal | vauthors = Holty JE, Bravata DM, Liu H, Olshen RA, McDonald KM, Owens DK | title = Systematic review: a century of inhalational anthrax cases from 1900 to 2005 | journal = Annals of Internal Medicine | volume = 144 | issue = 4 | pages = 270–80 | date = February 2006 | pmid = 16490913 | doi = 10.7326/0003-4819-144-4-200602210-00009 | s2cid = 8357318 }}</ref> because the infection area is limited to the skin, preventing the [[Anthrax lethal factor endopeptidase|lethal factor]], [[edema]] factor, and protective [[antigen]] from entering and destroying a [[vital organ]]. Without treatment, up to 20% of cutaneous skin infection cases progress to [[Bacteremia|toxemia]] and death.<ref name="Types of Anthrax {{!}} CDC">{{Cite web |date=2020-11-19 |title=Types of Anthrax {{!}} CDC |url=https://www.cdc.gov/anthrax/basics/types/index.html |access-date=2023-01-25 |website=www.cdc.gov |language=en-us |archive-date=11 May 2016 |archive-url=https://web.archive.org/web/20160511091519/http://www.cdc.gov/anthrax/basics/types/index.html |url-status=live }}</ref>

Before 2001, fatality rates for inhalation anthrax were 90%; since then, they have fallen to 45%.<ref name="Yellow2020" /> People that progress to the [[fulminant]] phase of inhalational anthrax nearly always die, with one case study showing a death rate of 97%.<ref>{{cite journal | vauthors = Holty JE, Bravata DM, Liu H, Olshen RA, McDonald KM, Owens DK | title = Systematic review: a century of inhalational anthrax cases from 1900 to 2005 | journal = Annals of Internal Medicine | volume = 144 | issue = 4 | pages = 270–80 | date = February 2006 | pmid = 16490913 | doi = 10.7326/0003-4819-144-4-200602210-00009 | s2cid = 8357318 }}</ref> Anthrax meningoencephalitis is also nearly always fatal.<ref>{{cite journal | vauthors = Lanska DJ | title = Anthrax meningoencephalitis | journal = Neurology | volume = 59 | issue = 3 | pages = 327–34 | date = August 2002 | pmid = 12177364 | doi = 10.1212/wnl.59.3.327 | s2cid = 37545366 }}</ref>

Gastrointestinal anthrax infections can be treated, but usually result in fatality rates of 25% to 60%, depending upon how soon treatment commences.

Injection anthrax is the rarest form of anthrax, and has only been seen to have occurred in a group of heroin injecting drug users.<ref name="Types of Anthrax {{!}} CDC"/>

== Epidemiology ==
Globally, at least 2,000 cases occur a year.<ref name=Glob2016/>

=== United States ===
The last fatal case of natural inhalational anthrax in the United States occurred in California in 1976, when a home weaver died after working with infected wool imported from Pakistan. To minimize the chance of spreading the disease, the body was transported to [[University of California, Los Angeles|UCLA]] in a sealed plastic body bag within a sealed metal container for autopsy.<ref name="Suffin1978">{{cite journal | vauthors = Suffin SC, Carnes WH, Kaufmann AF | title = Inhalation anthrax in a home craftsman | journal = Human Pathology | volume = 9 | issue = 5 | pages = 594–97 | date = September 1978 | pmid = 101438 | doi = 10.1016/S0046-8177(78)80140-3 }}</ref>

Gastrointestinal anthrax is exceedingly rare in the United States, with only two cases on record. The first case was reported in 1942, according to the Centers for Disease Control and Prevention.<ref name="boston.com">{{cite news | vauthors = Schweitzer S |date=4 January 2010 |title=Drummer's anthrax case spurs a public health hunt |newspaper=The Boston Globe |url=https://www.boston.com/news/health/articles/2010/01/04/nh_anthrax_case_linked_to_animal_skinned_drums/ |access-date=19 October 2014 |url-status=live |archive-url=https://web.archive.org/web/20131214142749/http://www.boston.com/news/health/articles/2010/01/04/nh_anthrax_case_linked_to_animal_skinned_drums/ |archive-date=14 December 2013 }}</ref> During December 2009, the New Hampshire Department of Health and Human Services confirmed a case of gastrointestinal anthrax in an adult female. The [[Centers for Disease Control and Prevention|CDC]] investigated the source and the possibility that it was contracted from an African drum recently used by the woman taking part in a [[drum circle]].<ref name="promedmail.org">{{cite web |url=http://www.promedmail.org/pls/otn/f?p=2400:1001:747000751311471::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,80634 |title=PROMED: Anthrax, Human – USA: (New Hampshire) |publisher=Promedmail.org |date=26 December 2009 |access-date=17 March 2014 |url-status=live |archive-url=https://web.archive.org/web/20110927141758/http://www.promedmail.org/pls/otn/f?p=2400%3A1001%3A747000751311471%3A%3ANO%3A%3AF2400_P1001_BACK_PAGE%2CF2400_P1001_PUB_MAIL_ID%3A1000%2C80634 |archive-date=27 September 2011 }}</ref> The woman apparently inhaled anthrax, in spore form, from the hide of the drum. She became critically ill, but with gastrointestinal anthrax rather than inhaled anthrax, which made her unique in American medical history. The building where the infection took place was cleaned and reopened to the public and the woman recovered. The New Hampshire state epidemiologist, Jodie Dionne-Odom, stated "It is a mystery. We really don't know why it happened."<ref>{{cite web |url=http://www.promedmail.org/pls/otn/f?p=2400:1001:130058575417351::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,82333 |title=PROMED: Anthrax, Human – USA: (New Hampshire) |publisher=Promedmail.org |date=18 April 2010 |access-date=17 March 2014 |url-status=live |archive-url=https://web.archive.org/web/20110927142617/http://www.promedmail.org/pls/otn/f?p=2400%3A1001%3A130058575417351%3A%3ANO%3A%3AF2400_P1001_BACK_PAGE%2CF2400_P1001_PUB_MAIL_ID%3A1000%2C82333 |archive-date=27 September 2011 }}</ref>

In 2007 two cases of cutaneous anthrax were reported in [[Danbury, Connecticut]]. The case involved a maker of traditional African-style drums who was working with a goat hide purchased from a dealer in New York City which had been previously cleared by Customs. While the hide was being scraped, a spider bite led to the spores entering the bloodstream. His son also became infected.<ref>{{cite news |vauthors=Kaplan T |title=Anthrax Is Found in 2 Connecticut Residents, One a Drummer |url=https://www.nytimes.com/2007/09/06/nyregion/06anthrax.html |access-date=16 May 2020 |work=The New York Times |date=6 September 2007 |archive-date=24 November 2020 |archive-url=https://web.archive.org/web/20201124102002/https://www.nytimes.com/2007/09/06/nyregion/06anthrax.html |url-status=live }}</ref>

=== Croatia ===
In July 2022, dozens of cattle in a nature park in [[Lonjsko Polje]], a flood plain by the [[Sava]] river, died of anthrax and 6 people have been hospitalized with light, skin-related symptoms.<ref>{{cite news |agency=Associated Press |title=Croatia: Anthrax found in dead cattle in nature park |url=https://www.washingtonpost.com/business/croatia-anthrax-found-in-dead-cattle-in-nature-park/2022/07/16/814e4cea-0523-11ed-8beb-2b4e481b1500_story.html |access-date=19 July 2022 |newspaper=The Washington Post |date=16 July 2022 |archive-date=22 July 2022 |archive-url=https://web.archive.org/web/20220722102814/https://www.washingtonpost.com/business/croatia-anthrax-found-in-dead-cattle-in-nature-park/2022/07/16/814e4cea-0523-11ed-8beb-2b4e481b1500_story.html |url-status=live }}</ref>

===United Kingdom===
In November 2008, a drum maker in the United Kingdom who worked with untreated animal skins died from anthrax.<ref>{{cite news |title=Man who breathed in anthrax dies |newspaper=BBC News |date=2 November 2008 |url=https://news.bbc.co.uk/2/hi/uk_news/7705328.stm |url-status=live |archive-url=https://web.archive.org/web/20160307095059/http://news.bbc.co.uk/2/hi/uk_news/7705328.stm |archive-date=7 March 2016 }}</ref> In December 2009, an outbreak of anthrax occurred among heroin addicts in the [[Glasgow]] and [[Stirling]] areas of Scotland, resulting in 14&nbsp;deaths.<ref name=":2">{{cite news |url=http://www.documents.hps.scot.nhs.uk/giz/anthrax-outbreak/anthrax-outbreak-report-2011-12.pdf |title=An Outbreak of Anthrax Among Drug Users in Scotland, December 2009 to December 2010 |series=A report on behalf of the National Anthrax Outbreak Control Team |work=HPS |date=December 2011 |access-date=14 December 2013 |archive-url=https://web.archive.org/web/20131020040629/http://www.documents.hps.scot.nhs.uk/giz/anthrax-outbreak/anthrax-outbreak-report-2011-12.pdf |archive-date=20 October 2013 }}</ref> The source of the anthrax is believed to have been dilution of the heroin with [[bone meal]] in Afghanistan.<ref name=":3">{{cite news |url=https://www.nytimes.com/2010/01/12/health/12glob.html |title=Anthrax: In Scotland, six heroin users die of anthrax poisoning |newspaper=The New York Times |date=12 January 2010 | vauthors = McNeil Jr DG |url-status=live |archive-url=https://web.archive.org/web/20160102002459/http://www.nytimes.com/2010/01/12/health/12glob.html |archive-date=2 January 2016 }}</ref>

== History ==
{{See also|List of anthrax outbreaks}}

=== Discovery ===
[[Robert Koch]], a German physician and scientist, first identified the bacterium that caused the anthrax disease in 1875 in [[Wolsztyn|Wollstein]] (now Wolsztyn, Poland).<ref name="pages 277-310"/><ref name="Brock">{{Cite book | veditors = Madigan M, Martinko J |title=Brock Biology of Microorganisms |edition=11th |publisher=Prentice Hall |year=2005 |isbn=978-0-13-144329-7}}</ref> His pioneering work in the late 19th century was one of the first demonstrations that [[Germ theory of disease|diseases could be caused by microbes]]. In a groundbreaking series of experiments, he uncovered the lifecycle and means of transmission of anthrax. His experiments not only helped create an understanding of anthrax but also helped elucidate the role of microbes in causing illness at a time when debates still took place over [[spontaneous generation#Spontaneous generation|spontaneous generation]] versus [[cell theory]]. Koch went on to study the mechanisms of other diseases and won the 1905 [[Nobel Prize in Physiology or Medicine]] for his discovery of the bacterium causing tuberculosis.<ref>{{cite web |title=The Nobel Prize in Physiology or Medicine 1905 |url=https://www.nobelprize.org/prizes/medicine/1905/summary/ |website=The Nobel Prize |publisher=The Nobel Foundation |access-date=2021-10-04 |archive-date=23 May 2020 |archive-url=https://web.archive.org/web/20200523071846/https://www.nobelprize.org/prizes/medicine/1905/summary/ |url-status=live }}</ref>

Although Koch arguably made the greatest theoretical contribution to understanding anthrax, other researchers were more concerned with the practical questions of how to prevent the disease. In Britain, where anthrax affected workers in the wool, [[worsted]], [[hide (skin)|hide]]s, and [[Tanning (leather)|tanning]] industries, it was viewed with fear. [[John Henry Bell]], a doctor born & based in [[Bradford]], first made the link between the mysterious and deadly "woolsorter's disease" and anthrax, showing in 1878 that they were one and the same.<ref>{{cite journal |title=John Henry Bell, M.D., M.R.C.S|journal=British Medical Journal|date=22 September 1906|pages=735–36|pmc=2382239|volume=2|issue=2386|doi=10.1136/bmj.2.2386.735}}</ref> In the early 20th century, [[Friederich Wilhelm Eurich]], the [[Germans|German]] [[bacteriologist]] who settled in Bradford with his family as a child, carried out important research for the local Anthrax Investigation Board. Eurich also made valuable contributions to a [[Home Office]] Departmental Committee of Inquiry, established in 1913 to address the continuing problem of industrial anthrax.<ref>{{cite journal|title=Industrial Infection by Anthrax|journal=British Medical Journal|date=15 November 1913|page=1338|pmc=2346352|volume=2|issue=2759}}</ref> His work in this capacity, much of it collaboration with the factory inspector [[G. Elmhirst Duckering]], led directly to the [[Anthrax Prevention Act]] (1919).

=== First vaccination ===
{{Further|Anthrax vaccines}}
[[File:Pasteur inoculating sheep against anthrax. Wellcome L0003758.jpg|thumb|200px|Louis Pasteur inoculating sheep against anthrax]]

Anthrax posed a major economic challenge in [[France]] and elsewhere during the 19th century. Horses, cattle, and sheep were particularly vulnerable, and national funds were set aside to investigate the production of a [[vaccine]]. French scientist [[Louis Pasteur]] was charged with the production of a vaccine, following his successful work in developing methods that helped to protect the important wine and silk industries.<ref name="Jones 2010">{{cite book| vauthors = Jones S |title=Death in a Small Package: A Short History of Anthrax|date=2010|publisher=Johns Hopkins University Press|location=Baltimore}}</ref>

In May 1881, Pasteur – in collaboration with his assistants [[Jean Joseph Henri Toussaint|Jean-Joseph Henri Toussaint]], [[Pierre Paul Émile Roux|Émile Roux]] and others – performed a public experiment at [[Pouilly-le-Fort]] to demonstrate his concept of vaccination. He prepared two groups of 25 [[sheep]], one [[goat]], and several [[cow|cattle]]. The animals of one group were twice injected with an anthrax vaccine prepared by Pasteur, at an interval of 15 days; the control group was left unvaccinated. Thirty days after the first injection, both groups were injected with a culture of live anthrax bacteria. All the animals in the unvaccinated group died, while all of the animals in the vaccinated group survived.<ref>{{cite book | vauthors = Decker J |title=Deadly Diseases and Epidemics, Anthrax |publisher=Chelesa House Publishers |year=2003 |isbn=978-0-7910-7302-5 |pages=[https://archive.org/details/anthraxdeadlydis00jane/page/27 27–28] |url=https://archive.org/details/anthraxdeadlydis00jane/page/27 }}</ref>

After this apparent triumph, which was widely reported in the local, national, and international press, Pasteur made strenuous efforts to export the vaccine beyond France. He used his celebrity status to establish Pasteur Institutes across Europe and Asia, and his nephew, [[Adrien Loir]], travelled to [[Australia]] in 1888 to try to introduce the vaccine to combat anthrax in [[New South Wales]].<ref name="Geison 2014">{{cite book | vauthors = Geison G |title=The Private Science of Louis Pasteur|date=2014|publisher=Princeton University Press}}</ref> Ultimately, the vaccine was unsuccessful in the challenging climate of rural Australia, and it was soon superseded by a more robust version developed by local researchers [[John Gunn (researcher)|John Gunn]] and [[John McGarvie Smith]].<ref name="Stark 2012">{{cite journal| vauthors = Stark J |title=Anthrax and Australia in a Global Context: The International Exchange of Theories and Practices with Britain and France, c. 1850–1920|journal=Health and History|date=2012|volume=14|issue=2|pages=1–25 |doi=10.5401/healthhist.14.2.0001|s2cid=142036883 }}</ref>

The [[Anthrax vaccine adsorbed|human vaccine for anthrax]] became available in 1954. This was a cell-free vaccine instead of the live-cell Pasteur-style vaccine used for veterinary purposes. An improved cell-free vaccine became available in 1970.<ref>{{cite web | url = https://www.cdc.gov/vaccines/vpd-vac/anthrax/downloads/ed-vpd2006-anthrax.ppt | title = Anthrax and Anthrax Vaccine – Epidemiology and Prevention of Vaccine-Preventable Diseases | archive-url = https://web.archive.org/web/20120824060412/http://www.cdc.gov/vaccines/vpd-vac/anthrax/downloads/ed-vpd2006-anthrax.ppt | archive-date=24 August 2012 | work = National Immunization Program | publisher = Centers for Disease Control and Prevention | date = January 2006 }}</ref>

=== Engineered strains ===
{{incomplete list|date=April 2018}}
* The Sterne strain of anthrax, named after the [[Trieste]]-born immunologist [[Max Sterne]], is an attenuated strain used as a vaccine, which contains only the [[anthrax toxin]] virulence plasmid and not the polyglutamic acid capsule expressing plasmid.
* [[Strain 836]], created by the Soviet bioweapons program in the 1980s, was later called by the ''[[Los Angeles Times]]'' "the most virulent and vicious strain of anthrax known to man".<ref>{{cite web | vauthors = [[David Willman|Willman D]] | url = https://www.latimes.com/archives/la-xpm-2007-jul-01-na-alibek1-story.html | title = Selling the Threat of Bioterrorism | work = [[Los Angeles Times]] | date = 1 July 2007 }}</ref><ref>{{cite book | vauthors = [[Annie Jacobsen|Jacobsen A ]] | date = 2015 | title = The Pentagon's Brain: An Uncensored History of DARPA, America's Top Secret Military Research Agency | location = New York | publisher = [[Little, Brown and Company]] | page = 293 }}</ref>
* The virulent [[Ames strain]], which was used in the [[2001 anthrax attacks]] in the United States, has received the most news coverage of any anthrax outbreak. The Ames strain contains two virulence [[plasmids]], which separately encode for a three-protein toxin, called [[anthrax toxin]], and a polyglutamic acid [[bacterial capsule|capsule]].
* Nonetheless, the [[Vollum strain]], developed but never used as a [[biological weapon]] during the [[Second World War]], is much more dangerous. The Vollum (also incorrectly referred to as Vellum) strain was isolated in 1935 from a cow in [[Oxfordshire]]. This same strain was used during the [[Gruinard Island|Gruinard]] bioweapons trials. A variation of Vollum, known as "Vollum 1B", was used during the 1960s in the US and UK bioweapon programs. Vollum 1B is widely believed<ref>{{cite web |url = http://www.ph.ucla.edu/epi/bioter/armyanthraxvictimsblood.html |access-date = 6 August 2009 |title = Army harvested victims' blood to boost anthrax |date = 23 December 2001 | vauthors = Shane S |work = Boston Sun |publisher = UCLA Dept. of Epidemiology site |url-status = live |archive-url = https://web.archive.org/web/20091229122543/http://www.ph.ucla.edu/epi/bioter/armyanthraxvictimsblood.html |archive-date = 29 December 2009 }}</ref> to have been isolated from William A. Boyles, a 46-year-old scientist at the [[United States Army Biological Warfare Laboratories|US Army Biological Warfare Laboratories]] at [[Fort Detrick|Camp (later Fort) Detrick]], [[Maryland]], who died in 1951 after being accidentally infected with the Vollum strain.

== Society and culture ==
=== Site cleanup ===
Anthrax spores can survive for very long periods of time in the environment after release. Chemical methods for cleaning anthrax-contaminated sites or materials may use [[oxidizing agent]]s such as [[peroxides]], [[ethylene oxide]], Sandia Foam,<ref>{{cite web|url=http://www.eurekalert.org/pub_releases/2007-04/dnl-sdf042607.php |title=Sandia decon formulation, best known as an anthrax killer, takes on household mold |date=26 April 2007 |access-date=13 August 2008| archive-url= https://web.archive.org/web/20080905212823/http://www.eurekalert.org/pub_releases/2007-04/dnl-sdf042607.php| archive-date= 5 September 2008 | url-status= live}}</ref> chlorine dioxide (used in the [[Hart Senate Office Building]]),<ref name = "Wang_2015">{{cite web | title = The Anthrax Cleanup of Capitol Hill | vauthors = Wang X | work = EPA Alumni Association | url = https://www.epaalumni.org/userdata/pdf/6C70838638374E92.pdf#page=8 | archive-url = https://web.archive.org/web/20180930034008/https://www.epaalumni.org/userdata/pdf/6C70838638374E92.pdf#page=8 | archive-date= 30 September 2018 | date = 12 May 2015 }}</ref>{{rp|8}} peracetic acid, ozone gas, hypochlorous acid, sodium persulfate, and liquid bleach products containing sodium hypochlorite. Nonoxidizing agents shown to be effective for anthrax decontamination include methyl bromide, formaldehyde, and metam sodium. These agents destroy bacterial spores. All of the aforementioned anthrax decontamination technologies have been demonstrated to be effective in laboratory tests conducted by the US EPA or others.<ref>{{cite web|url=http://www.epa.gov/nhsrc/aboutdecon.html#iodra|title=Remediating Indoor and Outdoor Environments|access-date=10 October 2013|archive-url=https://web.archive.org/web/20131013053043/http://www.epa.gov/nhsrc/aboutdecon.html#iodra|archive-date=13 October 2013}}</ref>

Decontamination techniques for ''Bacillus anthracis'' spores are affected by the material with which the spores are associated, environmental factors such as temperature and humidity, and microbiological factors such as the spore species, anthracis strain, and test methods used.<ref>{{cite journal | vauthors = Wood JP, Adrion AC | title = Review of Decontamination Techniques for the Inactivation of Bacillus anthracis and Other Spore-Forming Bacteria Associated with Building or Outdoor Materials | journal = Environmental Science & Technology | volume = 53 | issue = 8 | pages = 4045–62 | date = April 2019 | pmid = 30901213 | pmc = 6547374 | doi = 10.1021/acs.est.8b05274 | bibcode = 2019EnST...53.4045W }}</ref>

A bleach solution for treating hard surfaces has been approved by the EPA.<ref>{{cite web |url=http://ehso.com/bleach.htm |publisher=Society for Applied Microbiology |title=Using Bleach to Destroy Anthrax and Other Microbes |access-date=13 August 2008 |url-status=live |archive-url=https://web.archive.org/web/20080517034547/http://www.ehso.com/bleach.htm |archive-date=17 May 2008 }}</ref> [[Chlorine dioxide]] has emerged as the preferred biocide against anthrax-contaminated sites, having been employed in the treatment of numerous government buildings over the past decade.<ref name="rastogi">{{cite journal | vauthors = Rastogi VK, Ryan SP, Wallace L, Smith LS, Shah SS, Martin GB | title = Systematic evaluation of the efficacy of chlorine dioxide in decontamination of building interior surfaces contaminated with anthrax spores | journal = Applied and Environmental Microbiology | volume = 76 | issue = 10 | pages = 3343–3e51 | date = May 2010 | pmid = 20305025 | pmc = 2869126 | doi = 10.1128/AEM.02668-09 | bibcode = 2010ApEnM..76.3343R }}</ref> Its chief drawback is the need for ''[[in situ]]'' processes to have the reactant on demand.

To speed the process, trace amounts of a nontoxic [[catalyst]] composed of iron and tetroamido macrocyclic [[ligand]]s are combined with [[sodium carbonate]] and [[bicarbonate]] and converted into a spray. The spray formula is applied to an infested area and is followed by another spray containing [[tert-butyl hydroperoxide]].<ref name="Pesticide Disposal Goes Green">{{cite magazine |url=http://www.sciencenews.org/view/generic/id/5581/title/Pesticide_Disposal_Goes_Green |magazine=Science News |title=Pesticide Disposal Goes Green |access-date=8 June 2009 |url-status=live |archive-url=https://web.archive.org/web/20110629214707/http://www.sciencenews.org/view/generic/id/5581/title/Pesticide_Disposal_Goes_Green |archive-date=29 June 2011 }}</ref>

Using the catalyst method, complete destruction of all anthrax spores can be achieved in under 30 minutes.<ref name="Pesticide Disposal Goes Green" /> A standard catalyst-free spray destroys fewer than half the spores in the same amount of time.

Cleanups at a Senate Office Building, several contaminated postal facilities, and other US government and private office buildings, a collaborative effort headed by the [[United States Environmental Protection Agency|Environmental Protection Agency]]<ref name = "Wang_2015" />{{rp|3}} showed decontamination to be possible, but time-consuming and costly. Clearing the Senate Office Building of anthrax spores cost $27&nbsp;million, according to the Government Accountability Office. Cleaning the Brentwood postal facility in Washington cost $130&nbsp;million and took 26 months. Since then, newer and less costly methods have been developed.<ref>{{cite book | vauthors = Wessner D, Dupont C, Charles T, Neufeld J|title=Microbiology |date=3 December 2020 |publisher=John Wiley & Sons |isbn=978-1-119-59249-5 |url=https://books.google.com/books?id=GzcDEAAAQBAJ&dq=Cleaning+the+Brentwood+postal+facility+in+Washington+cost+%24130+million+and+took+26+months.+Since+then,+newer+and+less+costly+methods+have+been+developed.&pg=PA264 |language=en}}</ref>

Cleanup of anthrax-contaminated areas on ranches and in the wild is much more problematic. Carcasses may be burned,<ref>{{cite news |url=https://www.nytimes.com/2002/03/01/us/anthrax-expert-faces-fine-for-burning-infected-carcasses.html |title=Anthrax Expert Faces Fine for Burning Infected Carcasses | vauthors = Broad WJ |date=1 March 2002 |newspaper=The New York Times |access-date=26 December 2016 |archive-url=https://web.archive.org/web/20161226205419/http://www.nytimes.com/2002/03/01/us/anthrax-expert-faces-fine-for-burning-infected-carcasses.html |archive-date=26 December 2016 |url-status=live}}</ref> though often 3 days are needed to burn a large carcass and this is not feasible in areas with little wood. Carcasses may also be buried, though the burying of large animals deeply enough to prevent resurfacing of spores requires much manpower and expensive tools. Carcasses have been soaked in formaldehyde to kill spores, though this has environmental contamination issues. Block burning of vegetation in large areas enclosing an anthrax outbreak has been tried; this, while environmentally destructive, causes healthy animals to move away from an area with carcasses in search of fresh grass. Some wildlife workers have experimented with covering fresh anthrax carcasses with shadecloth and heavy objects. This prevents some scavengers from opening the carcasses, thus allowing the putrefactive bacteria within the carcass to kill the vegetative ''B. anthracis'' cells and preventing sporulation. This method also has drawbacks, as scavengers such as hyenas are capable of infiltrating almost any exclosure.{{citation needed|date=May 2021}}

The experimental site at [[Gruinard Island]] is said to have been decontaminated with a mixture of formaldehyde and seawater by the Ministry of Defence.<ref>{{cite news |url=https://news.bbc.co.uk/1/hi/uk/scotland/1457035.stm |title=Britain's 'Anthrax Island' |date=25 July 2001 |newspaper=BBC News |access-date=26 December 2016 |archive-url=https://web.archive.org/web/20161226205629/http://news.bbc.co.uk/2/hi/uk/scotland/1457035.stm |archive-date=26 December 2016 |url-status=live}}</ref> It is not clear whether similar treatments had been applied to US test sites.

=== Biological warfare ===
{{main|Anthrax weaponization}}
[[File:Colin Powell anthrax vial. 5 Feb 2003 at the UN.jpg|thumb|[[Colin Powell]] giving a [[Colin Powell's presentation to the United Nations Security Council|presentation to the United Nations Security Council]], holding a model vial of supposed weaponized anthrax]]

Anthrax spores have been used as a [[biological warfare]] weapon. Its first modern incidence occurred when Nordic rebels, supplied by the [[German General Staff]], used anthrax with unknown results against the [[Imperial Russian Army]] in Finland in 1916.<ref>{{cite web | vauthors = Bisher J | title = Anthrax sabotage in Finland or Baron von Rosen's sugarcoated anthrax weapon | quote = During World War I, Terrorists Schemed to Use Anthrax in the Cause of Finnish Independence | work = Military History | date = August 2003 | pages = 17–22 | url = http://www.geocities.com/jamie_bisher/anthrax.htm | archive-url = https://web.archive.org/web/20170324172104/https://web.archive.org/web/20091027151654/http://geocities.com/jamie_bisher/anthrax.htm | archive-date = 24 March 2017 }}</ref> Anthrax was first tested as a biological warfare agent by [[Unit 731]] of the Japanese Kwantung Army in [[Manchuria]] during the 1930s; some of this testing involved intentional infection of prisoners of war, thousands of whom died. Anthrax, designated at the time as Agent N, was also investigated by the Allies in the 1940s.<ref>{{Cite web |title=DOD Technical Information |url=https://apps.dtic.mil/sti/pdfs/ADB228585.pdf |access-date=31 October 2023 |archive-date=31 October 2023 |archive-url=https://web.archive.org/web/20231031204303/https://apps.dtic.mil/sti/pdfs/ADB228585.pdf |url-status=live }}</ref>

In 1942, British scientists at [[Porton Down]] began research on [[Operation Vegetarian]], an ultimately unused [[Biological warfare|biowarfare]] [[military operation plan]] which called for animal feed pellets containing [[Flax|linseed]] infected with anthrax spores of the [[Vollum strain|Vollum-14578 strain]] to be dropped by air over the countryside of [[Nazi Germany]]. The pellets would be eaten by cattle, which would in turn be eaten by the human population and as such severely disrupt the German war effort. In the same year, bioweapons tests were carried out on the uninhabited [[Gruinard Island]] in the [[Scottish Highlands]], with Porton Down scientists studying the effect of anthrax on the island's population of sheep. Ultimately, five million pellets were created, though plans to drop them over Germany using [[Royal Air Force]] bombers in 1944 were scrapped after the success of [[Operation Overlord]] and the subsequent Allied liberation of France. All pellets were destroyed using incinerators in 1945.<ref>{{Cite book| vauthors = Cole LA |title=Clouds of Secrecy: The Army's Germ Warfare Tests Over Populated Areas|publisher=Rowman and Littlefield|year=1990|isbn=978-0-8226-3001-2|url=https://archive.org/details/isbn_9780822630012}}</ref><ref>{{cite news |title=Saddam's germ war plot is traced back to one Oxford cow |newspaper=The Times |url=http://www.timesonline.co.uk/article/0,,2-1726745,00.html | vauthors = Robertson D |archive-url=https://web.archive.org/web/20051225102048/http://www.timesonline.co.uk/article/0,,2-1726745,00.html |archive-date=25 December 2005 }}</ref><ref>{{Cite news|title=UK planned to wipe out Germany with anthrax|work=Sunday Herald|location=Glasgow|date=14 October 2001}}</ref> 
 
Weaponized anthrax was part of the US stockpile prior to 1972, when the United States signed the [[Biological Weapons Convention]].<ref>{{cite book | veditors = Croddy EA, Wirtz JJ |title=Weapons of mass destruction: an encyclopedia of worldwide policy, technology, and history |url=https://books.google.com/books?id=ZzlNgS70OHAC&pg=PA21 |year=2005 |publisher=ABC-CLIO |isbn=978-1-85109-490-5 |page=21 |url-status=live |archive-url=https://web.archive.org/web/20170222225432/https://books.google.com/books?id=ZzlNgS70OHAC&pg=PA21 |archive-date=22 February 2017 }}</ref> President [[Richard Nixon|Nixon]] ordered the dismantling of US biowarfare programs in 1969 and the destruction of all existing stockpiles of bioweapons. In 1978–79, the [[Rhodesia]]n government used anthrax against cattle and humans during its campaign against rebels.<ref>{{cite news|title=Traditional Medical Practitioners Seek International Recognition |date=16 November 2001 | vauthors = Martin D |work=Southern African News Features |url=http://www.sardc.net/editorial/sanf/2001/iss21/specialreport.html |access-date=19 October 2014 |archive-url=https://web.archive.org/web/20130511004056/http://www.sardc.net/editorial/sanf/2001/iss21/specialreport.html |archive-date=11 May 2013 }}</ref> The Soviet Union created and stored 100 to 200 tons of anthrax spores at [[Kantubek]] on [[Vozrozhdeniya Island]]; they were abandoned in 1992 and destroyed in 2002.<ref>{{cite news |vauthors=Pala C |date=22 March 2003 |title=Anthrax buried for good |url=https://www.ph.ucla.edu/epi/bioter/anthraxburied.html |newspaper=[[The Washington Times]] |access-date=26 August 2020 |archive-date=17 May 2021 |archive-url=https://web.archive.org/web/20210517193233/http://www.ph.ucla.edu/epi/bioter/anthraxburied.html |url-status=live }}</ref>

[[Military of the United States|American military]] and [[British Army]] personnel are no longer routinely vaccinated against anthrax prior to active service in places where biological attacks are considered a threat.<ref name=anthraxmilitary />

==== Sverdlovsk incident (2 April 1979) ====
{{Main|Sverdlovsk anthrax leak}}
Despite signing the 1972 agreement to end bioweapon production, the government of the Soviet Union had an active bioweapons program that included the production of hundreds of tons of anthrax after this period. On 2 April 1979, some of the over one million people living in Sverdlovsk (now called [[Ekaterinburg, Russia]]), about {{convert|850|mi|km|order=flip}} east of Moscow, were exposed to an [[Sverdlovsk anthrax leak|accidental release of anthrax]] from a biological weapons complex located near there. At least 94 people were infected, of whom at least 68 died. One victim died four days after the release, 10 over an eight-day period at the peak of the deaths, and the last six weeks later. Extensive cleanup, vaccinations, and medical interventions managed to save about 30 of the victims.<ref name=Guillemin_1999_275>{{cite journal | vauthors = Guillemin J |title=Anthrax: The Investigation of a Deadly Outbreak |journal=New England Journal of Medicine |date=2000 |volume=343 |issue=16 |url=https://archive.org/details/anthraxinvestiga0000guil/page/275 |url-access=registration |publisher=University of California Press |isbn=978-0-520-22917-4 |pages=[https://archive.org/details/anthraxinvestiga0000guil/page/275 275–77] |pmid=11041763 |doi=10.1056/NEJM200010193431615 }}</ref> Extensive cover-ups and destruction of records by the [[KGB]] continued from 1979 until Russian President [[Boris Yeltsin]] admitted this anthrax accident in 1992. [[Jeanne Guillemin]] reported in 1999 that a combined Russian and United States team investigated the accident in 1992.<ref name=Guillemin_1999_275/><ref>{{cite web|url=https://www.pbs.org/wgbh/pages/frontline/shows/plague/sverdlovsk/ |title=Plague war: The 1979 anthrax leak |work=Frontline |publisher=PBS |access-date=13 August 2008| archive-url= https://web.archive.org/web/20080917132957/http://www.pbs.org/wgbh/pages/frontline/shows/plague/sverdlovsk/| archive-date= 17 September 2008 | url-status= live}}</ref><ref>{{cite web |url=http://www.medicinenet.com/script/main/art.asp?articlekey=18982 |title=Anthrax – From Russia with Love |work=Infectious Diseases: Causes, Types, Prevention, Treatment and Facts |publisher=MedicineNet.com |access-date=13 August 2008 | vauthors = Fishbein MC |url-status=live |archive-url=https://web.archive.org/web/20081024172944/http://www.medicinenet.com/script/main/art.asp?articlekey=18982 |archive-date=24 October 2008 }}</ref>

Nearly all of the night-shift workers of a ceramics plant directly across the street from the biological facility (compound 19) became infected, and most died. Since most were men, some [[NATO]] governments suspected the Soviet Union had developed a sex-specific weapon.<ref name="Alibek">{{Cite book | vauthors = Alibek K |title=Biohazard |location=New York |publisher=Delta Publishing |year=1999 |isbn=978-0-385-33496-9 |url=https://archive.org/details/biohazardchillin00alib_0 }}</ref> The government blamed the outbreak on the consumption of anthrax-tainted meat, and ordered the confiscation of all uninspected meat that entered the city. They also ordered all [[stray dog]]s to be shot and people not have contact with sick animals. Also, a voluntary evacuation and anthrax vaccination program was established for people from 18 to 55.<ref name="Meselson">{{cite journal | vauthors = Meselson M, Guillemin J, Hugh-Jones M, Langmuir A, Popova I, Shelokov A, Yampolskaya O | title = The Sverdlovsk anthrax outbreak of 1979 | journal = Science | volume = 266 | issue = 5188 | pages = 1202–08 | date = November 1994 | pmid = 7973702 | doi = 10.1126/science.7973702 | bibcode = 1994Sci...266.1202M }}</ref>

To support the [[cover-up]] story, Soviet medical and legal journals published articles about an outbreak in livestock that caused gastrointestinal anthrax in people having consumed infected meat, and cutaneous anthrax in people having come into contact with the animals. All medical and public health records were confiscated by the KGB.<ref name="Meselson" /> In addition to the medical problems the outbreak caused, it also prompted Western countries to be more suspicious of a covert Soviet bioweapons program and to increase their surveillance of suspected sites. In 1986, the US government was allowed to investigate the incident, and concluded the exposure was from aerosol anthrax from a military weapons facility.<ref>{{cite journal | vauthors = Sternbach G | title = The history of anthrax | journal = The Journal of Emergency Medicine | volume = 24 | issue = 4 | pages = 463–67 | date = May 2003 | pmid = 12745053 | doi = 10.1016/S0736-4679(03)00079-9 }}</ref> In 1992, President Yeltsin admitted he was "absolutely certain" that "rumors" about the Soviet Union violating the 1972 Bioweapons Treaty were true. The Soviet Union, like the US and UK, had agreed to submit information to the UN about their bioweapons programs, but omitted known facilities and never acknowledged their weapons program.<ref name="Alibek" />

==== Anthrax bioterrorism ====
In theory, anthrax spores can be cultivated with minimal special equipment and a first-year collegiate [[microbiology|microbiological]] education.<ref>{{cite web |url = http://news.virginia.edu/content/uva-researchers-find-anthrax-can-grow-and-reproduce-soil |access-date = 1 October 2013 |title = U.Va. Researchers Find Anthrax Can Grow and Reproduce in Soil |date = 17 October 2012 | vauthors = Barney J |work = U. Va. Health System |publisher = University of Virginia site |url-status = live |archive-url = https://web.archive.org/web/20121021063057/http://news.virginia.edu/content/uva-researchers-find-anthrax-can-grow-and-reproduce-soil |archive-date = 21 October 2012 }}</ref> To make large amounts of an [[aerosol]] form of anthrax suitable for biological warfare requires extensive practical knowledge, training, and highly advanced equipment.<ref>{{cite news |url=https://news.bbc.co.uk/1/hi/health/1590859.stm |access-date=16 April 2016 |title=Anthrax as a biological weapon |date=10 October 2001 |publisher=BBC News |url-status=live |archive-url=https://web.archive.org/web/20160505140938/http://news.bbc.co.uk/2/hi/health/1590859.stm |archive-date=5 May 2016 }}</ref>

Concentrated anthrax spores were used for bioterrorism in the [[2001 anthrax attacks]] in the United States, delivered by mailing postal letters containing the spores.<ref>{{Cite book| vauthors = Cole LA |title=The Anthrax Letters: A Bioterrorism Expert Investigates the Attacks That Shocked America – Case Closed?|publisher=SkyhorsePublishing|year=2009|isbn=978-1-60239-715-6|url=https://archive.org/details/anthraxlettersbi0000cole|url-access=registration}}</ref> The letters were sent to several news media offices and two Democratic senators: [[Tom Daschle]] of South Dakota and [[Patrick Leahy]] of Vermont. As a result, 22 were infected and five died.<ref name="Pimental04"/> Only a few grams of material were used in these attacks and in August 2008, the US Department of Justice announced they believed that [[Bruce Edwards Ivins|Bruce Ivins]], a senior biodefense researcher employed by the United States government, was responsible.<ref>{{cite news | vauthors = Bohn K | title = U.S. officials declare researcher is anthrax killer | publisher=CNN | date = 6 August 2008 | url = http://www.cnn.com/2008/CRIME/08/06/anthrax.case/index.html | access-date =7 August 2008| archive-url= https://web.archive.org/web/20080808213014/http://www.cnn.com/2008/CRIME/08/06/anthrax.case/index.html| archive-date= 8 August 2008 | url-status= live}}</ref> These events also spawned many [[anthrax hoaxes]].

Due to these events, the US Postal Service installed [[Autonomous Detection System|biohazard detection systems]] at its major distribution centers to actively scan for anthrax being transported through the mail.<ref>{{cite web |title = Cepheid, Northrop Grumman Enter into Agreement for the Purchase of Anthrax Test Cartridges |publisher = Security Products |date = 16 August 2007 |url = http://secprodonline.com/articles/2007/08/16/cepheid-northrop-grumman.aspx |access-date = 26 March 2009 |url-status = live |archive-url = https://web.archive.org/web/20110716031354/http://secprodonline.com/articles/2007/08/16/cepheid-northrop-grumman.aspx |archive-date = 16 July 2011 }}</ref> As of 2020, no positive alerts by these systems have occurred.<ref>{{Cite web|url=https://about.usps.com/news/state-releases/sc/2013/FAQ-BDS.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://about.usps.com/news/state-releases/sc/2013/FAQ-BDS.pdf |archive-date=2022-10-09 |url-status=live|title=USPS BDS FAQ}}</ref>

==== Decontaminating mail ====
In response to the postal anthrax attacks and hoaxes, the United States Postal Service sterilized some mail using gamma [[irradiation]] and treatment with a proprietary [[enzyme]] formula supplied by Sipco Industries.<ref>{{cite web|url=http://www.usps.com/news/facts/lfu_021202.htm|access-date=13 August 2008|title=Latest Facts Update |date=12 February 2002|publisher=USPS|archive-url=https://web.archive.org/web/20090509204939/http://www.usps.com/news/facts/lfu_021202.htm |archive-date=9 May 2009}}</ref>

A scientific experiment performed by a high school student, later published in the ''Journal of Medical Toxicology'', suggested a domestic [[ironing|electric iron]] at its hottest setting (at least {{convert|400|°F|°C}}) used for at least 5 minutes should destroy all anthrax spores in a common postal envelope.<ref>{{Cite journal |last=Roberge |first=Marc R. |date=June 2006 |title=Bacillus spores in the mail: “Ironing” out the anthrax problem |url=http://link.springer.com/10.1007/BF03161173 |journal=Journal of Medical Toxicology |language=en |volume=2 |issue=2 |pages=64–67 |doi=10.1007/BF03161173 |issn=1556-9039}}</ref><ref>{{cite news |title=Seventeen-year-old devises anthrax deactivator |date=23 February 2006 |url=https://www.nbcnews.com/id/wbna11522143 |work=[[NBC News]] |url-status=live |archive-url=https://web.archive.org/web/20141007082027/http://www.nbcnews.com/id/11522143/ns/msnbc-the_ed_show/t/seventeen-year-old-devises-anthrax-deactivator/ |archive-date=7 October 2014 }}</ref>

== Other animals ==
Anthrax, a bacterial disease caused by ''Bacillus anthracis'', can have devastating effects on animals. It primarily affects herbivores such as cattle, sheep, and goats, but a wide range of mammals, birds, and even humans can also be susceptible. Infection typically occurs through the ingestion of spores in contaminated soil or plants. Once inside the host, the spores transform into active bacteria, producing lethal toxins that lead to severe symptoms. Infected animals often exhibit high fever, rapid breathing, and convulsions, and they may succumb to the disease within hours to days. The presence of anthrax can pose significant challenges to livestock management and wildlife conservation efforts, making it a critical concern for both animal health and public health, as it can occasionally be transmitted to humans through contact with infected animals or contaminated products. Infected animals may stagger, have difficulty breathing, tremble, and finally collapse and die within a few hours.<ref>{{Cite web |title=Anthrax {{!}} FAQs |url=https://www.dshs.texas.gov/anthrax/anthrax-faqs |access-date=2023-10-19 |publisher=Texas DSHS |archive-date=25 October 2023 |archive-url=https://web.archive.org/web/20231025120511/https://www.dshs.texas.gov/anthrax/anthrax-faqs |url-status=live }}</ref>

Anthrax is especially rare in dogs and cats, as is evidenced by a single reported case in the United States in 2001.<ref>{{cite web | url = http://dogsinthenews.com/issues/0110/articles/011030a.htm | title = Can Dogs Get Anthrax? | archive-url = https://web.archive.org/web/20120406205603/http://dogsinthenews.com/issues/0110/articles/011030a.htm | archive-date=6 April 2012 | work = Canine Nation | date = 30 October 2001 | access-date = 17 February 2007 }}</ref> Anthrax outbreaks occur in some wild animal populations with some regularity.<ref name="Dragon1999">{{cite journal | vauthors = Dragon DC, Elkin BT, Nishi JS, Ellsworth TR | title = A review of anthrax in Canada and implications for research on the disease in northern bison | journal = Journal of Applied Microbiology | volume = 87 | issue = 2 | pages = 208–13 | date = August 1999 | pmid = 10475950 | doi = 10.1046/j.1365-2672.1999.00872.x | doi-access = free }}</ref>

Russian researchers estimate arctic [[permafrost]] contains around 1.5&nbsp;million anthrax-infected reindeer carcasses, and the spores may survive in the permafrost for 105 years.<ref name="RevichPodolnaya2011">{{cite journal | vauthors = Revich BA, Podolnaya MA | title = Thawing of permafrost may disturb historic cattle burial grounds in East Siberia | journal = Global Health Action | volume = 4 | page= 8482 | year = 2011 | pmid = 22114567 | pmc = 3222928 | doi = 10.3402/gha.v4i0.8482 }}</ref> A risk exists that [[global warming in the Arctic]] can thaw the permafrost, releasing anthrax spores in the carcasses. In 2016, an anthrax outbreak in reindeer was linked to a 75-year-old carcass that defrosted during a heat wave.<ref>{{cite web|url=http://siberiantimes.com/other/others/news/n0691-40-now-hospitalised-after-anthrax-outbreak-in-yamal-more-than-half-are-children/|title=40 now hospitalised after anthrax outbreak in Yamal, more than half are children|url-status=live|archive-url=https://web.archive.org/web/20160730185500/http://siberiantimes.com/other/others/news/n0691-40-now-hospitalised-after-anthrax-outbreak-in-yamal-more-than-half-are-children/|archive-date=30 July 2016}}</ref><ref>{{cite magazine |url=https://www.wired.com/2016/08/child-dead-climate-change-thawed-anthrax-infected-reindeer/ |title=Siberian Child Dies After Climate Change Thaws an Anthrax-Infected Reindeer | vauthors = Luhn A |date=8 August 2016 |magazine=Wired |access-date=19 August 2016 |url-status=live |archive-url=https://web.archive.org/web/20160817043745/http://www.wired.com/2016/08/child-dead-climate-change-thawed-anthrax-infected-reindeer/ |archive-date=17 August 2016 }}</ref>

== References ==
{{Reflist}}

== Further reading ==
{{refbegin}}
* {{cite book |title=Anthrax in humans and animals |date=2008 |publisher=World Health Organization |location=Geneva |isbn=978-92-4-154753-6 |edition=4th | url = https://www.who.int/csr/resources/publications/anthrax_web.pdf | archive-url = https://web.archive.org/web/20161130153732/https://www.who.int/csr/resources/publications/anthrax_web.pdf | archive-date = 30 November 2016 }}
* {{cite journal | journal = [[Scientific American]] | url = https://books.google.com/books?id=YIE9AQAAIAAJ | title = Earthworms and Anthrax | date = 23 July 1881 | page = 57 }}
{{refend}}

== External links ==
{{Commons category|Anthrax (disease)}}

{{Medical condition classification and resources
 | DiseasesDB = 1203
 | ICD11 = {{ICD11|1B97}}
 | ICD10 = {{ICD10|A|22}}
 | ICD9 = {{ICD9|022}}
 | ICDO =
 | OMIM =
 | OMIM_mult = {{OMIM|606410||none}} {{OMIM|608041||none}}
 | MedlinePlus = 001325
 | eMedicineSubj = med
 | eMedicineTopic = 148
 | MeshID = D000881
}}
{{Bioterrorism}}
{{Gram-positive bacterial diseases}}
{{Authority control}}

[[Category:Anthrax| ]]
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[[Category:Wikipedia infectious disease articles ready to translate]]
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