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A large local employer for whom you do preplacement examinations
calls to say that an employee in the mailroom saw an envelope with
a suspicious white powder coming from its seams. Following the CDC
guidelines, the company protocol for suspicious mail is followed:
the envelope is left undisturbed and the room is vacated and locked.
Although identification of the substance is pending, the company
president has many questions, including whether his employees must
be given a vaccine or antibiotics and wants your advice. What should
you say?
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Since antiquity, anthrax has affected livestock and humans. The
name anthrax derives from the Greek word for “coal” because
of the black skin lesions it can cause. One of the first records
of anthrax is in the Old Testament’s Book of Exodus as
the fifth and possibly sixth of the ten plagues (Fig. 14–1).
Virgil wrote verses on the disease in 25 bc describing
the toll it took on livestock and the health risks to humans from
exposure to infected meats and skins. The modern history of anthrax
begins in the late nineteenth century when Louis Pasteur identified
the bacterium responsible for anthrax, an observation that lent
early credibility to the germ theory of disease. Anthrax was used
as a weapon in World War I as a means to cause economic havoc through
the loss of livestock.
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Anthrax (Bacillus anthracis) is
a gram-positive, nonmotile spore-forming bacterium that infects
both humans and animals, particularly livestock. Anthrax is found
in a worldwide distribution. The spores, most commonly found in
soil, are hardy and may survive for decades. In humans, the disease
presents in three forms: inhalational, cutaneous, and gastrointestinal.
Mortality is greatest for the inhalational form. If diagnosed early,
anthrax is a highly treatable disease. Even weaponized anthrax,
such as that used in the attacks through the U.S. Postal Service,
is treatable with conventional antibiotics.
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The incidence of anthrax has dropped significantly over the years
in technologically advanced countries, in large part because of
vaccination of high-risk groups—those regularly exposed
to hides, wools, and other raw livestock products. Prior to the
anthrax attacks in 2001, American experience with anthrax was limited.
The only modern experience with the inhalational form was in 1979
with the accidental release of anthrax spores from the Soviet bioweapons
facility in Sverdlosk, Russia, in which 72 died. The last case of
inhalational anthrax in the United States occurred in 1972.
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Worldwide the disease is more common, with best estimates ranging
between 20,000 and 100,000 cases of anthrax annually, and almost
all occurring in developing nations. Most current public health
policies regarding anthrax, such as vaccination strategies and medical
management human experience are based on limited information and ...