Injectional anthrax in human: A new face of the old disease

Abstract

Unusual human behavior leads to the emergence of new forms of infectious diseases and new routes of infection. In recent years, a new form of anthrax, called injectional anthrax, emerged and was related to 2 human anthrax outbreaks in Europe. The infection was caused by heroin contaminated with anthrax spores. The new form of anthrax differs from the earlier known "natural" forms of the disease in symptoms, length of the incubation period and recommended treatment. Despite medical treatment, the mortality rate in injectional anthrax is about 35%. This article presents an overview of the forms of anthrax infection in humans, with focus on injectional anthrax syndrome, as well as actual recommendations for treatment, including antibiotic therapy, surgery and possibilities of administering anthrax antitoxin. As a source of contamination of heroin have not been identified and new cases of injectional anthrax might occur again in any country in the future.

JMM Profile: Bacillus anthracis

“…Ancillary treatments in systemic disease include drainage of cavity effusions and poly-or mono-clonal antitoxin (anti-PA) antibodies [16,29,31]. Surgical debridement may be necessary for injectional anthrax [10].…”

Current Status and Trends in Prophylaxis and Management of Anthrax Disease

“…Humans can be infected by four major routes: inhalational, cutaneous, gastrointestinal [19], and intravenous/injectional [20]. As a naturally occurring disease, primarily in herbivores, anthrax was one of the major causes of mortality in livestock until the development of live attenuated veterinary vaccines in the 1930s [6].…”

“…People at risk of contracting cutaneous anthrax are butchers, farmers, veterinarians, and those working with animal hide or wool [22,23]. In the EU, intravenous drug users were identified as an additional risk group from a new clinical manifestation of anthrax, i.e., intravenous/injectional anthrax [20].…”

“…Although humans are moderately resistant to anthrax, four types of human anthrax disease are now recognized, none of which are contagious [19,20]. Infectious doses are difficult to determine, but in the absence of skin lesions, 50% infective doses (ID 50 ) are in the thousands or tens of thousands of spores.…”

Routes of Spread of Anthrax in Natural Ecosystems

“…Встречается также инъекционная форма сибирской язвы, возникающая при внутривенном введении препаратов, контаминированных спорами B. anthracis, описанная у инъекционных опиатных наркоманов. Она проявляется локальными поражениями мягких тканей с выраженными отеками и/или тяжелой системной сибирской язвой с полиорганной недостаточностью и сибиреязвенным менингитом [18]. Однако из-за крайне специфического способа передачи инфекции эта форма болезни является редкой и не значима для эпидемиологии.…”