Disease and Condition

New York State Department of Health
Anthrax (malignant edema, woolsorters' disease)
Last Reviewed: November 2006
What is anthrax?
Anthrax is a rare infectious disease caused by the bacterium Bacillus anthracis. Anthrax occurs naturally
around the world in wild and domestic hoofed animals, especially cattle, sheep, goats, camels and antelopes.
It can also occur in humans when they are exposed to the bacterium, usually through handling animals or
animal hides. There are three forms of anthrax infection: cutaneous (skin), inhalation (lungs) and
gastrointestinal (stomach and intestine). If people have been intentionally exposed, as in a bioterrorist
release, contact with skin would be the most likely route of exposure. Breathing in the spores that have been
spread through the air could cause inhalation anthrax.
How common is anthrax and who can get it?
Anthrax can be found around the world. It is most common in agricultural regions where it occurs in animals.
It is more common in developing countries or countries without veterinary public health programs. Anthrax is
reported more often in some regions of the world (South and Central America, Southern and Eastern Europe,
Asia, Africa, the Caribbean and the Middle East) than in others. It has been extremely rare in the United
States in recent decades, and until cases in Florida and New York City in 2001, has been limited to the
cutaneous (skin) form. When anthrax affects humans, it is usually due to an occupational exposure to infected
animals or their products. However, anthrax is considered to be one of a number of potential agents for use in
biological terrorism.
How is anthrax spread?
Anthrax is usually spread in the form of a spore. (A spore is a dormant form that certain bacteria take when
they have no food supply. Spores can grow and cause disease when better conditions are present, as in the
human body.) Anthrax is generally spread in one of three ways. Most persons who are exposed to anthrax
become ill within one week:
�� Skin (cutaneous) - Most anthrax infections occur when people touch contaminated animal products like
wool, bone, hair and hide. The infection occurs when the bacteria enters a cut or scratch in the skin.
�� Inhalation (lung) - Some anthrax infections occur when people breathe in the spores of the bacteria.
However, the infectious dose for inhalational anthrax is quite high, and requires exposure to a large
number of spores (8,000-10,000).
�� Gastrointestinal - Some people may get anthrax by eating infected meat that has not been properly
cooked.
What are the symptoms of anthrax?
�� Skin (cutaneous) - This is the most common form of anthrax. Infection requires a break in the skin. The
first symptoms include itching where the skin has been exposed. Then, a large boil or sore appears. The
sore becomes covered by a black scab. If not treated, the infection can spread to the lymph nodes and
bloodstream.
�� Inhalation - Inhalation anthrax has been very rare in the U.S. First symptoms include fever, fatigue,
malaise and a cough or chest pain. High fever, rapid pulse and severe difficulty breathing follow in two
to five days. Inhalation anthrax is often fatal.
�� Gastrointestinal - This form occurs only after eating infected, undercooked meat. First symptoms
include fever; abdominal pain; loose, watery bowel movements; and vomiting with blood.

How soon after exposure do symptoms develop?
Symptoms usually develop between one and seven days after exposure but prolonged periods up to 12 days
for cutaneous (skin) anthrax and 60 days for inhalation anthrax are possible, though rare.
Can anthrax be spread person to person?
Inhalation (lung) anthrax is not spread from person to person. Even if you develop symptoms of inhalation
anthrax, you are not contagious to other persons. If you develop cutaneous (skin) anthrax, the drainage from
an open sore presents a low risk of infection to others. The only way cutaneous (skin) anthrax can be
transmitted is by direct contact with the drainage from an open sore. Anthrax is not spread from person to
person by casual contact, sharing office space or by coughing and sneezing.
How is it diagnosed?
Anthrax is diagnosed when the Bacillus anthracis bacterium is found in the blood, skin lesions or respiratory
secretions by a laboratory culture. It can also be diagnosed by measuring specific antibodies in the blood of
infected persons. Nasal swabs are not a good way to diagnose anthrax because a swab cannot definitively
determine if someone has not been exposed to anthrax.
What is the treatment for illness caused by anthrax?
There are several antibiotics that are used successfully to treat anthrax. Treatment is highly effective in cases
of cutaneous (skin) anthrax and is effective in inhalation and gastrointestinal anthrax if begun early in the
course of infection. The United States has a large supply of these antibiotics and can quickly manufacture
more if needed.
Is there a way to prevent infection?
Persons known to be exposed to confirmed anthrax spores will be given antibiotics, usually ciprofloxacin
(cipro) or doxycycline, to prevent infection.
Do I need to disinfect myself or my belongings if I believe I was exposed to
anthrax?
Most threats regarding anthrax have proven to be hoaxes. However, in the event of a possible exposure to a
powder or other unknown substance with a threat that may indicate anthrax, call 911 and leave the material
alone. To prevent infection if you have a skin exposure to the powder or other substance, wash your hands
vigorously with soap and water, and shower with soap and water if necessary. Similarly, washing possibly
contaminated clothes in the regular laundry will safely remove any possible anthrax. To be inhaled, anthrax
spores must first be aerosolized (dispersed in the air) which does not usually occur. In the unlikely event that
you do inhale spores, medical evaluation and treatment is needed, usually after spores are identified.
Revised: November 2006

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