Anthrax is a zoonosis caused by Bacillus Anthracis. There are four types of anthrax: inhalational anthrax (also known as woolsorter's disease and ragsorter's disease), cutaneous anthrax, injection anthrax and intestinal anthrax.
The disease burden of anthrax decreased so dramatically in the Western world over the last century that concern about the disease became primarily driven by bioterrorism events, however the disease remains endemic in some parts of the developing world. More recently there have been outbreaks of the injection form of the disease in intravenous drug users in Europe, particularly Northern Europe 1.
Most cases of anthrax are of the cutaneous form 2. Cutaneous anthrax is known classically as a disease that forms an eschar.
Inhalational anthrax is described as a disease that causes cough, fever and dyspnea.
Bacillus anthracis is found in soil and has a reservoir in animals. Although animals are typically understood as the vector for the disease, anthrax can also be acquired through insect bites 3. The various forms of anthrax are distinguished by their suspected acquisition route. Intestinal anthrax is ingested with the meat of infected animals, cutaneous anthrax is acquired through contact with infected animals or animal products such as hides, and injected anthrax is due to injected contaminated IV drugs.
Recently it has become clear that some isolates of Bacillus cereus can cause an anthrax-like disease which may be similarly severe 8,9.
Inhalational anthrax is associated with pleural effusions and mediastinal widening 4-6. There are a few reports in the literature of the imaging findings of anthrax-related meningoencephalitis 7, and it is generally described as a disease with multiple hemorrhagic lesions.
- 1. Hope VD, Palmateer N, Wiessing L, Marongiu A, White J, Ncube F, Goldberg D. A decade of spore-forming bacterial infections among European injecting drug users: pronounced regional variation. (2012) American journal of public health. 102 (1): 122-5. doi:10.2105/AJPH.2011.300314 - Pubmed
- 2. Shafazand S, Doyle R, Ruoss S, Weinacker A, Raffin TA. Inhalational anthrax: epidemiology, diagnosis, and management. (1999) Chest. 116 (5): 1369-76. doi:10.1378/chest.116.5.1369 - Pubmed
- 3. Kasradze A, Echeverria D, Zakhashvili K, Bautista C, Heyer N, Imnadze P, Mirtskhulava V. Rates and risk factors for human cutaneous anthrax in the country of Georgia: National surveillance data, 2008-2015. (2018) PloS one. 13 (2): e0192031. doi:10.1371/journal.pone.0192031 - Pubmed
- 4. Wood BJ, DeFranco B, Ripple M, Topiel M, Chiriboga C, Mani V, Barry K, Fowler D, Masur H, Borio L. Inhalational anthrax: radiologic and pathologic findings in two cases. (2003) AJR. American journal of roentgenology. 181 (4): 1071-8. doi:10.2214/ajr.181.4.1811071 - Pubmed
- 5. Vessal K, Yeganehdoust J, Dutz W, Kohout E. Radiological changes in inhalation anthrax. A report of radiological and pathological correlation in two cases. (1975) Clinical radiology. 26 (4): 471-4. doi:10.1016/s0009-9260(75)80100-0 - Pubmed
- 6. Krol CM, Uszynski M, Dillon EH, Farhad M, Machnicki SC, Mina B, Rothman LM. Dynamic CT features of inhalational anthrax infection. (2002) AJR. American journal of roentgenology. 178 (5): 1063-6. doi:10.2214/ajr.178.5.1781063 - Pubmed
- 7. Kim HJ, Jun WB, Lee SH, Rho MH. CT and MR findings of anthrax meningoencephalitis: report of two cases and review of the literature. (2001) AJNR. American journal of neuroradiology. 22 (7): 1303-5. Pubmed
- 8. Cross AR, Baldwin VM, Roy S, Essex-Lopresti AE, Prior JL, Harmer NJ. Zoonoses under our noses. (2019) Microbes and infection. 21 (1): 10-19. doi:10.1016/j.micinf.2018.06.001 - Pubmed
- 9. Marston CK, Ibrahim H, Lee P, Churchwell G, Gumke M, Stanek D, Gee JE, Boyer AE, Gallegos-Candela M, Barr JR, Li H, Boulay D, Cronin L, Quinn CP, Hoffmaster AR. Anthrax Toxin-Expressing Bacillus cereus Isolated from an Anthrax-Like Eschar. (2016) PloS one. 11 (6): e0156987. doi:10.1371/journal.pone.0156987 - Pubmed