Protected: Anthrax (Bacillus Anthracis)

Anthrax is usually a disease of herbivorous mammals and is caused by the bacterium Bacillus anthracis. Anthrax is contracted through environmental exposure and cannot be transmitted from person to person.

In humans, anthrax can be contracted through direct or indirect contact with infected animals, including handling meat, hides, hair and wool. There are also concerns about the use of anthrax as a bioterrorism agent.

Incubation Period :

• Cutaneous: 1 to 7 days (usually 48 hours)
• Gastrointestinal: 1 to 7 days
• Inhalation (Pulmonary): 1 to 7 days (rarely up to 2 months)
• Injection anthrax: 1-4 days after exposure

The symptoms of anthrax depend on route of infection and take four main forms: inhalation, gastrointestinal, cutaneous and injection.

• Inhalation (pulmonary) anthrax can occur when a person inhales spores that are in the air (aerosolized) during the industrial processing of contaminated materials, such as wool, hides, or hair.

Following inhalation of spores, time to onset of symptoms is dependent on the number of spores inhaled. Symptoms may include mild pyrexia and malaise lasting a few days; followed by a flu-like illness, leading quickly to shock, collapse and death.

• Gastrointestinal anthrax can occur through ingestion of spores and leads to severe gastrointestinal disease with nausea, vomiting, anorexia and fever leading to shock, collapse and death.
• Cutaneous anthrax (>90% cases) can occur when workers who handle contaminated animal products get spores in a cut or scrape on their skin.

Entry through a skin lesion leads to the development initially of a pimple which, within two to three days, develops to form a dry, black firmly adherent scab from two to several cm in diameter across. The lesion rarely causes much pain, but there is nearly always considerable oedema which may spread a long way from the site of the lesion and may take up to six weeks to resolve.

• Injection anthrax is a novel form of infection seen in heroin users and most likely contracted from using heroin contaminated with anthrax spores.

Symptoms are fever and chills, small blisters/ bumps at the injection site which change to a painless skin sore with a black centre, swelling around the sore often accompanied with abscesses at the injection site.

All types of anthrax have the potential, if untreated, to spread throughout the body and cause severe illness and even death.

If NIAS staff are aware that the patient has a suspected or confirmed Anthrax this should be communicated to EAC and ED staff when transferring the patient to ensure effective patient care and management.

• Standard Precautions should be used.
• Hand Hygiene should be completed as per the 5 moments in line with usual practice.
• All equipment and the ambulance should have a deep clean paying particular attention to touch points.
• Gloves and Aprons should be risk assessed and worn if contact with the patient’s blood or bodily fluids.
• Eye protection should be risk assessed for any concern regarding a splash risk.
• Laundry should be treated as contaminated, placed into an alginate bag and placed into a red laundry bag.

No staff follow up required.

The IPC team can be contacted for further advice. The team will be able to help staff risk assess the patient and precautions required and to provide support where required.