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Facts about Anthrax,
Botulism, Smallpox, and Pneumonic Plague
Anthrax is an acute infectious disease caused by the
spore-forming bacterium Bacillus anthracis.
Anthrax most commonly occurs in hoofed mammals and can
also infect humans.
Symptoms of disease vary depending on how the disease was
contracted, but usually occur within 7 days after
exposure. The serious forms of human anthrax are inhalation
anthrax, cutaneous anthrax, and
Initial symptoms of inhalation anthrax
infection may resemble a common cold. After several days,
the symptoms may progress to severe breathing problems
and shock. Inhalation anthrax is often fatal.
Most (about 95%) anthrax infections are cutaneous,
and occur when the bacterium enters a cut or abrasion on
the skin, such as when handling contaminated wool, hides,
leather or hair products (especially goat hair) of
infected animals. Skin infection begins as a raised itchy
bump that resembles an insect bite but within 1-2 days
develops into a vesicle and then a painless ulcer,
usually 1-3 cm in diameter, with a characteristic black
necrotic (dying) area in the center. Lymph glands in the
adjacent area may swell. About 20% of untreated cases of
cutaneous anthrax will result in death. Deaths are rare
with appropriate antimicrobial therapy.
The intestinal disease form of anthrax
may follow the consumption of contaminated food and is
characterized by an acute inflammation of the intestinal
tract. Initial signs of nausea, loss of appetite,
vomiting, and fever are followed by abdominal pain,
vomiting of blood, and severe diarrhea.
Direct person-to-person spread of anthrax is
extremely unlikely, if it occurs at all.
Therefore, there is no need to immunize or treat contacts
of persons ill with anthrax, such as household contacts,
friends, or coworkers, unless they also were also exposed
to the same source of infection.
In persons exposed to anthrax, infection can be prevented
with antibiotic treatment.
Early antibiotic treatment of anthrax is
essentialdelay lessens chances for survival. Anthrax
usually is susceptible to penicillin, doxycycline, and
An anthrax vaccine also can prevent infection.
Vaccination against anthrax is not recommended for the
general public to prevent disease and is not available.
Botulism is a muscle-paralyzing disease caused by a toxin
made by a bacterium called Clostridium botulinum.
There are three main kinds of botulism:
occurs when a person ingests pre-formed toxin that leads
to illness within a few hours to days. Foodborne botulism
is a public health emergency because the contaminated
food may still be available to other persons besides the
occurs in a small number of susceptible infants each year
who harbor C. botulinum in their intestinal tract.
occurs when wounds are infected with C. botulinum that
secretes the toxin.
With foodborne botulism, symptoms begin within 6 hours to
2 weeks (most commonly between 12 and 36 hours) after
eating toxin-containing food. Symptoms of botulism
include double vision, blurred vision, drooping eyelids,
slurred speech, difficulty swallowing, dry mouth, muscle
weakness that always descends through the body: first
shoulders are affected, then upper arms, lower arms,
thighs, calves, etc. Paralysis of breathing muscles can
cause a person to stop breathing and die, unless
assistance with breathing (mechanical ventilation) is
Botulism is not spread from one person to
another. Foodborne botulism can occur in all age
A supply of antitoxin against botulism is maintained by
CDC. The antitoxin is effective in reducing the severity
of symptoms if administered early in the course of the
disease. Most patients eventually recover after weeks to
months of supportive care.
about Pneumonic Plague
Plague is an infectious disease of animals and humans
caused by the bacterium Yersinia pestis. Yersinia
pestis is found in rodents and their fleas in many
areas around the world.
Pneumonic plague occurs when Yersinia pestis
infects the lungs. The first signs of illness in
pneumonic plague are fever, headache, weakness, and cough
productive of bloody or watery sputum. The pneumonia
progresses over 2 to 4 days and may cause septic shock
and, without early treatment, death.
Person-to-person transmission of pneumonic plague occurs
through respiratory droplets, which can only infect those
who have face-to-face contact with the ill patient.
Early treatment of pneumonic plague is essential. Several
antibiotics are effective, including streptomycin,
tetracycline, and chloramphenicol.
There is no vaccine against plague.
Prophylactic antibiotic treatment for 7 days will protect
persons who have had face-to-face contact with infected
Smallpox infection was eliminated from the world in 1977.
Smallpox is caused by variola virus. The incubation
period is about 12 days (range: 7 to 17 days) following
exposure. Initial symptoms include high fever, fatigue,
and head and back aches. A characteristic rash, most
prominent on the face, arms, and legs, follows in 2-3
days. The rash starts with flat red lesions that evolve
at the same rate. Lesions become pus-filled and begin to
crust early in the second week. Scabs develop and then
separate and fall off after about 3-4 weeks. The majority
of patients with smallpox recover, but death occurs in up
to 30% of cases.
Smallpox is spread from one person to another by infected
saliva droplets that expose a susceptible person having
face-to-face contact with the ill person. Persons with
smallpox are most infectious during the first week of
illness, because that is when the largest amount of virus
is present in saliva. However, some risk of transmission
lasts until all scabs have fallen off.
Routine vaccination against smallpox ended in
1972. The level of immunity, if any, among
persons who were vaccinated before 1972 is uncertain;
therefore, these persons are assumed to be susceptible.
Vaccination against smallpox is not recommended to
prevent the disease in the general public and therefore
is not available.
In people exposed to smallpox, the vaccine can
lessen the severity of or even prevent illness if given
within 4 days after exposure. Vaccine against
smallpox contains another live virus called vaccinia. The
vaccine does not contain smallpox virus.
The United States currently has an emergency supply of
There is no proven treatment for smallpox but research to
evaluate new antiviral agents is ongoing. Patients with
smallpox can benefit from supportive therapy (intravenous
fluids, medicine to control fever or pain, etc.) and
antibiotics for any secondary bacterial infections that
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