Anthrax in Haiti

Anthrax is the deadly spore that resulted in five deaths during the bio terrorism attack in the US in the weeks following 911.

Cutaneous anthrax is endemic (always present) in Haiti. 

Anthrax is caused by Bacillus anthracis, a bacteria that forms spores. The spores can survive for extended periods in the soil and are eaten by domestic animals who graze on contaminated vegetation or drink contaminated water. The infection develops when the skin is in contact with an infected animal (cutaneous anthrax), when a person eats meat from an infected animal (gastrointestinal anthrax) or when an individual inhales spores from the hide of an infected animal (pulmonary anthrax).  

Cutaneous anthrax usually involves the skin of the head, neck, forearms, or hands. The spores enter the skin through minor cuts or abrasions. The incubation period is usually 5 to 7 days, during which time the spores germinate, multiply, and release toxins, which are responsible for the symptoms. About 20 percent of cutaneous infections spread into the blood stream and result in sepsis, meningitis and death. As such, all cases of cutaneous anthrax should be treated with antibiotics. With prompt antibiotic therapy, mortality from cutaneous anthrax is virtually zero. During the anthrax scare in September 2001, many government officials were treated with a preventative antibiotic.  

The infection starts as a painless, itchy papule. The lesion enlarges and develops a central vesicle which progresses to an ulcer with a central depressed black area. The surrounding tissue is swollen and the regional lymph nodes are increased. Fever and headache might develop.  

Cutaneous anthrax lesion with central depressed black area.
Photo courtesy Wikipedia.

The diagnosis requires a gram stain of the lesion and the demonstration of the typical gram positive rod.  

Oral ciprofloxin (15 mg/kg) divided bid is the recommended treatment.

Anthrax in humans is not considered contagious. 

Goat-hide souvenirs exported from Haiti are a reported source of the infection.

While in Haiti I will keep my eyes open for skin lesions with a black center.