Siberian Anthrax

379 Statistics and geographical distribution.

395 Siberian anthrax, or anthrax (from Greek anthrax - coal, in French charbon, in German Milzbrand), is an acute infectious disease of domestic animals, primarily herbivores, belonging to zoonoses. It also infects humans either directly from sick animals or through animal products or through insect vectors. Etiology. The causative agent of S. a. - Bacillus anthracis - was the first pathogenic bacterium discovered. In 1850, Davaine and Rayer saw it in the blood of sheep that had died from S. a., in 1855, Pollender - in the blood and tissues of cattle, and almost simultaneously, Brauell - in the blood not only of people, sheep, and horses that had died from S. a., but also in living sick animals. Brauell succeeded in the first vaccinations using material containing the rods he had seen under the microscope. After Koch (1876) and Pasteur (1877) published their methods for cultivating Bacillus anthracis in pure form and their experiments with it on animals, comprehensive experimental study of S. a. began. - Bacillus anthracis in its vegetative form consists of straight (non-motile) rods 4.5-10 μ in length and 1-1.5 μ in thickness, lying in fresh anthrax blood singly or in the form of short chains of 2-3 segments, but on artificial media forming more or less long thread-like combinations. The ends of the rods appear rounded in a hanging drop, but after drying and staining they appear as if cut off, slightly thickened and concave, so that the entire thread resembles a bamboo cane. (See separate table to the article Syphilis, fig. 8.) In the blood and tissues of the diseased organism, Bacillus anthracis is surrounded by a more or less dense capsule; outside the organism, it is possible to induce capsule formation only by adding to nutrient media blood serum, fresh or defibrinated blood, egg white, etc. Under certain conditions, Bacillus anthracis is capable of forming spores; for this it requires free access to atmospheric oxygen, a temperature not below 18° (according to some authors not below 14°) and not above 42.5°, moisture, and a neutral or slightly alkaline reaction of the medium (pH 7.3). Due to the absence of the first of these conditions, sporulation never occurs in the bodies of sick animals or in the carcasses of animals that died from S. a. as long as their integrity is not violated. - The vegetative forms of Bacillus anthracis are easily stained with ordinary solutions of basic aniline dyes, as well as by Gram's method. For staining capsules, it is possible to do without the complex methods proposed in large numbers by various authors; Löffler's blue stains the rods blue, the capsules pinkish; when stained with safranin, the rods appear red, the capsules yellow; by Giemsa's method, dark blue rods in a pink capsule are obtained. Cultivation of Bacillus anthracis on artificial nutrient media is possible under aerobic conditions (slowly and irregularly under anaerobic conditions), at a temperature of 30-37° (minimum 12°, maximum 45°), at an optimal pH of 7.5-7.8 (minimum 6.0, maximum 8.5). Due to the formation of long, twisting threads, the growth of Bacillus anthracis on artificial media presents rather characteristic pictures. In broth, whitish, fluffy, cotton-like clots form, floating in completely transparent liquid and gradually settling to the bottom; when shaken, they break up, causing uniform cloudiness of the medium. On agar, young colonies also have a fluffy appearance; especially characteristic are the edges, consisting of loose curls of long threads protruding far into the surrounding environment (picture of a "jellyfish head"); old overgrown or merged colonies form grayish dense, slightly slimy coatings with fringed edges. On gelatin, Bacillus anthracis grows along the entire stab as a white rod, from which delicate horizontal branches extend in all directions, giving the culture the appearance of an inverted fir tree. On the 3rd-4th day, liquefaction of the gelatin begins from the top, with the bacterial masses settling to the bottom, leaving completely transparent liquid above them. The ability to form enzymes is also manifested in the growth of Bacillus anthracis in milk, which it first coagulates (after 2-4 days) and then slowly dissolves. The oxidative capacity of Bacillus anthracis is manifested on litmus milk serum and on media with dextrose. It does not form indole, does not produce hemolysis. By prolonged cultivation at temperatures above 42.5° or on media with the addition of chemicals that inhibit sporulation (carbolic acid, potassium bichromate, etc.), it is possible to completely deprive it of the ability to form spores and create "asporogenous" strains. The emergence of such mutant strains in nature is not excluded. The resistance of the vegetative forms of anthrax virus to physical and chemical agents is very slight. Direct sunlight kills the rods of S. a. in periods (measured in hours) depending on the actinic properties of the light and composition of the medium; they cannot withstand complete drying; they perish when heated to 55° (the temperature at which protein coagulates); they are easily destroyed by many saprophytic microbes, especially under anaerobic conditions (e.g., in carcasses, in the depths of manure piles); in gastric juice they die in 15-20 minutes. All chemical substances used in disinfection practice kill them in usual concentrations. In contrast to the vegetative forms of Bacillus anthracis, its spores possess great resistance, varying within certain limits in different strains. Drying has no effect on them; direct sunlight kills them only with prolonged action, measured in days; putrefactive processes do not affect them. Therefore, spores can maintain their viability and virulence for months (in liquid manure), years (in water), and decades in soil. Dry heat at 120-140° the spores resist for up to three hours, while moist steam, flowing or autoclave, kills them in 3-5 minutes, boiling in 15 minutes. Chemical disinfectants act very slowly on S. a. spores, especially those enclosed in organic substances; a relatively quick effect is given by a mercuric-carbolic solution (1:1000 mercuric chloride + 3% carbolic acid). Spores are not neutralized by salting and smoking.

A.

Vladimirov. Statistics and Geographical Distribution. S. y. occurs in all parts of the world and all countries. In non-European countries it is endemic in Asia—in India, China, and Persia; in Africa—in the Nile Valley and in most colonies; in South America—in Chile, Brazil, and in the basin of the La Plata River. In Australia thousands of sheep die annually from S. y. (Hubener). In Germany before the war about 7,000 domestic animals died annually from S. y. (1912—6,283; 1913—6,816; 1914—7,181). The distribution of S. y. among individual species of domestic animals is shown by the following figures from Germany, where according to official data cases were reported (Table 1; according to Sobernheim): Table 1. Years Horses Horned cattle Sheep Goats Swine 4,498 1,993 4,218 2,706 S. y. among humans is subject to compulsory registration in far from all countries. General figures of registered cases for the period from 1926 to 1931 in some countries are given in Table 2. Table 2. - Number of registered cases of S. y. among humans in individual countries for 1926-31. Countries 1926 1927 1928 1S29 1930 1931 European: Austria . 17 ' Bulgaria Hungary* Ь6 Germany Greece* . - - - Italy . . 1 75^ 2 003 1 676 Poland . Romania . - 1 199 1 358 1 528 Czechoslovakia . . . Yugoslavia 4,086 Non-European: Turkey . Kenya (Africa) Uruguay . Chile* . . иг 70 ! * Number of yiv НфШИХ. As can be seen from these figures, the largest number of diseases is observed in agricultural countries with poorly organized veterinary supervision (Bulgaria, Italy, Romania, Yugoslavia). The highest morbidity rates (per 10,000 population) in recent years are in Bulgaria (1.2-1.4), Romania (0.7-0.8), Yugoslavia (0.5-0.8), Italy (0.4-0.5). In Austria, Germany and Poland this rate is 0.02 per 10,000* population, in the USA—0.01. In the Netherlands about 50 cases of S. y. are registered annually. In England for the period from 1911 to 1922, from 5 to 25 cases of disease were registered annually among the agricultural population and from 25 to 100 diseases among workers. In Argentina, 302 people died from S. y. in 1916, 501 in 1917, and 511 in 1918; these data are incomplete; they refer only to some provinces of this country. As can be seen from Table 2, S. y. in the last 10 years in most countries does not show a tendency to decrease. During the world war in some countries, for example in Germany, a noticeable decrease in S. y. morbidity was noted, which German researchers explain by the cessation of importation of infected raw materials from abroad in those years. In recent years the number of diseases in Germany has again risen to approximately the previous level. In pre-war Russia with its small-scale farming and extremely weak veterinary organization, S. y. morbidity was very high. The number of diseases among humans according to official data for the last 10 years before the war was (Table 3): Table 3. Years Number of diseases Years Number of diseases 1905 1903 1907 1908 1909 14,323 18,027 18,137 17,288 19,769 1910 1911 1912 1913 1911 17,967 17,031 15,474 15,167 11,753 Diseases were concentrated mainly in agricultural provinces: b. Voronezh, Samara, Saratov, Kharkov, Yekaterinoslav, Kherson, etc. In the USSR in connection with the collectivization of agriculture, S. y. diseases decreased significantly, S. y. everywhere has a sharply pronounced professional character. It is observed as a rule in persons who come into contact with animals or animal raw materials in the course of their work. Diseases of a non-professional* nature, for example during shaving (infected brush), occur in isolated cases. In Italy almost all cases of disease refer to the agricultural population. The same applies to Bulgaria and Yugoslavia. In the USSR also—the main mass of diseases is observed among the rural population. In Germany for the period from 1910 to 1914 out of 1,275 cases of S. y., in 92.9% a connection of the disease with the patient's occupation was established, and only in 7.1% they did not have a professional character. In subsequent years (1925-1931) non-professional diseases accounted for from 2.5% to 15.2% (Dornedden). In industry S. y. is observed mainly in the processing of leather, hair and wool. According to three industrial states of Europe, professional S. y. diseases were established in the following types of industry (Table 4; according to Sclavo). S. y. mainly affects adults over 20 years of age, men get sick significantly more often than women: in Germany for the period from 1925 to 1931, 1,082 men and only 107 women got S. y. (Dornedden). In some areas of the USSR morbidity among men exceeded that among women by 4 times. Such age and sex distribution of S. y. is explained by the professional nature of this disease. Localization. In humans S. y. most often occurs in the form of cutaneous anthrax. In France for 1910-1920 out of 405 cases only 3 diseases of internal organs were observed, in Germany for the period from 1910 to 1931 out of 3,096 cases of internal organs anthrax, 113 cases were observed (3.7%). With the cutaneous form, the pustule is most often localized in the head area and upper extremities. According to English statistics (Legge) the cutaneous form of S. y. was localized in the following parts of the body (Table 5): Table 5. Localization Number of diseases Number of deaths Mortality (in %) Forehead ........ Chin .... Lower jaw .... Extremities .... 2 17 12 9 7 71 14 3.3 10.9 19.7 23.1 23.3 24.3 6.7 Total . . . 15.5 German statistics (Dornedden) for 1910-1931 gives the following figures for localization of various forms of S. y. (Table 6): Table 6. Localization Number of cases Number of deaths Mortality (in %) Internal organs Head, neck, occiput Upper extremities Lower extremities ........ 1086 56 1 791= 200 13 95.8 18.1 23.2 6.2 4.3 Total . . . 3,096 14.8 Mortality from S. y. fluctuates around 15%. For 1926-1930 it was in individual countries: in Germany—9.5, in Bulgaria—10.3, in the USA - 24.5, in Yugoslavia-12.5, in Austria-13.1, in Poland-14.4. In the same country large fluctuations in mortality are observed. Thus, in Germany for the period from 1910 to 1929 mortality from S. y. on average was 14.5%, in Thuringia during this period it was 8.4%, in Prussia-42.4%, in Saxony-18.8%, in Hamburg-34.7%. Also according to data from Russian authors it is not the same: according to Ivashentsov (Leningrad) for example it is 15-25% with the cutaneous form, according to Stefanovsky (Odessa) it does not exceed 5%. Unequal mortality depends on the localization of the process (Tables 5 and 6), on the time of seeking medical help, etc. Seasonal distribution. Among domestic animals S. y. is mainly observed during the pasture period, mainly in summer months. This also explains the higher morbidity of S. y. among the agricultural population during these months. In industry the spread of anthrax is associated with production processes (receipt and disassembly of raw materials, etc.), but not with the seasons of the year.

I. Dobreytser. The epidemiology of S. y. is in complete dependence on its epizootology, as people contract S. y. directly or indirectly from sick domestic animals. Animals in turn contract S. y. from the soil, ingesting it along with plants on infected pastures or with silt from the bottom of bodies of water on such pastures, or through feeds harvested from unfavorable meadows. Cases of transmission of S. y. through insects (see Horseflies) can also be considered as indirect infection from the soil, as they are in time and place closely connected with the main epizooty that arose in a certain territory. The concept of S. y. as a soil infection serves as the basis for rational control of it. The soil is the only reservoir of the anthrax bacillus in nature. From it, it can at times under special conditions be transmitted to animals, and from them return again to the soil. This circulus vitiosus must be broken in order to stop the infection of animals, and thereby of humans. The infection of S. y. of still uninfected areas of soil and the superinfection of already infected areas occurs when their surface receives excretions from sick animals or serum exuding from the natural orifices of fallen animals, equally when anthrax carcasses are not removed. The spores forming under such conditions in contact with air are absorbed into the soil in the presence of sufficient moisture. The spores remaining on the surface, carried away by surface waters or wind (after drying), can penetrate the soil at a greater or lesser distance from their place of formation. The dynamics of spore movement in the soil itself depends on its physical structure (porosity) and the movement of soil waters. Movement in the horizontal direction is determined by the relief of the terrain, movement downward is again determined by the porosity of the soil, while the conditions for upward movement from deep layers have not been clarified. The role of earthworms and other representatives of the soil fauna in this regard is overestimated. The preservation of Bacillus anthracis spores in the soil is apparently unlimited. The multiplication of the anthrax bacillus in the soil is beyond doubt; vegetative forms grow from spores depending on meteorological conditions: heating of the soil by the sun and maintenance of moisture. Further multiplication of the bacilli in the soil occurs insofar as they find a corresponding pH of the medium and as long as there are no antagonistic bacteria hindering their development. Thanks to abundant sporulation during each vegetative period, there can be a constant increase in the contamination of a given area with stable forms of the S. y. virus. Thus, unfavorable areas for S. y. (so-called 'cursed fields') are created and maintained, in most cases swampy areas and lowlands subject to periodic flooding. On them, S. y. appears as an enzooty, but not necessarily every year, but depending on the presence of the above-mentioned meteorological conditions, which also explains their seasonality, corresponding to the hottest months of the year. As epizootological factors, one should also note the introduction of S. y. into favorable areas with virus-carrying animals, the infection of soil and bodies of water with waste from factories where unfavorable animal raw materials are processed, the use as fertilizer or feed of bone meal from infected sources, and the import of other feeds contaminated with S. y. spores. All epidemiological factors depend on the socio-economic structure of the country. Only socialist agriculture makes possible real control over the favorable status in relation to S. y. of the entire animal population, as well as over its movement and feed supply, in order to promptly take radical preventive measures. Only state industry is able to protect workers in the processing industry from the danger of infection with S. y. through animal raw materials of both domestic and imported origin, and at the same time also the consumers of the products of this industry. Raising the sanitary and living conditions of the rural population to the proper level, closely connected with its cultural education, eliminates the epidemiological factor of direct infection of people from S. y. patients and fallen animals. Pathological anatomy. The pathoanatomical picture of S. y. in fallen animals usually presents the following appearance. The carcasses are more or less strongly swollen; rigor mortis is weakly expressed; from the natural orifices exudes dark serum; the visible mucous membranes are cyanotic and often show hemorrhages. On autopsy, the blood is found to be tar-like in consistency, dark, almost black, and only very weakly and slowly lightens in the air. The connective tissue—subcutaneous, submucous, subserous, intermuscular—is in places, depending on the proximity to the primary infect or to secondary processes, over a greater or lesser extent strongly stretched by a serous or yellowish gelatinous infiltrate, penetrated by dark hemorrhages of various sizes. The lymph glands near the infiltrates are considerably enlarged, succulent, hyperemic, and often contain ecchymoses. The spleen, with rare exceptions, is very greatly enlarged; its capsule is tightly stretched (sometimes to the point of rupture); the pulp is softened, pasty, or even semi-liquid; only in rare cases is the spleen lesion limited to separate dark red softened foci. In the liver and kidneys, hyperemia, flabbiness, and cloudy degeneration of the parenchyma are encountered. The lungs are very hyperemic, edematous, and sometimes contain lobular foci and hemorrhagic infarcts. The mucous membranes of the respiratory passages are swollen and hyperemic with numerous ecchymoses. In the digestive tract, especially in the region of the duodenum and small intestines, the mucous membrane together with the submucous tissue is over a greater or lesser extent swollen, reddened, and penetrated by small dark hemorrhages; in other cases these changes are limited to the lymph apparatus (plaques and follicles), the affected areas protruding tumor-like into the lumen of the intestine and often undergoing necrotic disintegration, forming ulcers with raised dark edges and with sloughs of dead tissue separating from the center. Primary skin changes in S. y. appear, much more frequently in man than in animals, in the form of a blister filled with bloody pus on an edematous, hyperemic background (malignant pustule or malignant carbuncle, pustula maligna). In later stages of development, an ulcer is found in its place with dense, uneven edges, a necrotically disintegrating dark bottom, and a dark scab (anthrax carbuncle, carbunculus malignus), and near it secondary pustules. Primary as well as secondary anthrax edema of the skin without ulceration occurs more frequently in animals (horses, sheep) than in man. It should be noted the special pathoanatomical picture in pigs, in which in most cases the entire anthrax process is limited to the region of the pharynx and throat: inflamed and swollen mucous membranes, tonsils covered with pseudomembranes, gelatinous-hemorrhagic infiltrated peripharyngeal and perilaryngeal tissue, enlarged regional lymph glands with brick-red hemorrhagic areas on section. In exceptional cases, especially in the fulminating form, autopsy of animals reveals no characteristic pathoanatomical changes. Routes of infection and pathogenesis. As for the routes of natural infection with S. y., in this regard three possibilities present themselves: through damaged external coverings, through the digestive tract, through the respiratory passages. The view of Bezredk that the skin is the only organ through which infection with S.-y. can occur is not generally accepted. For the penetration of the virus through the skin, contamination of the slightest suffices. Among the rural population, it most often occurs as a result of participation in the removal of hides from fallen animals, more rarely from the bite of blood-sucking insects or from the passive transfer of the virus to existing wounds by insects that have previously fed on anthrax carcasses. In industry processing animal raw materials, skin infection of workers is a phenomenon the frequency of which depends entirely on sanitary measures preventing the entry into processing of materials from anthrax animals. Among consumers of the products of this industry, skin infection is observed when wearing half-fur coats from infected sheepskins, when using for shaving brushes made of infected hair, etc. In animals, primary infection of S. y. of external coverings occurs much less frequently than in man, and moreover almost exclusively through transmitting insects. On the contrary, infection through the digestive tract in man is an exceptional rarity, while in animals it plays a dominant role. In this connection, the possibility of penetration of the S. y. virus through intact mucous membranes is completely denied by most observers; only in pigs is it admitted as the portal of entry in the intact oral cavity, the lymph apparatus of the tonsils.

Carnivores, especially predatory animals, can become infected through injuries from bones received when eating anthrax-infected carcasses. In the overwhelming majority of cases, however, intestinal infection occurs in herbivores that contract the virus directly from infected soil—while grazing on infected fields or using contaminated water sources in such areas. The integrity of the gastrointestinal tract mucous membranes is quite often disrupted, especially in cattle, which not only consume various prickly plant parts but also often various piercing foreign objects (wire, nails, etc.).-Primary infection of the respiratory organs with anthrax again has considerable importance in human pathology, whereas in veterinary practice not a single confirmed case has been recorded. In humans, the pulmonary form of anthrax is a professional disease in work involving inhalation of dust that infects the mucous membranes with Bacillus anthracis spores, such as: when sorting and processing wool and bristles, sorting rags ('rag-picker's disease'), sorting dried medicinal plants, etc. The fate of the anthrax pathogen, entering the body by one means or another, depends, on the one hand, on the form and virulence of the pathogen itself, and on the other hand, on the degree of resistance (susceptibility) of the body.'Spores and non-capsulated vegetative forms are easily absorbed by phagocytes; capsulated bacilli, as a rule, are not phagocytosed. Among biochemical protective means, special importance is attributed to so-called 'anthracocidal substances' found in the blood and juices of normal animals. If the process does not remain limited to the site of primary infection, then the spread of the virus occurs along the lymphatic pathways, which can carry it to the bloodstream. Blood does not provide a favorable medium for the multiplication of Bacillus anthracis, but serves only as a means of distributing it throughout the body. Getting stuck in the capillaries of various tissues (in the spleen, liver, kidneys, lungs, intestinal wall, subcutaneous tissue), the virus forms secondary foci, from which it can again enter the bloodstream in increased quantities. The anthrax septicemia that occurs in most cases shortly (16-18 hours) before death is explained by some authors as the exhaustion of anthracocidal substances or their quantitative inadequacy to the influx of bacilli.-Excretion of the anthrax virus from the affected organism can occur during life from open skin foci, with bloody pus from ulcers on mucous membranes, with intestinal contents, with urine in the presence of hemorrhages in the kidneys (but not with milk, since its secretion stops from the moment of illness); after death—with serum flowing from natural openings, or when the integrity of the corpse is disrupted by any part of it. As a result of the interaction between Bacillus anthracis and the body, the former can acquire increased virulence, which is presumably based on the formation of more powerful and dense protective capsules and the production of endo- and exotoxins and aggressins, the presence of which, however, has not yet been experimentally precisely established. The body, in turn, reacts to anthrax infection by producing anti-substances such as precipitins, agglutinins, complement-binding substances, and others, which through artificial superinfection can be accumulated to such an extent that they acquire practical importance in serodiagnosis and serotherapy. In animals that have recovered, the protective capacity of the phagocytic apparatus apparently also increases.-The cause of death in anthrax has not yet found a generally accepted explanation. The theory of internal suffocation due to the interception of oxygen by bacilli in the blood and the theory of blockage of small vessels vital for life by bacilli are inapplicable in cases ending lethally without bacteremia. But the theory of fatal intoxication by products of Bacillus anthracis cannot be based on indisputable experimental facts. In the same way, it is unclear on what factors immunity in anthrax is based. Innate resistance to anthrax varies greatly among different species of animals. The most susceptible are small laboratory animals—white mice, guinea pigs, rabbits—followed by herbivores—sheep, horses, reindeer, cattle, and to a lesser extent goats. To an even lesser degree are pigs, dogs, and cats, and especially rats. In addition to species gradations, racial differences in sensitivity are also found in nature: thus, Algerian sheep are more resistant to artificial anthrax infection than European ones. Birds and cold-blooded animals are considered completely immune. Humans in general are relatively little susceptible to anthrax. The natural degree of resistance can change in either direction; factors that decrease it include fatigue, pregnancy, hunger, avitaminosis, overheating or cooling of the body, etc. (even in animals naturally immune); factors that increase it include the transfer of natural or artificial infection. It should be noted that only live, even if attenuated, anthrax virus has active immunizing properties, but not killed virus.

A. Vladimirov. 1. Clinical picture. S. y. in humans is observed in three forms: cutaneous, pulmonary, and intestinal. The cutaneous form (siberian anthrax carbuncle - pustula maligna, carbunculus contagiosus, old name - symptomatic carbuncle), the most common form in humans, usually occurs on easily accessible areas of skin for penetration of the infectious agent, such as exposed areas of the skin on the hands, face, neck, and back of the head. After an incubation period of 2-3 days, a red, usually itchy spot appears at the site of infection, quickly turning into a papule surrounded by a demarcated redness and swelling of the skin. After 12-15 hours, a blister filled with turbid, sometimes blood-tinged exudate forms in the center of the papule. This blister soon bursts or is scratched off, forming a black eschar (from which the French name for the disease is charbon - coal), surrounded by infiltrated and hemorrhagically impregnated skin. Around such an eschar, new blisters may form, which, upon drying, increase the size of the eschar, reaching 6-9 cm. As the eschar enlarges, the infiltration and swelling of the skin around it also expand. Nearby lymph nodes become enlarged, painful to the touch, and the skin in their area becomes infiltrated. A characteristic feature of S. y. is the absence of pain in the ulcer itself, and only newly formed blisters may cause itching. Sometimes the 'siberian anthrax carbuncle' forms directly from a papule, without first passing through the blister stage. Mild and moderate forms of S. y. usually occur without impairment of the patient's general well-being and are accompanied by an elevation of temperature that does not reach high levels. The temperature does not follow any definite course, and its duration depends on the nature and duration of the local process. In mild cases, by the end of the week, the process begins to subside—the skin swelling decreases, the eschar sloughs off, leaving behind a granulating ulcer surface that heals with a scar. In severe cases of S. y., the local process is more aggressive from the first days of the illness, and early signs of general intoxication are noted. Lymphangitis forms around the carbuncle, the skin swelling takes on the character of hemorrhagic infiltration, and newly formed blisters may be hemorrhagic, turning into ulcers, some of which gangrenously necrose. The temperature, accompanied by repeated chills, rises to high levels and is constant or remittent. The pulse becomes frequent and irregular, signs of toxic myocarditis develop. The tongue is dry and coated. Vomiting, sometimes with blood streaks, may occur; there may be diarrhea, which in some cases is hemorrhagic. The spleen is enlarged. Kidney damage is noted. Headaches and confusion appear. In the blood of patients, leukocytosis is usually observed, sometimes reaching 20,000-30,000 due to an increase in neutrophils (80-85%); in individual cases, eosinophilia is encountered (Jochmann). Pollender's bacilli may be found in the blood. Bacilli that enter the bloodstream can cause damage to the central nervous system, manifesting as edema and hemorrhages both in the brain substance itself and its membranes, which leads to impaired function of this system. Pollender's bacilli may be found in the cerebrospinal fluid. In the further course of the disease, the patient's general condition worsens, blood pressure falls, the amount of urine decreases, consciousness becomes clouded, cardiac weakness increases, and with signs of cardiac failure, death occurs. When the infectious agent enters through visible mucous membranes, the anthrax process localizes on the mucous membranes, giving a clinical picture similar to that of skin lesions. Anthrax bacilli do not cause suppuration, but when the ulcer necrotizes, pyogenic microbes may enter it and cause a mixed infection, which in severe cases leads to septicemia. A special form of the anthrax process is the specific edema of the skin or mucous membranes—without the formation of a primary carbuncle. This edema was first described by Bourgeois d'Etampe in 1840, is most often observed on the skin of the eyelids, and usually runs a favorable course. Blisters with turbid contents may develop on the edematous surface, in such cases bringing this form of the disease closer to the usual cutaneous form. Edema of the oral mucosa, especially when it involves the tongue, pharynx, or larynx, may run a very severe course and, causing disturbances in swallowing and respiration, often leads to a fatal outcome. The second most common form of S. y.—pulmonary—develops when the infectious agent enters the respiratory tract and is usually an occupational disease of sorters of contaminated rags (rag-sorter's disease) or of wool or hair from animals that have died of S. y. The disease begins with chills, a sharp rise in temperature with general malaise, cough, shortness of breath, stabbing pains in the sides, and weakening of cardiac activity. The mucous membrane of the upper respiratory tract (nose, pharynx, larynx, sometimes epiglottis) is injected and swollen. The tonsils are also injected and swollen, on which coatings may sometimes be observed. In the lungs, signs of bronchopneumonia are noted: diffuse bronchitis and foci of inflammation of the lung tissue itself. These foci, by merging, can cause consolidation, giving dullness on percussion and bronchial breathing. The pleura is often involved in the process, which intensifies the painful sensations, and acutely swollen mediastinal glands increase the difficulty of respiratory excursions. The bloody sputum contains Pollender's bacilli. The pulmonary process, rapidly progressing, causes signs of general intoxication, increasing cardiac weakness, and usually leads to death in 2-3 days with signs of collapse. In very rare cases, the process is limited and may end in recovery. The third form of S. y.—intestinal (anthrax intestinalis, former name mycosis intestinalis), less frequently observed in humans as an independent form, is caused by consuming contaminated milk or meat. The disease begins with general malaise, headache, loss of appetite, and epigastric pain. The temperature more often shows slight elevations, sometimes during the height of the disease it falls below normal, and rarely rises to high levels. To the initial symptoms, signs of acute inflammation of the gastrointestinal tract quickly join—vomiting, often with blood streaks, and diarrhea, predominantly bloody, sometimes accompanied by convulsions in the extremities. The tongue is strongly coated, the abdomen is bloated and painful. The spleen is enlarged. Cardiac weakness increases. Pollender's bacilli may be found in the feces. Sometimes hemorrhages into the skin and peritonitis due to perforation of ulcers are noted. The disease usually progresses rapidly and death occurs in 2-3 days with signs of collapse. In rarely observed mild cases, the intestinal form may end in recovery. Sometimes the three described forms of S. y. may combine, giving an extremely severe picture of the disease. In rare cases, S. y. runs as a septic disease without a definite local localization, in the absence of entry gates. Apparently, the infectious agent enters the blood through the tonsils or upper respiratory tract and causes general infection of the body. In such forms, the disease runs as a very severe sepsis with high temperature, damage to the central nervous system, and signs of rapidly increasing cardiac weakness. Sometimes to the picture of general intoxication, secondary lesions specific to S. y. of the skin, lungs, or intestines are added.

m. Kiriesv. In animals, Siberian anthrax clinically presents in the form of fulminating, acute, and subacute forms. The fulminating, or apoplectic form, is common in sheep but also occurs in cattle. Animals that appear completely healthy suddenly collapse and die within a few minutes, showing symptoms of convulsions, dyspnea, and bloody discharge from natural openings, due to pure siberian anthrax bacteremia without a specific localization of the process. In large animals, the acute and subacute forms are preceded by an incubation period of 2-3 days, after which the temperature quickly rises (above 40°) only to sharply fall before death. The excitement sometimes observed initially gives way to a state of depression; breathing becomes rapid and difficult; mucous membranes are injected; from the digestive tract, diarrhea is observed, often with blood admixture, colic (in horses), tympany (in cattle); urine is dark red (sometimes bloody); milk secretion ceases from the very beginning of the disease; in some cases (especially in horses), extensive, rather dense subcutaneous edema develop on the neck, chest, and in the groin. The disease lasts 2-5 days, rarely 7 days, and usually ends in death with symptoms of asphyxia. In pigs, death from suffocation occurs within 1-2 days due to localization of the process in the throat area. Diagnosis, Bacteriological and experimental diagnosis of S. a. Based on simple microscopic examination, only a preliminary diagnosis can be made, since on the one hand, B. anthracis can be present in a mixture with other morphologically similar bacteria both in antemortem secretions and in the blood and tissues of corpses, and on the other hand, its detection can be hindered by the loss in non-fresh materials of its characteristic morphological features. In the blood of sick animals, it appears only a few hours before death, and only finding it at this moment or immediately after death in microscopic preparations in the typical capsular form allows for an immediate positive diagnosis. In all other cases, it is necessary to resort to growing pure cultures and inoculating susceptible animals. For this purpose, the material under investigation is sown on Petri dishes with agar; after standing in an incubator for 16-20 hours, the grown colonies corresponding to the growth of B. anthracis are transferred to fresh agar and to broth for differentiation mainly from anthrax-like (B. anthracoides) and pseudo-anthrax (B. pseudoanthracis) bacteria, which resemble B. anthracis morphologically in their colonies on agar but differ from it mainly in their growth in broth (cloudiness, crumbly precipitate), blueing of litmus milk, hemolytic ability, and their non-pathogenicity for small laboratory animals. Other morphologically B. anthracis-like spore-bearing bacteria, such as B. subtilis, B. mesentericus, etc., as well as anaerobes like B. oedematis maligni, are comparatively easily distinguishable bacteriologically. To prevent non-spore-bearing bacteria from complicating the work, any material that may contain foreign microbes (blood and tissues of dead animals, manure, soil, water, animal raw materials, etc.) is freed from vegetative forms by preliminary heating in a water bath at 70-80° for 15-30 minutes. For a complete diagnosis, inoculations are made on experimental animals—white mice, guinea pigs, or rabbits—either with pure cultures isolated by the above method, or in suitable cases with the original material, previously freed from vegetative forms by heating. When pathogenic spore-bearing anaerobes are suspected in the material under investigation, they are first removed by Gruber's method: initial sowings on broth are cultured for two days in an incubator under anaerobic conditions, under which anthrax spores do not germinate, and then are heated three times at daily intervals to kill the developed anaerobic bacilli, after which the broth with surviving B. anthracis spores is used for inoculations. After subcutaneous inoculation, white mice die on average after 1 day, guinea pigs after 2-3 days, rabbits after 3-4 days. Taking material from a dead animal for examination should be done in such a way as to avoid contamination of the soil. In the USSR, the method of cutting off the entire ear from the corpse is particularly widespread, with the incision site being thoroughly disinfected or cauterized, and the ear itself for delivery to the laboratory is wrapped in material soaked in a disinfectant solution. Similar precautions are taken when blood is taken from superficial veins for examination. Post-mortem examination of an anthrax corpse should generally not be performed; in case of necessity, special veterinary-sanitary measures are taken. Blood and pulp of the spleen can be delivered to the laboratory in jars or test tubes, but also in the form of thick smears, dried on slides or on pieces of filter paper. In Germany, for this purpose, special gypsum sticks are used, and if not available, pieces of brick, chalk, etc., which are coated with blood or pulp. Transport of such samples must occur in packaging that guarantees complete safety. Of the serodiagnostic methods in S. a., only the Ascoli-Valenti precipitation reaction is practically applicable (see Ascoli-Valenti reaction).

A. Vladimirov. Clinical Diagnosis. In the presence of a typical anthrax carbuncle and epidemiological history, the diagnosis of S. y. in humans presents no difficulty. Unlike the common carbuncle, the anthrax carbuncle is painless, develops much faster, and forms a significant edema around itself, sometimes a rim of fresh vesicles. Glanders nodules are usually multiple, smaller in size, painful, and when appearing on the face are accompanied by significant specific lesions of the nasal mucosa. Anthrax edema can be mistaken for erysipelas, but in the latter case there are usually sharply defined borders, inflammatory redness, and painfulness. Bacteriological examination helps to establish a definitive diagnosis. Anthrax bacilli can be found, in cases of their significant content, directly in smears from blood. Sometimes they can be detected when examining the discharge from the carbuncle. The most frequent positive results are obtained from examining the contents of the vesicles and the fluid saturating the edematous tissue. The material obtained can give a positive result in bacterioscopic examination of preparations stained by Löffler's methylene blue or by Gram, or in bacteriological research after preliminary seeding on broth or sugar agar, or by inoculation to mice and guinea pigs (see above). More difficult is the establishment of diagnosis in the so-called internal forms of S. y. Acute inflammation of the lungs only in persons who had the opportunity in their profession to contract S. y., may give rise to the assumption of the specificity of this disease. The exact diagnosis is established only after positive findings from the examination of sputum or blood. The intestinal form, giving similar symptoms in various bacterial infections, toxicoses, and chemical poisonings of the gastrointestinal tract, may suggest anthrax disease only when there is indication of the use of suspicious or S. y.-infected milk or meat. Detection of specific bacilli in feces or blood makes it possible to establish an accurate diagnosis. The recognition of anthrax sepsis is based on finding Pasteurella bacilli in the blood or cerebrospinal fluid. Prognosis. In anthrax carbuncle, mortality is observed in 10-25% of patients who did not receive specific treatment (see above--statistics). Signs of general infection worsen the prognosis. Anthrax edema gives a worse prognosis. In the "internal" forms, the prognosis is very unfavorable, recovery is observed only in individual cases. Treatment. The best effect in "external" S. y. is given by the following treatment: the patient is prescribed bed rest, complete rest, symptomatic drug treatment depending on their general condition, local application of non-irritating wet dressings-at the beginning of the disease from solutions of rivanol (1:1,000), physiological, Burrow's solution, etc., after the eschar falls off, dressings from indifferent ointments (vaseline, boric, xeroform, etc.) and possibly the earliest possible administration of specific serum. With great swelling of the eyelids, incisions are recommended to prevent necrosis. With this method of treatment, if patients seek medical help within the first 24 hours, the mortality rate is zero, and in relation to all seeking help 5-6 (Neisser). The use of vigorous intervention in the form of surgical removal of the carbuncle, the application of caustic substances to the ulcer (zinc chloride, carbolic acid, tincture of iodine, etc.), cauterization of the ulcer at the present time is not recommended as a method that cannot destroy all the infectious agent nesting not only in the ulcer itself but also in the edema, possibly in the lymph glands, and surgical intervention can also more widely open the gateway for infection. Favorable results, even in severe cases of anthrax sepsis (Boidin, Jochmann), are given by specific serotherapy. In our country, the serum is produced by veterinary research institutes of the People's Commissariat of Agriculture and in a more purified form is released in ampoules labeled "pro humano uso", and if such is not available, one can with equal therapeutic success and in the same doses use the serum intended for animals. The serum is administered intramuscularly or intravenously, usually in doses of 20-40 cm³ at a time, in more severe cases 60-100 cm³; the infusion can be repeated daily until the edema and signs of general intoxication disappear. What is the action of this serum-antitoxic or bactericidal-has not yet been established with certainty, but its favorable effect both as immunizing and therapeutic is undoubtedly established both in experiments on animals and in application to humans. According to Italian statistics (Sclavo), mortality in patients treated with serum decreased from 24.16% to 6.09%. French authors also indicate the equally favorable effect of serum (Machoux, Boidin). According to data from the Botkin Hospital in Moscow, mortality in patients treated with serum was 2.2% (Oonova). A number of authors in America observed favorable results from the use of normal horse or bovine serum, on the basis of which it was proposed to replace the serum with a solution of Witte's peptone (Witte's peptone 5.0, sodium chloride 5.0, distilled water 100.0). This solution after filtration and sterilization was administered daily intramuscularly 30 cm³ and in treated patients reduced mortality to 6.77% (Bezancon, Philibert). Observations on the relationship between Pasteurella bacilli and Pseudomonas (Bouchard, Charrin) showed that in vitro Pseudomonas hinders the growth of anthrax, and in the experiments of the same authors on animals it turned out that vaccination with cultures or toxin of Pseudomonas, performed several hours before infection with S. y., eliminated the fatal outcome in such animals. On the basis of these observations, a proposal was made (Fortineau) to use as a therapeutic measure injections of 10-20 cm³ of Pseudomonas culture in physiological solution with 2-3 day intervals, which reduced mortality in people who contracted S. y. to 10% (Bezancon and Philibert). In 1911, Becker proposed intravenous infusion of salvarsan (0.3 each) or neosalvarsan (0.6), which gives a favorable therapeutic effect. Of other proposed therapeutic measures, one can mention the intramuscular administration of electroalgol, atoxyl, intravenous-collargol, solution of iodine in potassium iodide, and finally the old method of administering carbolic acid solutions around S. y. With the latter method, it is necessary to consider the possibility of a reaction from the kidneys and excessive irritation of the edematous tissue. In the "internal" forms of S. y., it is appropriate to use the above-mentioned methods, which have the character of action on a specific septic disease, and at the same time symptomatic treatment, but to the present time all attempts at therapeutic intervention in these forms usually remain fruitless. Every case of S. y. disease is subject to mandatory hospitalization and immediate notification of sanitary supervision. The patient is considered non-infectious after the disappearance of the bacilli and can be discharged from the medical institution no earlier than the disappearance of clinical manifestations. Restoration of working capacity occurs after the restoration of the functional abilities of the body, impaired by the disease, and depending on the nature of the work.

M. Kireev. Prevention of S. a. should be directed at breaking the above-mentioned cycle 'soil-animal-soil'. The most desirable approach is to disinfect soil infected with anthrax. For this purpose, two methods are currently proposed: draining affected areas and plowing them with alkaline fertilizer. Both methods are designed to deprive B. anthracis of the ability to multiply in the soil. Their effectiveness is not absolute and requires further practical study. To prevent new soil infection, all attention must be directed at preventing B. anthracis from entering the soil from the bodies of sick or dead animals; therefore, no operations (bloodletting) or manipulations (autopsies) are permissible, and in case of violation of the integrity of the carcass, the surrounding soil surface must be disinfected in the most energetic manner. Anthrax carcasses, as a rule, must be burned on the spot until completely turned to ash by methods developed by veterinary technicians. If it is impossible to carry out this task, the carcasses must be buried as soon as possible in a livestock cemetery (see Cemetery) with observance of appropriate veterinary-sanitary rules. Infection of water bodies with anthrax can occur through wastewater from factories processing animal raw materials, where insufficient preventive measures may allow contaminated raw materials to enter. Therefore, special attention must be paid to the neutralization of wastewater from such factories (see Wastewater, industrial). Preventive measures for people engaged in agriculture, transportation, and processing industry who come into contact with anthrax-infected animals or with raw materials suspected of being contaminated cannot be successfully carried out without the conscious participation of the workers themselves. This explains the particular importance of sanitary-educational propaganda and training in methods of personal precaution. In transportation, systematic veterinary control is exercised over transported animals, and sanitary measures are regulated in case of detection of anthrax-suspect livestock. Among these measures should be mentioned special disinfection of infected cars at washing stations established by railroads and others. For workers handling animal raw materials, appropriate special clothing and washstands are necessary. In addition, factory premises and workshops must be properly lit, easily cleanable, and ventilated (exhaust devices in operations associated with dust formation). During regular medical-sanitary examinations of workers, special attention is paid to the condition of the nails with periodic bacteriological examination of subungual dirt in view of the established fact of self-infection with anthrax through scratching. On a national scale, industrial prevention is carried out through organized control over animal raw materials coming from both anthrax-suspect domestic areas and from abroad. In special institutions, this raw material is subjected to laboratory examination - skin examination by Ascoli's method - and in appropriate cases is disinfected by special methods developed for this purpose, such as the Shattenfro method for hides, the Liverpool method for wool, etc. (see Disinfection, disinfection of raw animal products). All skin raw materials intended for export must pass through 'ascolization'. Although primary intestinal anthrax infection in humans is extremely rare, and milk from anthrax-infected cows has no epidemiological significance, the export of raw food animal products from areas declared anthrax-suspect is prohibited by law (see Quarantine, quarantine in veterinary medicine). Prevention of animals from anthrax infection is carried out in two directions. On the one hand, veterinary-sanitary measures (according to the 'Veterinary Statute of the RSFSR') are taken to prevent the introduction and importation of the anthrax virus into anthrax-free areas and to localize any enzootics and epizootics of anthrax that may appear. On the other hand, anti-anthrax vaccinations are applied to susceptible domestic animals, both in areas threatened by epizootics (preventive vaccinations) and in areas where the disease has already appeared (compulsory vaccinations). In the latter case, the aim is to break out and extinguish the erupted epizootic. The classic Pasteur method of subcutaneous administration of vaccine twice with an interval of 10-12 days (I-more attenuated and II-less attenuated) is used in the USSR by means of Tsenkovsky's vaccine, which has replaced Pasteur's bacillary preparations with spore ones. In addition, single subcutaneous injections of vaccine II in combination with anti-anthrax serum (according to Zobernheim), the so-called 'simultaneous method' or 'serovaccination', are used. Intradermal preventive vaccinations according to Bezredka's method, either in the form of two injections (I and II) of vaccine with a somewhat shortened interval between them or in the form of a single administration of vaccine II with a simultaneous subcutaneous injection of anti-anthrax serum, are also part of veterinary practice. Passive protection with serum alone according to Zobernheim is appropriate in cases requiring immediate, even if short-term, immunization (see Vaccination, animal vaccination).