Symptoms of anthrax in adults

Symptoms of anthrax appear after the incubation period, which depends on the path of infection and the infectious dose of the pathogen. Isolate skin (external, localized) and generalized (internal, visceral, septic) forms of anthrax. Generalized forms can be primary (carbuncle absent) and secondary (in the presence of carbuncle). The cutaneous form of anthrax is subdivided into carbuncle, edematous, bullous, erysipelas and ocular variants, and the generalized form - to pulmonary, intestinal and septic variants.

The most common (95-98% of all cases of anthrax) is the cutaneous form. The incubation period with cutaneous form of anthrax is from 2 to 14 days. With timely antibacterial therapy, the symptoms of anthrax are relatively benign and complete with recovery. More often there is a carbuncle variant.

At the site of the pathogen (usually on the hands or head) there is a reddish or bluish speck that looks like an insect bite. In a few hours it is transformed into a papule of copper-red color, then (within a day) into a vial filled with serous-hemorrhagic contents. Patients are concerned about burning and itching. When combing or spontaneously the vial is opened with the formation of a sore covered with a dark brown scab, an anthrax carbuncle is formed. It is located on a dense infiltrated base, surrounded by a whisk of bright hyperemia. The daughter bubbles formed around are also opened, so the size of the scab increases to 0.5-3.0 cm in diameter and more. Then the symptoms of anthrax are that around the carbuncle develops a sharp widespread edema of soft tissues, which has a jelly-like consistency. Pain sensitivity in the field of carbuncle and edema due to the effect of toxin on the nerve endings is sharply reduced or completely absent. Skin in the edema zone is pale. Regional lymph nodes are dense, mobile, moderately enlarged, slightly sensitive to palpation. When the carbuncle is localized in the area of the hand or forearm, lymphangitis is possible. After reducing edema (8-10th day of the disease), the scab rises above the surface of the skin, under it are processes of scarring and epithelization of the ulcer. In 10-30 days the scab is rejected. The ulcer completely cicatrizes. Carbuncles can be single and multiple (up to ten or more).

When the carbuncle is localized on the face or neck, a severe leaking edema variant of the skin form of anthrax sometimes develops. Extensive edema spreads to the cellulose of the chest and even the stomach. When spreading edema on the soft tissues of the pharynx, asphyxiation is possible. In the zone of edema, vesicles are formed, after the opening of which large areas of necrosis are formed. A bullous version of anthrax is also possible (instead of a typical carbuncle, blisters are formed, filled with serous-hemorrhagic exudates) and an erysipelas version with the presence of skin hyperemia in the area of edema. With the skin form of anthrax, the general condition of the patient on the first day of the disease remains satisfactory, on the second and third day there is chills, weakness, headache, body temperature rises to 38-40 ° C, tachycardia, arterial hypotension. Body temperature remains elevated for 3-7 days, then falls critically to normal, the general condition of the patient improves rapidly, the symptoms of anthrax subsided, the edema in the carbuncle area decreases, and then the scab is rejected and a full recovery comes.

Significantly less often after a short-term improvement, a chill appears suddenly, the general condition worsens and a generalized infection develops. Currently, with modern antibiotic therapy, the disease is relatively benign and ends with recovery. Mortality in the cutaneous form of anthrax does not exceed 2-3% in treatment, without antibiotic therapy it reaches 20%.

The primary generalized form of anthrax develops in the case of an aerogenic or alimentary pathway of infection and is extremely rare - when the pathogen is introduced through the skin or mucous membrane (eg, the lips). In this case, the carbuncle is not formed at the site of the pathogen. The generalized form is characterized by a violent onset, the symptoms of anthrax are characterized by tremendous chills, hyperthermia, pronounced symptoms of intoxication, headache, vomiting, tachycardia, progressive hypotension, deafness of heart tones. Often, the liver and spleen increase, hemorrhagic rash on the skin, cyanosis, symptoms of CNS damage. At a pulmonary variant on the first day of illness the headache, pains in muscles, catarrhal phenomena are possible, therefore often diagnose ORZ or a flu, but in some hours the intoxication syndrome develops, the temperature reaches 39-41 ° С and on the foreground these symptoms act. As a feeling of suffocation, pain in the chest during breathing, shortness of breath, cough with frothy bloody sputum, which quickly turns into jelly. The skin becomes pale, tachycardia arises, the deafness of heart tones, the drop in blood pressure progresses rapidly. The symptoms of respiratory failure are rapidly increasing. With percussion of the chest, shortening of percussion sound and easing of respiration in the lower parts of the lungs are revealed in connection with the development of pleurisy. A variety of wet rales are heard. Death occurs on the 2-3rd day of the disease from infectious-toxic shock and respiratory failure. The lethality is 80-100%. A positive prognosis is possible at the beginning of the complex therapy before the development of the shock pattern.

For the intestinal variant of the anthrax, in addition to general symptoms, from the first day of the disease, such symptoms of anthrax as: cutting pains, mainly in the lower abdomen, bloody vomiting, frequent loose stools with a trace of blood, rapidly developing intestinal paresis and peritonitis. The outcome is also unfavorable. At all variants of the disease complications are possible: ITH, sepsis, meningitis, acute respiratory failure.

[1], [2], [3], [4], [5], [6]