Anthrax Facts: What It Is, What to Do

Q: What is anthrax?

A: Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax most commonly occurs in wild and domestic lower vertebrates (cattle, sheep, goats, camels, antelopes and other herbivores), but it can also occur in humans. There are three forms of the disease: cutaneous anthrax, which is highly treatable, and inhalation and intestinal anthrax, which are usually lethal.

Experts say inhalation anthrax first presents itself with flulike symptoms. What are they?

According to the American Public Health Association, the initial symptoms of inhalation anthrax are mild and nonspecific and may include fever, malaise and mild cough or chest pain. Respiratory distress, higher fever and shock can follow, often culminating in death.

What are the symptoms of cutaneous anthrax?

In cutaneous anthrax, itching of an exposed skin surface occurs first, followed by a lesion that in several weeks develops into a depressed black scab. About 20 percent of untreated cases of cutaneous anthrax will result in death. Deaths are rare with appropriate antimicrobial therapy.

How long does it take for symptoms to appear? And how long do anthrax spores survive?

The incubation period is usually one to seven days, though periods up to 60 days are possible, according to the Centers for Disease Control and Prevention. Anthrax spores can survive in the soil and remain infective for decades, perhaps centuries. They are highly resistant to most external influences, including heat.

If I were in a building suspected of being contaminated with anthrax spores, could my clothes carry some of them to my home and infect my family?

Experts say it is unlikely but not impossible. In the past, wool mill workers were the most likely to get anthrax, and they rarely carried it home to their families, according to C.J. Peters, a former head of special pathogens for the CDC who now heads a bioterrorism center at the University of Texas.

But Richard Levinson, associate executive director of the American Public Health Association, said that it is possible for some spores to be carried home and that the primary danger would be cutaneous anthrax.

Would washing clothes with regular detergent or bleach kill the anthrax spores?

No, Levinson said, the spores are unlikely to be destroyed by common detergents but would probably go down the drain. Contaminated clothes should be turned over to public health officials.

Should we worry that anthrax spores from a tainted envelope in a postal facility could contaminate other mail delivered to our homes?

Phillip Brachman, professor of public health at Emory University and a former CDC official, said it would be "hard to think" that mail that went through a contaminated facility would actually have anthrax spores on the outside. "I'm going to continue to open my mail at home," he said.

However, Levinson said there was some risk that some spores could land and remain on the outside of an envelope.

Would microwaving or ironing mail kill any anthrax spores?

No. In fact, that could be dangerous. Microwaving may cause a sealed envelope to rupture or burn, thus spreading anthrax spores that might be inside. Ironing a letter with a steam iron could allow any anthrax spores to escape the weakened envelope and be released into the environment.

Everybody is talking about Cipro. Is it the only drug that works against anthrax?

Cipro -- or ciprofloxacin, as it is generically known -- is only one of several medicines approved by the Food and Drug Administration to treat anthrax. Mohammad Akhter, executive director of the American Public Health Association, said four first-line treatments approved for anthrax are penicillin, tetracycline, erythromycin and chloramphenicol.

Should I take Cipro or another antibiotic as a preventive measure against anthrax?

Medical experts say it can be dangerous to take antibiotics that have not been prescribed by a doctor for a specific illness.The drug can kill other bacteria in your body, including the beneficial bacteria that line your skin, mouth, throat and stomach. Taking it as a preventive measure would work only if you became infected soon after starting the drug and continued with a 60-day regimen, according to Terry Krulwich, dean of the Graduate School of Biological Sciences at Mount Sinai School of Medicine in New York.

Does Cipro have side effects?

Yes, it can cause nausea, diarrhea, allergic reactions, skin rashes, tremors and nerve damage. If taken with certain other medications, Cipro can cause organ damage.

Is there an anthrax vaccine?

Yes, but there is some controversy about its effectiveness, and it has been available thus far only to military populations and some researchers. It has not been tested with a control population like other vaccines, and it has never been used in the civilian population.

-- Valerie Strauss