So, first things first: what is anthrax? Some may remember it from the news back in 2001, but even so--and for anyone that didn’t catch that series of stories--it’s so rare these day it could use a bit of recap.
Anthrax is an infection caused by the spores of the bacteria Bacillus anthracis. This disease usually affects grazing animals--sheep, cows, goats, etc.--but under certain circumstances can be passed on to humans as well.(1) Animals get the disease by ingesting or inhaling spores while grazing, and humans get it by coming in contact with infected animals: handling ill livestock or corpses, eating contaminated meat, or working with other infected products such as wool or animal skins.(2)
There was a time when anthrax was fairly common, earning its alternative name "woolsorter’s disease" by its prevalence among those who worked with fleece(3), but due to a better understanding of how infection works and vaccines developed for cattle instances of this disease have dropped drastically. Cases still occur in parts of Africa, Asia, Central and South America, and portions of South and East Europe, but it’s all but unheard of in more modern areas of the world.(2),(4)(5)
There are three naturally occurring types of anthrax infections depending on how a person is exposed:
There are three naturally occurring types of anthrax infections depending on how a person is exposed:
Cutaneous Anthrax
Cutaneous Anthrax is an infection of the skin. It’s the most common form of the disease, accounting for roughly 95% of all naturally occurring infections(6 Page 43), and is contracted when the bacteria spores are exposed to a wound or cut. It starts as a painless, though supposedly itchy, rash with surrounding swelling. As the infection progresses the rash is replaced with a characteristic black-centered ulcer and the swelling spreads, resulting in a horrible red and purple mess. Nearby lymph nodes can be affected as well, casing them to swell painfully. The black ulcer will usually scab over and fall off within a few days to weeks, but the extensive swelling the infection causes can take much longer to subside. (6 Page 44)(7)
Cutaneous Anthrax is an infection of the skin. It’s the most common form of the disease, accounting for roughly 95% of all naturally occurring infections(6 Page 43), and is contracted when the bacteria spores are exposed to a wound or cut. It starts as a painless, though supposedly itchy, rash with surrounding swelling. As the infection progresses the rash is replaced with a characteristic black-centered ulcer and the swelling spreads, resulting in a horrible red and purple mess. Nearby lymph nodes can be affected as well, casing them to swell painfully. The black ulcer will usually scab over and fall off within a few days to weeks, but the extensive swelling the infection causes can take much longer to subside. (6 Page 44)(7)
Death from this kind of anthrax usually isn’t from the skin infection directly--though that can occur if the infection is on the face and the swelling closes off the throat(6 Page 44)--mortality usually occurs if the infection becomes extensive and bacteria--as well as the toxin the bacteria produces--spread into the bloodstream, resulting in blood poisoning.(7)
Anthrax skin infections are scary and they look awful, but it's usually painless, reasonably easy to identify, and has a whole arsenal of antibiotics capable of eradicating it. Mortality is less than 2% with proper medical attention(8), so it shouldn’t be that big of a problem (unless there’s no medical attention available or somebody is dumb enough to not see a doctor). Even without treatment at all mortality is only about 20%(9). Still not great odds, but like I said, that's without treatment of any kind, and it's downright wonderful compared to other forms of the infection.
Gastrointestinal Anthrax
Gastrointestinal anthrax is an infection of the intestines. This version of the disease is significantly less pleasant, resulting in diarrhea and vomiting (often with blood), pain, nausea, and serious inflammation of the intestines. As with skin infections, if untreated the bacteria will spread from the intestines to the bloodstream resulting in sepsis and death(6 Page 47). Mortality for this one is quite a bit higher, hanging around 40% even with treatment(8). It all depends on the severity of the infection and how soon people figure out it’s anthrax. So long as you don't eat suspicious meat and you cook everything thoroughly, though, everything should be fine.
Inhalation Anthrax
Inhalation Anthrax
The last natural form of infection is that of the lungs. As suggested by the name, you get it by inhaling the spores, which is actually pretty hard to do under normal circumstances. This is the most dangerous form of Anthrax, with a mortality rate of 45% even with treatment(8) , and some sources claimed it as even higher.
The lung infection progresses in two stage. It starts by infecting the lymph nodes in the chest causing shortness of breath, chest pain, coughing and general flu-like symptoms. That's why this form of Anthrax is so problematic: its similarity to the flu. Often the infection isn’t discovered to be anthrax until serious damage has already been done. The second stage is full on pneumonia. The infection moves from the lymph nodes into the lungs within days to hours of the onset of symptoms. This causes extreme difficulty in breathing and shock as the toxins the bacteria produce destroy the lungs and infiltrate the bloodstream, usually results in death within a few hours. If the infection reaches this stage before proper diagnosis or treatment it is often fatal.(6 Page 47)(7)
All these forms of anthrax are treatable by a range of antibiotics(7). Effectiveness of said treatment depends on how fast the disease is identified, though, and as already stated, identification can be difficult since the more deadly forms of anthrax are hard to distinguish from common ailments such a flu and food poisoning. If known exposure to anthrax has occurred, early--or even pre-symptom in some instances--treatment can be administered to prevent severe infection.(6 Page 86)
Because of its rarity in the modern era, it would take specific circumstances for anthrax to be a valid plot point in most stories. Naturally occurring cases in developing countries hold some potential for certain narrative types, such as missionary and travel adventure stories, but even then it would take special care and execution to keep the plot point from feeling contrived. Anthrax doesn’t pass readily from person to person,(2) so it’s not a good candidate for your typical natural plague scenario, and because of its extremely toxic nature and general quick fatality it’s not a good way to explain zombies either. It may be good for killing zombies, though. Zombies are still warm bodied as far as my understanding goes, and their general state of existence would make their systems easy to infiltrate if they came in contact with the spores. Once exposed to anthrax a zombie would probably melt down to jelly in short order, but I’m getting off topic. The most relevant place to use Anthrax, in my opinion, would be an an ancient, or ancient-esque setting. Many medieval fantasies are strangely void of background ailments (excepting the black plague, which has become something of a cliche). If handled properly a, simple mention of such a thing in the shepherding communities could be a great depth adding detail.
There is one other way anthrax could be brought into play in the modern age. Remember that reference at the top of this post about 2001? If you’re familiar with that incident, you probably know where I’m going with this. And that instance wasn’t alone: Anthrax has a long history as a bioweapon.
But more on that to come.
References and Further reading on Anthrax:
The fast and dirty guide to anthrax - https://en.wikipedia.org/wiki/Anthrax
(1) A brief summary on Anthrax from the Washington State department of health - https://www.doh.wa.gov/Emergencies/BePreparedBeSafe/BioterrorismandTerrorism/Anthrax
(2) The Center for Disease Control's overview of anthrax as well numerous links to in depth studies and articles - https://www.cdc.gov/anthrax/basics/
(3) Anthrax and the Wool Trade: a report by John Henry Bell - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222232/
(4) European Center for Disease Prevention and Control: Anthrax Annual Epidemiological Report 2016 - https://ecdc.europa.eu/en/publications-data/anthrax-annual-epidemiological-report-2016-2014-data
(5) National Organization for Rare Diseases on anthrax - https://rarediseases.org/rare-diseases/anthrax/
(6) Blooming massive report on anthrax from the World Health Organization (very useful) - http://www.who.int/csr/resources/publications/anthrax_web.pdf
(7) An overview of anthrax infection by Caitlin W. Hicks, Daniel A. Sweeney, Xizhong Cui, Yan Li, and Peter Q. Eichacker (Warning: Contains extremely graphic medical photos) - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3523299/#!po=17.5676
(8) CDC’s travel guide for anthrax - https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/anthrax
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