What is anthrax?
Anthrax is a colorless, odorless, tasteless bacterium that protects itself from sunlight, heat and disinfectant by forming a protective coat. With this coat, the bacterium is called a "spore." The spores are so small that even 8,000-10,000 spores appear smaller than a speck of dust. This is the amount that animal studies suggest could be required for a lethal dose, although scientists are considering a much smaller dose could cause anthrax in people.
If inhaled, anthrax spores can germinate and lead to infection within one to 60 days. This is pulmonary anthrax, which usually causes death.
Less lethal forms include cutaneous infections, which occur if anthrax spores come in contact with a cut or other opening in the skin.
Another form of anthrax develops in the intestine of those who eat improperly cooked meat of animals that have been infected with anthrax.
All three forms of anthrax disease can be caused by the same bacterium — Bacillus anthracis.
Is anthrax contagious?
Inhalation anthrax does not spread from person to person. It is a "one-time agent" — to catch it a person must come directly in contact with the bacterium. Cutaneous anthrax can be transmitted in the rare instance that a cut or other opening in a person's skin comes in direct contact with the drainage from an open sore.
What are the symptoms of anthrax?
Symptoms of pulmonary anthrax are very similar to the flu, which can make an initial diagnosis somewhat difficult. However, in light of recent events many doctors have a heightened awareness of the possibility, and are therefore more likely to diagnose it.
Symptoms of the disease vary depending on how the disease was contracted, but usually occur within seven days. Officials at the Centers for Disease Control list the following:
Cutaneous: Most (about 95 percent) anthrax infections occur when the bacterium enters a cut or abrasion on the skin, such as when handling contaminated wool, hides, leather or hair products (especially goat hair) of infected animals. Skin infection begins as a raised itchy bump that is dark in color and resembles an insect bite but within 1-2 days develops into a vesicle and then a painless ulcer, usually 1-3 centimeters in diameter, with a characteristic black area in the center. Lymph glands in the adjacent area may swell. About 20 percent of untreated cases of cutaneous anthrax will result in death. Deaths are rare with appropriate therapy.
Inhalation: Initial symptoms may resemble a common cold. These symptoms may actually then retreat for a short period. But after several days, the symptoms progress to severe breathing problems and shock. Inhalation anthrax is usually fatal.
Intestinal: The intestinal disease form of anthrax may follow the consumption of contaminated meat and is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, fever are followed by abdominal pain, vomiting of blood, and severe diarrhea. Intestinal anthrax results in death in 25 percent to 60 percent of cases.
How is anthrax infection diagnosed?
For people with suspected anthrax disease, the CDC lists a number of laboratory testing that can identify the disease. Tests can include:
Taking cultures of blood and spinal fluid to detect antibodies to the disease. These tests should be done before antibiotic treatment has been initiated.
Cultures of tissue or fluids from affected areas, which could include fluid from a skin sore or sputum coughed up from the lungs.
A PCR (polymerase chain reaction) test that amplifies trace amounts of DNA to detect if the anthrax bacteria is present.
How is anthrax exposure detected?
The most common way to detect anthrax exposure is to take samples swabbed from the nose to detect any anthrax spores present there. The CDC emphasizes, however, that nasal swabs cannot rule out exposure but are helpful because they can provide clues to help investigators assess where spores may have traveled.
What is the treatment for anthrax?
Antibiotics, including Ciprofloxacin (sometimes shortened to "Cipro") and penicillin can be effective, especially for cases of cutaneous anthrax. For pulmonary anthrax, the drugs must be administered before or very soon after infection to be effective.
Should people who were not exposed take antibiotics?
No. Only those persons determined by health officials to be at risk of exposure should take antibiotics. Taking antibiotics unnecessarily can be dangerous. The course of antibiotic treatment to prevent anthrax infection is long (60 days), and many people experience side effects.
Although most side effects are mild, severe ones may occur, such as diarrhea, abdominal symptoms, rash, and allergic reactions, and the use of antibiotics may dangerously interfere with other medications. In addition, the inappropriate use of antibiotics may cause the development of antibiotic-resistant strains of common bacteria.
Should I keep a supply of antibiotics on hand, just in case?
No, storing a supply of antibiotics "just in case" can be dangerous. Antibiotics should only be taken under the supervision of a physician who has done an evaluation to minimize the potential for side effects or interaction with other medications.
Is there a vaccine?
Only one American company, BioPort Corporation of Lansing, Mich., is licensed to produce an Anthrax vaccine right now. Robert Kramer, President and COO of BioPort told ABC's 20/20 that they have enough vaccine to support the anthrax vaccination immunization program that is currently sponsored by the Department of Defense, and at some point in the future, they will have additional vaccine available for civilian use.
BioPort plans to file papers to ship new Anthrax vaccines next year, but the drug, as planned, would not be safe for children, pregnant women or the elderly. (See "full coverage" above, left.)
Critics of the vaccine have raised many questions about its safety. More than 400 members of the military have either quit or faced court-martial rather than take the anthrax vaccine for fear of side effects reported, such as extreme fatigue, headaches, muscular problems and insomnia.
Some strains of anthrax could be resistant to the vaccine. Someone with the proper knowledge and materials could try to culture such a strain. Vaccine- and antibiotic-resistant anthrax was one of the weapons being developed in the former Soviet Union. Still, there is little or no reason to believe that this particular material ever made it out of the laboratory.
Is household bleach effective against anthrax?
According to Good Morning America's Dr. Nancy Snyderman, bleach, even bleach diluted with water, can work to disinfect a surface from anthrax contamination.
How easy is it to launch an anthrax attack?
Experts say it remains very difficult to transform the deadly bacterium into a weapon that can be effectively dispersed and kill large numbers of people. To develop an anthrax strain in its most lethal form — pulmonary anthrax — spores have to be crafted to just the right size. If too small, a person will exhale the spores. If too large, the spores fall to the ground and become ineffective.
A bomb carrying anthrax would likely destroy the germ as it explodes. Dispersing the bacterium with aerosols is challenging because, unless it is in spore form, it is a wet substance and can clog sprayers. The Aum Shinrikyo cult, which released the nerve gas sarin in the Tokyo subway system in 1995, killing 12 people, repeatedly tried to produce and disseminate anthrax, but failed to hurt anyone each time, according to testimony of its members.
How easy is it to react to an anthrax attack?
Rapid detection of a disease outbreak remains a problem since many doctors have not been trained in how to recognize early symptoms of anthrax infection, though they have become much more alert in light of recent events. Emergency room doctors were quick to identify anthrax in the Florida cases.
There is new technology available that can help with detection. A portable DNA analyzer is available to quickly identify specific biological agents once an attack is suspected. Lawrence Livermore National Labs has invented a machine that tests air quality every half-hour and can sound an alarm if any of several pre-programmed biological or chemical agents are detected.
The machines can be installed at possible terrorist targets, including airports, subway stations, and government buildings.
Once detected, Anthrax is a relatively easy germ to handle, given that it is usually responsive to early antibiotics and is not contagious.
-- Healthology.com and ABCNEWS' Amanda Onion, Nicholas Regush and Jeff Carpenter contributed to this report.