Anthrax occupational exposure

Fig. 22-5. This roentgenogram, taken on day 2 of illness, shows the lungs of a 51-year-old laborer with occupational exposure to airborne anthrax spores. Marked mediastinal widening is evident, with a small parenchymal infiltrate. Reprinted from Binford CH, Connor DH, eds. Pathology of Tropical and Extraordinary Diseases. Vol 1. Washington, DC Armed Forces Institute of Pathology 1976 119. AFIP Negative 71-1290-2.

Anthrax is a specific infection with Bacillus anthraciSy a gram-positive, encapsulated organism that can survive as spores for over 20 years in soil. Herbivores are primarily affected. In endemic countries (some parts of Africa, Pakistan, India, Iran, the Middle East and parts of Russia), human infections remain a serious problem. In Western Europe or the United States, anthrax often follows occupational exposure during care of livestock or the handling of products. Therefore, most cases occur in wool, hair or bristle industries. Unsterilised, imported bone meal, sacks contaminated with it or even straw remain a potential hazard. 

The 249,000 occupational illnesses included repeat trauma such as carpal tunnel syndrome, noise-induced hearing loss, and poisonings. It is my professional opinion that many occupational illnesses go unreported when the employer or worker is not able to link exposure with the symptoms the employees exhibit. In addition, physicians fail to ask the right questions regarding the patient s employment history, which can lead to the commonest diagnosis of a cold or flu. This has become very apparent with the recent occupational exposure to anthrax where a physician sent a worker home with anthrax without addressing potential occupational exposure hazards. Unless the physician is trained in occupational medicine, he or she seldom addresses work as the potential exposure source. 

Inactivated anthrax vaccine is mainly used for protection against occupational anthrax exposure. A complete vaccine series consists of three 0.5-ml subcutaneous doses at 2-week intervals, followed by three additional doses 6, 12, and 18 months after the first dose. Mild local reactions occur in 30% of vacci-nees, including local erythema and tenderness, which occurs within 24 hours and begins to subside within 48 hours. The reactions tend to increase in severity by the fifth injection. Systemic reactions are rare and usually characterized by malaise and lassitude, chills, and fever (1). 

Anthrax mainly occurs in three forms cutaneous, inhalation, and gastrointestinal. Exposure to B. anthracis most likely in an occupational setting is the cause of cutaneous anthrax. The incubation period varies from 1 to 12 days. In most cases, the disease remains localized to the skin lesion. Major diagnostic characteristic is the development of edema around the... 

Anthrax spores, commonly found in the soil throughout the world (5), can cause infection when ingested by herbivore animals. Naturally occurring human infections follow exposnre to the infected animals or infected animal products. Occupational exposnre has been the most common cause of anthrax, with industrial mill wool sorters at greatest risk. From 1900 to 1978, there were 18 reported human cases in the United States, all in occupations associated with specific exposure, such as goat hair mill workers, tannery workers, and laboratory workers. Widespread animal vaccination programs have reduced animal mortality from anthrax and naturally occurring human anthrax is now a very rare disease (5). 

OSHA considers skin diseases as illnesses caused by exposure to chemicals, plants, or other hazardous substances. OSHA dehnes respiratory conditions or illnesses as breathing-related problems associated with pneumonitis, pharyngitis, rhinitis, farmer s lung, beryllium disease, tuberculosis, occupational asthma, reactive airways dysfunction syndrome, chronic obstructive pulmonary disease, and hypersensitivity. Examples can include heatstroke, hypothermia, decompression sickness, effects of ionizing radiation, exposure to ultraviolet (UV) rays, anthrax, and bloodbome pathogen diseases. 

These include all other occupational illnesses. Examples are heatstroke, sunstroke, heat exhaustion, heat stress and other effects of environmental heat freezing, frostbite and other effects of exposure to low temperatures decompression sickness effects of ionizing radiation (isotopes, x-rays, radium) effects of non-ionizing radiation (welding flash, ultraviolet rays, lasers) anthrax bloodbome pathogenic diseases, such as AIDS, HIV, hepatitis B or hepatitis C brucellosis malignant or benign tumors histoplasmosis, coccidioidomycosis. 

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