Symptoms of anthrax in adults

Symptoms of anthrax appear after an incubation period, which depends on the route of penetration and the infecting dose of the pathogen. There are cutaneous (external, localized) and generalized (internal, visceral, septic) forms of anthrax. Generalized forms can be primary (no carbuncle) and secondary (with the presence of a carbuncle). The cutaneous form of anthrax is divided into carbuncle, edematous, bullous, erysipelas-like and ocular variants, and the generalized form is divided into pulmonary, intestinal and septic variants.

The cutaneous form is the most common (95-98% of all cases of anthrax). The incubation period for cutaneous anthrax is from 2 to 14 days. With timely antibacterial therapy, the symptoms of anthrax are relatively benign and end in recovery. The carbuncle variant is more common.

At the site of pathogen penetration (usually on the hands or head), a reddish or bluish spot appears, similar to an insect bite. After a few hours, it transforms into a copper-red papule, then (within 24 hours) into a blister filled with serous-hemorrhagic contents. Patients are bothered by burning and itching. When scratching or spontaneously, the blister opens with the formation of an ulcer covered with a dark brown scab, an anthrax carbuncle is formed. It is located on a dense infiltrated base, surrounded by a rim of bright hyperemia. The daughter vesicles formed around it also open, so the size of the scab increases to 0.5-3.0 cm in diameter or more. Then the symptoms of anthrax consist of the development of a sharp widespread swelling of soft tissues around the carbuncle, which has a jelly-like consistency. Pain sensitivity in the area of the carbuncle and swelling is sharply reduced or completely absent due to the effect of the toxin on the nerve endings. The skin in the area of swelling is pale. Regional lymph nodes are dense, mobile, moderately enlarged, slightly sensitive to palpation. If the carbuncle is localized in the area of the hand or forearm, lymphangitis is possible. After the swelling has decreased (8-10th day of illness), the scab rises above the surface of the skin, and scarring and epithelialization of the ulcer occur under it. After 10-30 days, the scab is rejected. the ulcer is completely scarred. Carbuncles can be single or multiple (up to ten or more).

When a carbuncle is localized on the face or neck, a severe edematous variant of cutaneous anthrax sometimes develops. Extensive edema extends to the tissue of the chest and even the abdomen. Asphyxia is possible when the edema extends to the soft tissues of the pharynx. Blisters form in the edema area, which, when opened, form extensive areas of necrosis. A bullous variant of anthrax is also possible (instead of a typical carbuncle, blisters filled with serous-hemorrhagic exudate form) and an erysipelas-like variant with hyperemia of the skin in the edema area. With cutaneous anthrax, the general condition of the patient remains satisfactory on the first day of the disease, on the 2nd-3rd day, chills, weakness, headache appear, the body temperature rises to 38-40 ° C, tachycardia and arterial hypotension are noted. The body temperature remains elevated for 3-7 days, then drops critically to normal, the patient's general condition quickly improves, the symptoms of anthrax subside, the swelling in the area of the carbuncle decreases, and then the scab falls off and complete recovery occurs.

Much less frequently, after a short-term improvement, chills suddenly appear, the general condition deteriorates sharply, and a generalized infection develops. At present, with modern antibiotic therapy, the disease proceeds relatively benignly and ends in recovery. Mortality in the cutaneous form of anthrax does not exceed 2-3% with treatment, without antibiotic therapy it reaches 20%.

The primary generalized form of anthrax develops with an airborne or alimentary route of infection and extremely rarely - with the introduction of the pathogen through the skin or mucous membrane (for example, the lips). In this case, a carbuncle does not form at the site of introduction of the pathogen. The generalized form is characterized by a violent onset, the symptoms of anthrax are characterized by stunning chills, hyperthermia, pronounced symptoms of intoxication, headache, vomiting, tachycardia, progressive hypotension, muffled heart sounds. The liver and spleen often enlarge, hemorrhagic rash on the skin, cyanosis, symptoms of damage to the central nervous system appear. With the pulmonary variant, headache, muscle pain, catarrhal phenomena are possible on the first day of the disease, therefore, acute respiratory infections or flu are often diagnosed, but after a few hours, an intoxication syndrome develops, the temperature reaches 39-41 ° C and such symptoms come to the fore. as a feeling of suffocation, chest pain when breathing, shortness of breath, cough with foamy bloody sputum, which quickly coagulates into jelly. The skin becomes pale, tachycardia, muffled heart sounds occur, and a drop in blood pressure rapidly progresses. Symptoms of respiratory failure rapidly increase. Percussion of the chest reveals a shortening of the percussion sound and weakening of breathing in the lower parts of the lungs due to the development of pleurisy. Wet rales of various sizes are heard. Death occurs on the 2nd-3rd day of the disease from infectious toxic shock and respiratory failure. Mortality is 80-100%. A positive prognosis is possible with the beginning of complex therapy before the development of a picture of shock.

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

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