The incidence of anthrax in humans has decreased during the past century, and it is now very rare in developed countries including the United States. From 1980 through 2000, only seven cases of anthrax were reported to the United States Centers for Disease Control and Prevention (CDC) . However, in 2001, 22 confirmed or suspected anthrax cases occurred in the United States after Bacillus anthracis spores were sent through the mail in powder-containing envelopes .
Sporadic cases of inhalation and cutaneous anthrax also occurred between 2006 and 2008 in persons using contaminated imported animal hides for drum making, including two cases of cutaneous anthrax in the United States in a drum maker and a family member [3,4]. Both cutaneous and inhalation anthrax have also been associated with the playing of goatskin drums contaminated with Bacillus anthracis spores [5-7]. (See "Microbiology, pathogenesis, and epidemiology of anthrax", section on 'Bioterrorism' and "Microbiology, pathogenesis, and epidemiology of anthrax", section on 'Natural infection'.)
Spores can persist in the soil for years to decades. Decontamination of the soil is generally not practical; thus, sporadic cases of epizootic anthrax continue to occur in areas of high endemicity, such as Iran, Iraq, Turkey, Pakistan, and sub-Saharan Africa, where the use of anthrax vaccine in animals is not comprehensive. Animals become infected with B. anthracis by ingesting spores while grazing on contaminated grass or feed. Naturally-occurring transmission to humans occurs through direct exposure to infected animals or animal products through skin exposure, ingestion, or inhalation. (See "Microbiology, pathogenesis, and epidemiology of anthrax", section on 'Natural infection'.)
The treatment of anthrax will be reviewed here. The pathogenesis, epidemiology, clinical manifestations, diagnosis, and prevention of anthrax are discussed separately. (See "Microbiology, pathogenesis, and epidemiology of anthrax" and "Clinical manifestations and diagnosis of anthrax" and "Prevention of anthrax".)
B. anthracis is highly susceptible to a variety of antimicrobial agents including penicillin, chloramphenicol, tetracycline, erythromycin, streptomycin, and fluoroquinolones [3-5]. B. anthracis is NOT susceptible to cephalosporins or trimethoprim-sulfamethoxazole [3-7]; thus, these agents should not be used for the treatment or prevention of anthrax.