Anthrax - Blackpool, England

I had no idea this news had broken when I made the earlier post, odd coincidence really. Sorry to "go on" about it ...

From BBC @ 15:00 today, HPA and NHS Blackpool :-

Anthrax Case in Blackpool Confirmed by HPA

The Health Protection Agency (HPA) and NHS Blackpool can confirm they are investigating the death of a drug injecting heroin user in Blackpool. The investigation has confirmed that the cause of death was anthrax following positive test results.

This is the second case of anthrax seen in an injecting drug user in England, the first announced in London on 5 February.  Similar cases have been seen in Scotland since December 2009 with nineteen cases having been confirmed and one in Germany. Similarities to the cases in Scotland suggest that the heroin, or a contaminated cutting agent mixed with the heroin, is the likely source of infection.

Dr Arif Rajpura, Director of Public Health from NHS Blackpool, said:” While public health investigations are ongoing, it must be assumed that all heroin in the North West carries the risk of anthrax contamination. I urge all heroin users to be extremely alert to the risks and to seek urgent medical advice if they experience signs of infection such as redness or excessive swelling at or near an injection site, or other symptoms of general illness such a high temperature, chills or a severe headache or breathing difficulties, as early antibiotic treatment can be lifesaving.

“Heroin users are strongly advised to cease taking heroin by any route, if at all possible, and to seek help from their local drug treatment services. This is a very serious infection for drug users and prompt treatment is crucial.

“Drug injecting is an extremely risky and dangerous practice and users are vulnerable to a wide range of infectious diseases, both from the action of piercing the skin, as well as contaminants in the drugs that they use.” 

Symptoms (from HPA) :-

What are the symptoms in humans?

There are two main forms of anthrax infection: cutaneous and inhalation.

In cutaneous (skin) anthrax, a lesion appears on the skin, often on the head, neck, forearms or hands. This lesion starts as a small bump and develops into a characteristic ulcer with a black centre. It is rarely painful, but if untreated the infection can spread to cause blood poisoning. If untreated, the disease can be fatal in 5% of cases, but with prompt antibiotic treatment recovery occurs.

Inhalation anthrax is normally much less common. Symptoms begin with a flu-like illness followed by respiratory difficulties and shock after 2-6 days.

Injection anthrax - since December 2009, a signficant number of drug users in Scotland have been found to have anthrax infection. it is thought that they contracted the infection from using heroin contaminated by anthrax spores. Further information

Intestinal anthrax is a very rare form of food poisoning, and results in severe gut disease, fever and blood poisoning.

Inhalation and intestinal anthrax are serious and can often be fatal. They can be treated effectively with antibiotics if identified early enough, but this can be difficult as the initial symptoms are similar to other illnesses.

and here, also from HPA :-

Anthrax in drug users appears to be very rare; prior to the current outbreak in Scotland, only one previous case had been reported in Norway in 2000.

Q5. How long can you have the infection before developing symptoms?

This is dependent on the dose and route of exposure and may vary from one day to eight weeks. However, symptoms usually develop within 48 hours with inhalation anthrax and 1-7 days with cutaneous anthrax. It is not known exactly how long symptoms can take to develop following the use of contaminated heroin, however in most cases during the current outbreak, symptoms started within 1 to 7 days of taking heroin.

Q6. What are the symptoms?

Early identification of anthrax can be difficult as the initial symptoms are similar to other illnesses.

Symptoms vary according to the route of infection:

Anthrax in drug users

Drug users may become infected with anthrax when heroin or the cutting agent mixed with heroin has become contaminated with anthrax spores. This could be a source of infection if injected, smoked or snorted. The clinical presentation is likely to vary according to the way in which the heroin is taken and might include:

• Swelling and redness at an injection site, which may or may not be painful
• Abscess or ulcer at an injection site often with marked swelling (oedema)
• Septicaemia (blood poisoning)
• Meningitis
• Symptoms of inhalational anthrax (see below)

Cutaneous anthrax - Local skin involvement after direct contact.

• Commonly seen on hands, forearms, head and neck. The lesion is usually single
• 1-7 days after exposure a raised, itchy, inflamed pimple appears followed by a papule that turns vesicular (into a blister). Extensive oedema or swelling accompanies the lesion – the swelling tends to be much greater than would normally be expected for the size of the lesion and this is usually PAINLESS
• The blister then ulcerates and then 2-6 days later the classical black eschar develops
• If left untreated the infection can spread to cause blood poisoning

Inhalation anthrax - symptoms begin with a flu-like illness (fever, headache, muscle aches and non-productive cough) followed by severe respiratory difficulties and shock 2-6 days later. Untreated disease is usually fatal, and treatment must be given as soon as possible to reduce mortality.

Intestinal anthrax is contracted by the ingestion of contaminated carcasses and results in severe disease which can be fatal. This is found in some parts of the world where the value of an animal dying unexpectedly outweighs any fears of contracting the disease.

Q7. Can anthrax be treated?

Cutaneous anthrax can be readily treated and cured with antibiotics. Mortality is often high with inhalation and gastrointestinal anthrax, since successful treatment depends on early recognition of the disease.

Prompt treatment with antibiotics and, where appropriate, surgery is important in the management of anthrax related to drug use.

Q8. How is anthrax spread?

A person can get anthrax if they inject, inhale, ingest or come into direct physical contact (touching) with the spores from the bacteria. These spores can be found in the soil or in contaminated drugs. It is extremely rare for anthrax to spread from person-to-person. Airborne transmission from one person to another does not occur; there have been one or two reports of spread from skin anthrax but this is very, very rare.

Q9. How do drug users become infected with anthrax?

Heroin or the cutting agent mixed with heroin may become contaminated with anthrax spores from the environment. This could be a source of infection if injected, smoked, or snorted.

(Q&As courtesy of Health Protection Scotland)

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