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Pathology - Cutaneous

Cutaneous infection develops following exposure to anthrax-infected animals (1). Cuts or breaks in the skin make a person more susceptible to infection. After the spore germinates in skin tissues, toxin production initially results in macular or papular skin lesions. The macules or papules enlarge into ulcers which are usually 1-3 cm in diameter. Vesicles may also develop which discharge clear or serosanguinous fluid. This is followed by the development of painless black eschars surrounded by massive edema and a number of purplish vesicles. The eschars eventually dry and fall off within 1 to 2 weeks. Systemic disease is associated with lymphangitis and painful lymphadenopathy.

Antibiotics are used to treat infection, and although treatment does not prevent the formation of eschars, it does prevent progression to systemic disease. If the infection is treated with antibiotics, death is rare. However, if antibiotics are not used, there is a 20% death rate.

Approximately 2000 cases of cutaneous anthrax are reported annually, making it the most common naturally occurring form of anthrax. The largest epidemic occurred between 1979 and 1985 in Zimbabwe with more than 10,000 cases of cutaneous anthrax reported. Only 224 cases were reported in the US from 1944 to 1994 (6).