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Pathology - Gastrointestinal

Gastrointestinal infection is associated with ingestion of undercooked contaminated meat (1). There are 2 distinct syndromes of gastrointestinal anthrax: oral-pharyngeal and abdominal. The oral-pharyngeal form of the disease results from the deposition and germination of spores in the upper gastrointestinal tract. Local lymphadenopathy, edema, and sepsis develop after an oral or esophageal ulcer. Dysphagia and respiratory difficulties usually occur as a result. The abdominal form of the disease develops from the deposition and germination of spores in the lower gastrointestinal tract, which results in a primary intestinal lesion (6). Symptoms appear two to five days after ingestion, and include nausea, abdominal pain, vomiting, and malaise, eventually progressing to bloody diarrhea, acute abdomen, or sepsis (6 and 7). Massive edema and mucosal necrosis occur at the sites of infection. Due to the ulceration of the gastrointestinal mucosa, blood-tinged vomiting usually occurs. Ascites eventually develop two to four days after the onset of symptoms (7).

Mortality rates are high in gastrointestinal anthrax because of the difficulty of early diagnosis (6). Intestinal perforation or anthrax toxemia are the usual causes of death. The morbidity of gastrointestinal anthrax is due to blood loss, electrolyte imbalance, and subsequent shock (7).

Gastrointestinal anthrax cases are uncommon, however, there have been reported outbreaks in Africa and Asia (6). Abdominal anthrax is more common than the oral-pharyngeal form (7). The consumption of contaminated buffalo meat resulted in 24 cases of oral-pharyngeal anthrax in Thailand in 1982. Five years later, 14 cases were reported in Thailand with both oral-pharyngeal and abdominal disease occurring. Gastrointestinal anthrax has not been reported in the United States (6).