Workplace Medical Mystery Solved: Drum Maker Develops a Suspicious Rash

Ousmane, a drum maker living in Washington, DC, was concerned about the lesion that had developed on his forearm. His doctor thought it was likely an infected spider bite, but after taking antibiotics for 7 days, the sore had gotten worse, not better. Ousmane decided to go see an infectious disease specialist.

Laboratory tests showed that Ousmane’s sore was caused by the bacteria, Bacillus anthracis, or anthrax. Ousmane’s doctor prescribed a 60-day course of the antibiotic, ciprofloxacin (Cipro), the drug of choice to treat anthrax.

Bacillus anthracis produces spores that are hardy and can live in the environment, like soil, for a long time, even decades. Anthrax infections occur naturally in wild and unvaccinated domestic animals in many countries including the U.S. Workers can be infected if they are exposed to infected animals or to meat or products (such as wool or hides) from infected animals.

The Centers for Disease Control and Prevention and the local health department conducted an environmental evaluation to confirm that the source of Ousmane’s exposure to anthrax spores occurred in his workspace. Subsequent evaluations found anthrax spores in his vehicle and residence. The findings suggested that Ousmane’s primary exposure to the bacteria resulted from scraping an animal hide that was contaminated with anthrax in his workspace, potentially making any anthrax spores present airborne. The spores likely got into his skin through an open wound such as the insect bite or penetrating injury that he felt on his arm. The findings also indicate that contamination can be spread from the source to other areas, often referred to as secondary contamination.

People get infected with anthrax when spores get into the body. When anthrax spores get inside the body and become active, the bacteria can multiply, spread out in the body, produce toxins (poisons), and cause severe illness. This can happen when people breathe in spores (inhalation anthrax), eat food or drink water that is contaminated with spores (gastrointestinal anthrax), or get spores in a cut or scrape in the skin (cutaneous anthrax). Cutaneous anthrax, the type of anthrax infection Ousmane was diagnosed with, may occur from skin contact with contaminated animal carcasses, wool, hides, or fur. Cutaneous anthrax is the most common and mildest form of the disease—with treatment, it is seldom fatal. You cannot catch anthrax from another person the way you might catch a cold or the flu.

Ousmane reported he routinely wore a face mask to avoid the strong odor associated with the animal hides, which may have reduced the amount of bacteria he breathed in. However, taking all recommended precautions, such as wearing a NIOSH-approved N95 respirator and durable protective gloves; regularly washing hands thoroughly with soap and warm water; and working in a well-ventilated area, a worker’s risk for both cutaneous and inhalation anthrax exposure would be lessened, but not necessarily eliminated.

The best way for drum makers to prevent anthrax is to use animal hides known to be free of anthrax spores. Cattle or goat hides can be treated to help reduce the risk of getting anthrax when handling them. Hides that have been tanned, pickled in a solution of salt and mineral acid, or treated with lime are considered to pose less of a risk for infectious diseases such as anthrax.

Stephanie Stevens, MA, is a Health Communication Specialist in the NIOSH Office of the Director.

This is the most recent installment in the NIOSH Workplace Medical Mystery Series. This “mystery” is loosely based on Health Hazard Evaluation (HHE) reports conducted by NIOSH and other sources, and any recommendations made herein were for the specific facility evaluated and may not be universally applicable. Any recommendations made are not to be considered as final statements of NIOSH policy or of any agency or individual involved.  HHEs are publicly available at www.cdc.gov/niosh/hhe/reports/, but the names of individuals and facilities mentioned in the HHE reports and in this series have been changed to protect their identities. For more information on the NIOSH HHE program, visit www.cdc.gov/niosh/hhe/.

Sources:

National Institute for Occupational Safety and Health. (2014). Anthrax

Centers for Disease Control and Prevention. (2013). Anthrax: Cutaneous Anthrax 

Centers for Disease Control and Prevention. (2014). Anthrax: Symptoms

Centers for Disease Control and Prevention. (2008). Cutaneous Anthrax Associated with Drum Making Using Goat Hides from West Africa—Connecticut, 2007. MMWR 57(23):628-631 

Centers for Disease Control and Prevention. (2006). Inhalation Anthrax Associated with Dried Animal Hides—Pennsylvania and New York City, 2006. MMWR 55(10):280-282

Centers for Disease Control and Prevention. CDC Health Information for International Travel 2014. New York: Oxford University Press; 2014

Mayo Clinic. (2014). Diseases and Conditions: Anthrax