The Anthrax Disease in Iran From 2000 to 2016: The Predominance of Cutaneous and Gastrointestinal Form

Context: Anthrax is a zoonotic and occupational disease caused by bacterium Bacillus anthracis. The agent produces spores which persist in the environment for years. This review assessed previous reports on anthrax disease in Iran from 2000 to 2016.
Evidence acquisition: The reports of anthrax from 2000 to 2016 were reviewed. The keywords "Bacillus anthracis", "Anthrax", "clinical signs", "Iran" and "zoonosis" were investigated in the searching databases such as "Google Scholar", "Google", "PubMed" and other sites. The reports of soil isolation and spores from environments were excluded. However, the clinical outcome of the cases, history of animal exposure, wool contaminations and meat in slaughterhouses were included. Results of Persian reports were also included in this review. Data were analyzed using Excel and GraphPad Prism version 6.1. The standardized mean difference (SMD) was used for data analysis.. Overall, 768 cases of anthrax were found in human, sheep, goats and cattle. Six hundred of the human cases aged between 2.5 and 71 years old were included. Four-hundred ten (68.33%) patients were male (mean age=28.1 ± 1.5) and 190 (31.66%) patients were female (mean age = 17±1.5). Clinical manifestations in patients were mostly in 2 cutaneous (56.6%) and gastrointestinal (42.83%) forms. Sporadic anthrax outbreaks occurred in the country in 2007, 2008 and 2011. No molecular typing has been performed for B. anthracis strains countrywide. The virulence factors encoded by the genes located on plasmids pXO1 and pXO2 were detected in various areas with high prevalence.
Cutaneous and gastrointestinal anthrax are 2 main manifestations of the disease in Iran. Male patients were significantly more infected. Although rare, anthrax continues to be a dreadful consequence of herds or soil exposure and consumption of undercooked meat of infected animals. Education plans and proper animal vaccination plans with the consideration of virulence factors are helpful for the prevention of the disease.