Gastrointestinal & Zoonoses

You are in: Skip Navigation LinksHPS Home | Gastrointestinal & Zoonoses | Anthrax

Gastrointestinal & Zoonoses



Anthrax is usually a disease of herbivorous mammals and is caused by the bacterium Bacillus anthracis. The ability of this organism to form spores and survive for many years in a dormant state is a key feature of its epidemiology.

In humans, anthrax is a potentially serious infection, although it is very rare in Europe. It occurs through direct or indirect contact with infected animals, including handling meat, hides, hair and wool. There are also concerns about the use of anthrax as a bioterrorism agent.

Main clinical features

These are dependent on the route of infection and take 4 main forms:

  1. Cutaneous (>90% cases) – entry through a skin lesion leads to the development initially of a pimple which, within two to three days, develops to form a dry, black firmly adherent scab from two to several cm in diameter across. The lesion rarely causes much pain, but there is nearly always considerable oedema which may spread a long way from the site of the lesion and may take up to six weeks to resolve.
  2. Pulmonary – entry is through inhalation of spores and illness begins insidiously with mild symptoms of slight fever and malaise lasting a few days. This is followed by an abrupt overt flu-like illness with fever and chills, leading quickly to prostration, shock, collapse and death.
  3. Intestinal – entry is through ingestion of spores and leads to severe gastrointestinal disease with nausea, vomiting, anorexia and fever leading to shock, collapse and death.
  4. Injection anthrax –this is a novel form of infection seen in heroin users and most likely contracted from using heroin contaminated with anthrax spores. Cases of injectional anthrax among people who inject drugs (PWID) in Scotland were first reported during an outbreak in 2009/2010. Further cases have been reported in 2012 and 2013. For general resources and guidance on managing anthrax infection in PWID see here:Guidance for managing anthrax among people who inject drugs and for further information on the outbreak in 2010 see here: Anthrax Outbreak December 2009-December 2010

Incubation period

  1. Cutaneous: One to seven days (rarely up to seven weeks)
  2. Pulmonary: One to seven days (usually 48 hours)
  3. Intestinal: one to seven days.


Voluntary laboratory reports.

Annual Surveillance Tables

No cases reported in Scotland between 1987 and 2005. One case was laboratory confirmed in 2006. In 2009 an outbreak of anthrax in drug users began, which continued into 2010. Information is provided in the link at the top of the page.

Frequently Asked Questions (FAQs)


Last reviewed: March 2013