[An anthrax epidemic in Switzerland. Clinical, diagnostic and epidemiological aspects of a mostly forgotten disease].

On average in Switzerland there is only one case of human anthrax every two years, and this is almost exclusively caused through contact with sick animals in agriculture. However, within less than 3 years, 25 workers in one textile factory have contracted this anthropo-zoonosis. 24 cases had cutaneous and one inhalation anthrax. The infection was imported in goat's hair from Pakistan. This almost unique industrial epidemic was due to various circumstances. In particular, the rarity of the illness contributed to a general lack of experience and therefore hindered recognition of the clinical symptoms. In addition, repeated attempts failed to identify the pathogenic agent conclusively. In most cases, the diagnosis was only confirmed retrospectively using the Russian allergen "Anthraxin"--an intracutaneous test unknown up to that time in human medicine in the West--and later also by EIA. All the patients recovered. The clinical picture, diagnosis and epidemiology of cutaneous anthrax are described in detail. The typical features are, in the beginning, a pruritic insect-bite-like pimple, then a painless ulcer surrounded by serous-hemorrhagic, often rapidly confluent vesicles and non-pitting edema. On the ground of the ulcer a black necrosis develops which is never colliquative but is transformed into the typical pitch-black firmly adherent eschar. Lymphadenitis and lymphangitis are concomitant manifestations. The bacteriological findings and occupational history are decisive for the diagnosis. Anthrax spores can survive many decades. The vegetative organisms are highly susceptible to almost all antibiotics. The latter prevent the invasion of the anthrax bacilli and the toxinemia if administered in time, but they do not influence the development of the local lesions. For the detection of anthrax bacillus, sterile swabs should be soaked in the fluid of the vesicles. It must be done before beginning of any antibiotic treatment. For the examination of animal products, preparatory procedures are necessary to destroy contaminants that may be antagonistic to or overgrow Bacillus anthracis.