Endemic Gastrointestinal Anthrax in 1960s Lebanon: Clinical Manifestations and Surgical Findings

Anthrax is an ancient disease caused by the grampositive Bacillus anthracis; recently, it has gained much attention because of its potential use in biologic warfare.Anthrax infection occurs in three forms: cutaneous, inhalational, and gastrointestinal.The last type results from ingestion of poorly cooked contaminated meat.Intestinal anthrax was widely known in Lebanon in the 1960s, when a series of >100 cases were observed in the Bekaa Valley.We describe some of these cases, introduce the concept of the surgical management of advanced intestinal anthrax, and describe some of the approaches for treatment. S everal reports and reviews have recently shed light onanthrax and its cutaneous and pulmonary manifestations, focusing on its threat as a biologic weapon.The third form of the disease, gastrointestinal anthrax, has not received as much attention, and the research describing its manifestations is scarce.We report on several cases of intestinal anthrax from 1960 to 1974 in the Bekaa Valley in Lebanon, where the consumption of raw or poorly cooked meat is customary.One of the authors (A.Ghossain) treated and operated on all the patients described here.We describe a series of gastrointestinal anthrax cases, the reporting of which has become paramount with the current renewed interest in this entity, the scarcity of information in the research on this particular form of anthrax, and the high fatality rate in advanced disease.The cases described in this report were chosen to illustrate the protean manifestations of gastrointestinal anthrax. Clinical Manifestations and Surgical FindingsIn March 1960, an acute and particularly severe abdominal syndrome was recognized in the Bekaa Valley in Lebanon.The first cases were described in male patients from 4 to 25 years of age with an illness that consisted of three phases.Phase I was marked by fainting spells, asthenia, low-grade fever, and headache.Patients rarely sought medical treatment at this stage because the symptoms were not serious enough.