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Case Reports
. 2022 Oct 17;75(Suppl 3):S354-S363.
doi: 10.1093/cid/ciac535.

Welder's Anthrax: A Tale of 2 Cases

Katherine Hendricks  1 , Roosecelis Brasil Martines  1 , Hannah Bielamowicz  2 , Anne E Boyer  3 , Stephen Long  4 , Paul Byers  5 , Robyn A Stoddard  1 , Kathryn Taylor  5 , Cari Beesley Kolton  1 , Maribel Gallegos-Candela  3 , Christine Roberts  5 , Marlene DeLeon-Carnes  1 , Johanna Salzer  6 , Patrick Dawson  7 , Dannette Brown  8 , Lindsey Templeton-LeBouf  4 , Ryan C Maves  9 , Chris Gulvik  1 , David Lonsway  10 , John R Barr  3 , William A Bower  1 , Alex Hoffmaster  1
Affiliations
Case Reports

Welder's Anthrax: A Tale of 2 Cases

Katherine Hendricks et al. Clin Infect Dis. .

Abstract

Bacillus anthracis has traditionally been considered the etiologic agent of anthrax. However, anthrax-like illness has been documented in welders and other metal workers infected with Bacillus cereus group spp. harboring pXO1 virulence genes that produce anthrax toxins. We present 2 recent cases of severe pneumonia in welders with B. cereus group infections and discuss potential risk factors for infection and treatment options, including antitoxin.

Keywords: Bacillus cereus; Bacillus tropicus; antitoxin; welder's anthrax; welding.

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Figures

Figure 1.
Figure 1.
Supportive care and treatments and hematology results for case patient 1, hospital days 1–14.
Figure 2.
Figure 2.
Portable chest radiograph for case patient 1 from hospital day 3 showing dense consolidation in the right lung, greatest in the mid and upper chest. Air bronchograms were present. Pleural fluid was possibly present, and empyema was a consideration. Patchy, milder infiltrates were seen in the left lung.
Figure 3.
Figure 3.
A, Portable chest radiograph for case patient 1 from the afternoon of hospital day 6, before antitoxin dose 1, showing extensive air-space consolidation throughout most of the right lung and nodular infiltrates throughout the left lung. B, Portable chest radiograph for case patient 1 from early morning hospital day 7, shortly after antitoxin dose 1, showing extensive confluent infiltrates throughout both lungs, with greater confluent disease of the right lung.
Figure 4.
Figure 4.
Anthrax lethal factor (LF) and anti-protective antigen (PA) immunoglobulin G (IgG) for case patient 1 by hospital day.
Figure 5.
Figure 5.
A, Portable chest radiograph of case patient 1 from hospital day 13, 1 day before antitoxin dose 2, showing slight radiographic improvement, especially on the left. B, Portable chest radiograph of case patient 1 from hospital day 15, 1 day after antitoxin dose 2, showing persistent bilateral pleural and parenchymal opacities, decreased aeration at right lung base, and increased aeration on left.
Figure 6.
Figure 6.
A, Chest radiograph for case patient 2 showing bilateral alveolar infiltrates consistent with pneumonia. B, Computed tomography abdomen lung window in case patient 2 showing diffuse bilateral consolidation.
Figure 7.
Figure 7.
Histopathological, special stain, and immunohistochemical findings for case patient 2. A, Low magnification of lung showing bronchopneumonia with neutrophilic inflammatory hemorrhage and necrosis. B, Lillie-Twort Gram stain showing abundant gram-positive bacilli. C, Warthin–Starry stain in the same area showing many bacilli. D, Abundant immunostaining of granular and bacilliform antigens seen using Bacillus anthracis cell wall immunohistochemistry assay. E, Immunostaining of B. anthracis cell wall antibody present within histiocytic cells. F, Area of lung showing abundant hemosiderin-laden macrophages; inset image shows iron-rich granules highlighted by Prussian blue stain. G, Liver showing small and large droplet steatosis and mild mononuclear inflammatory infiltrate in the portal area.
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