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About 95 percent of all cases of anthrax worldwide result from skin contact with infected animals or tissue, and ranchers and animal handlers are sometimes at risk.

Two suspected case of so-called cutaneous anthrax have been reported in Texas this year, both in ranch workers. The U.S. Centers for Disease Control and Prevention reported another cutaneous case in a North Dakota rancher last year.

Anthrax is an animal disease that rarely spreads to humans and almost never is transmitted from person to person. In the North Dakota outbreak, 32 farms were quarantined, and 157 animals died.

The North Dakota case was the first in the United States since 1992. In the early 1900s, there were about 200 cases annually.

Anthrax can also be caused by eating tainted meat or by breathing in anthrax spores. No cases of digestive anthrax have been reported to the CDC. Only 18 inhalation cases in the United States were documented in the 20th century, the most recent in 1976.

Cutaneous anthrax often begins with a bump on the hands, arms or head that eventually turns into a sore. More severe symptoms may follow, including fever, swelling and headache. The infection can be cured with a variety of antibiotics, including penicillin and Cipro. But when left untreated, about 20 percent of patients die.

Inhalation anthrax is far more serious. Symptoms typically start within seven days of breathing in spores of the bacterium, Bacillus anthracis, although they can develop six to eight weeks later.

First symptoms may resemble a cold, with cough and fever, but the disease progresses to severe breathing problems and shock. Once symptoms begin, the disease often responds poorly to antibiotic treatment. Without treatment, 90 percent of victims die within a few days.

The largest experience with inhalation anthrax was in Russia in 1979, when anthrax spores were accidentally released from a military biology facility. Seventy-nine cases of anthrax were reported, and 68 died.