Practical and effective diagnosis of animal anthrax in endemic low-resource settings

Olubunmi R. Aminu*, Tiziana Lembo, Ruth N. Zadoks, Roman Biek, Suzanna Lewis, Ireen Kiwelu, Blandina T. Mmbaga, Deogratius Mshanga, Gabriel Shirima, Matt Denwood, Taya L. Forde

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)
21 Downloads (Pure)


Anthrax threatens human and animal health, and people’s livelihoods in many rural communities in Africa and Asia. In these areas, anthrax surveillance is challenged by a lack of tools for on-site detection. Furthermore, cultural practices and infrastructure may affect sample availability and quality. Practical yet accurate diagnostic solutions are greatly needed to quantify anthrax impacts. We validated microscopic and molecular methods for the detection of Bacillus anthracis in field-collected blood smears and identified alternative samples suitable for anthrax confirmation in the absence of blood smears. We investigated livestock mortalities suspected to be caused by anthrax in northern Tanzania. Field-prepared blood smears (n = 152) were tested by microscopy using four staining techniques as well as poly-merase chain reaction (PCR) followed by Bayesian latent class analysis. Median sensitivity (91%, CI95% [84–96%]) and specificity (99%, CI95% [96–100%]) of microscopy using azure B were comparable to those of the recommended standard, polychrome methylene blue, PMB (92%, CI95% [84–97%] and 98%, CI95% [95–100%], respectively), but azure B is more available and convenient. Other commonly-used stains performed poorly. Blood smears could be obtained for <50% of suspected anthrax cases due to local customs and condi-tions. However, PCR on DNA extracts from skin, which was almost always available, had high sensitivity and specificity (95%, CI95% [90–98%] and 95%, CI95% [87–99%], respec-tively), even after extended storage at ambient temperature. Azure B microscopy represents an accurate diagnostic test for animal anthrax that can be performed with basic laboratory infrastructure and in the field. When blood smears are unavailable, PCR using skin tissues provides a valuable alternative for confirmation. Our findings lead to a practical diagnostic approach for anthrax in low-resource settings that can support surveillance and control efforts for anthrax-endemic countries globally.

Original languageEnglish
Article numbere0008655
Pages (from-to)1-17
Number of pages17
JournalPLoS Neglected Tropical Diseases
Issue number9
Publication statusPublished - 14 Sept 2020

Bibliographical note

Funding Information: O. R. Aminu was supported by grants from the Bill & Melinda Gates Foundation (Program for Enhancing the Health and Productivity of Livestock, project reference ID 1083453). T. Forde was supported by a Marie Skłodowska-Curie Individual Fellowship (659223), a fellowship from the Natural Sciences and Engineering Research Council of Canada (PDF-471750-2015), and a Biotechnology and Biological Sciences Research Council (BBSRC) Future Leader Fellowship (FORDE/BB/R012075/1). The work was also supported by the Wellcome Trust through a Springboard award (SBF002\1168) to T. Lembo by the Academy of Medical Sciences. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Open Access: This is an open access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publisher Copyright: © 2020 Aminu et al.

Citation: Aminu OR, Lembo T, Zadoks RN, Biek R, Lewis S, Kiwelu I, et al. (2020) Practical and effective diagnosis of animal anthrax in endemic low-resource settings. PLoS Negl Trop Dis 14(9): e0008655.



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