Anthrax bacteria.Inhalational anthrax - Mediastinal widening
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Anthrax disease

Anthrax, also referred to as splenic fever, is an acute infectious disease caused by the bacteria Bacillus anthracis and is highly lethal in its most virulent form. Anthrax most commonly occurs in wild and domestic herbivores, but it can also occur in humans when they are exposed to infected animals, tissue from infected animals, or high concentrations of anthrax spores. Still there are no cases of people who got sick through contact with a diseased person. more...

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The word anthrax is derived from the Greek word anthrakis, which means "coal", and is used because victims develop black skin lesions.

Anthrax infection is rare but not remarkably so in herbivores such as cattle, sheep, goats, camels, and antelopes. Anthrax can be found globally. It is more common in developing countries or continents without veterinary public health programs. Certain regions of the world (North America, Western and Northern Europe, and Australia) report less anthrax in animals than others. Anthrax comes in 89 known strains. The best known is the virulent Ames strain, used in the 2001 anthrax attacks in the United States. The Vollum (also incorrectly refered to as Vellum) strain, another one suitable for use as a biological weapon, was isolated in 1935 from a cow in Oxfordshire, UK, and used (specifically the Vollum 1B strain) during 1960s in the US and UK bioweapon programs; Iraq also attempted to acquire it during 1980s, together with Ames. Other strains are eg. Sterne (a benign form used for inoculations, named after a South African researcher), ANR-1, δAmes, A-3, RP4 and RP42. The strains differ in presence and activity of various genes, determining their virulence and production of antigens and toxins. See the list of strains.

Exposure

When anthrax affects humans, it is usually due to an occupational exposure to infected animals or their products (such as skin and meat). Workers who are exposed to dead animals and animal products from countries where anthrax is more common may become infected with B. anthracis, and anthrax in wild livestock has occurred in the United States. Although many such workers are routinely exposed to significant levels of anthrax spores, most are not sufficiently exposed to develop symptoms.

Means of infection

Anthrax can enter the human body through the intestines, lungs (inhalation), or skin (cutaneous). Anthrax is non-contagious, and is unlikely to spread from person to person.

Pulmonary (pneumonic, respiratory, inhalation) anthrax

Inhalation infection initially presents with cold or flu-like symptoms for several days, followed by severe (and often fatal) respiratory problems. If not treated soon after exposure, before symptoms appear, inhalation infection is the most deadly, with a nearly 100% mortality rate. A lethal case of anthrax is reported to result from inhaling 10,000-20,000 spores. This form of the disease has also been known as Woolsorters' disease. Other routes have included the slicing up of animal horns for the manufacture of buttons, and handling bristles used for the manufacturing of brushes.

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CDC Updates Interim Guidelines for Anthrax Exposure Management and Antimicrobial Therapy - Centers for Disease Control and Prevention
From American Family Physician, 12/1/01 by Genevieve Ressel

The Centers for Disease Control and Prevention (CDC) has issued an update on the investigation of recent cases of anthrax exposure. This update includes the susceptibility patterns of Bacillus anthracis isolates, and provides interim recommendations for managing potential threats and exposures and for treating anthrax. The complete report appears in the October 26, 2001 issue of Morbidity and Mortality Weekly Report and is available on the CDC Web site at www.cdc.gov/mmwr. A copy of the report is also available on the Web site of the American Academy of Family Physicians at www.aafp.org/resources.

Managing Exposure

The highest priority is to identify at-risk persons and initiate appropriate interventions to protect them. The exposure circumstances are the most important factors that direct decisions about prophylaxis. Persons with an exposure or contact with an environment known, or suspected, to be contaminated with B. anthracis--regardless of laboratory test results--should be offered antimicrobial prophylaxis. Exposure or contact, not laboratory results, is the basis for initiating treatment.

Antimicrobial Treatment

A high index of suspicion and rapid administration of effective antimicrobial therapy is essential for prompt diagnosis and effective treatment of anthrax. Limited clinical experience is available and no controlled trials in humans have been performed to validate current treatment recommendations for inhalational anthrax. Based on studies in nonhuman primates and other animals and in vitro data, ciprofloxacin or doxycycline should be used for initial intravenous therapy until antimicrobial susceptibility results are known (Table 1).

Two or more antimicrobial agents predicted to be effective are recommended because of the mortality associated with inhalational anthrax. Other agents with in vitro activity suggested for use in conjunction with ciprofloxacin or doxycycline include rifampin, vancomycin, imipenem, chloramphenicol, penicillin and ampicillin, clindamycin and clarithromycin, but other than for penicillin, limited or no data exist about using these agents in the treatment of inhalational B. anthracis infection. Cephalosporins and trimethoprim-sulfamethoxazole should not be used for therapy, and penicillin G and ampicillin alone should not be used to treat systemic infection because the combination may not be clinically effective for inhalational anthrax where large numbers of organisms are likely to be present.

Toxin-mediated morbidity is a major complication of systemic anthrax. Corticosteroids have been suggested as adjunct therapy for inhalational anthrax associated with extensive edema, respiratory compromise, and meningitis.

For cutaneous anthrax, ciprofloxacin and doxycycline are first-line therapy (Table 2). Intravenous therapy with a multidrug regimen is recommended if signs of systemic involvement, extensive edema, or lesions on the head and neck are present. Antimicrobial treatment may render lesions culture negative in 24 hours, but progression to eschar formation still occurs. Typically, cutaneous anthrax is treated for seven to 10 days, but with the latest attacks, the risk for simultaneous aerosol exposure appears to be high. Although infection may produce an effective immune response, a potential for reactivation of latent infection may exist, so patients should be treated for 60 days.

All medications may have side effects and allergic reactions. Physicians should be aware of these side effects and consult an infectious diseases specialist as needed. Patients should be urged to inform their health care provider of any adverse events.

COPYRIGHT 2001 American Academy of Family Physicians
COPYRIGHT 2002 Gale Group

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