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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Anthrax treatment reviewed for serious adverse events - Tips from Other Journals
From American Family Physician, 3/1/04 by Bill Zepf

A bioterrorist attack involving anthrax spores sent to various targets by mail in October 2001 resulted in 22 cases of confirmed anthrax poisoning, including five fatal infections. The Centers for Disease Control and Prevention (CDC) coordinated the health care response to patients exposed to anthrax. Tierney and colleagues reviewed the adverse events associated with treatment for anthrax exposure.

Specific exposure criteria were defined by the CDC in consultation with other health authorities. Those at risk for significant exposure to inhalational anthrax received a 60-day course of antibiotic therapy. Concern arose that this therapy might not provide sufficient protection when it became apparent that compliance with the antibiotic regimen was suboptimal, and there was evidence that anthrax spores could persist for more than 60 days, then germinate and cause inhalational anthrax poisoning.

The CDC provided two treatment regimens for extended protection against anthrax. The first option involved an additional 40 days of antibiotic therapy (i.e., ciprofloxacin, doxycycline, or amoxicillin), while the second option combined extended antibiotic therapy with three doses of anthrax vaccine, spaced at two-week intervals. An informed consent educational program was provided to 5,420 exposed persons, of whom 1,727 (32 percent) opted to undergo extended treatment. Most of the enrollees chose to receive only extra antibiotics. Anthrax vaccine was given to 199 persons. Surveillance for adverse events was accomplished via a telephone hotline and post-treatment interviews.

During surveillance, 71 potential adverse events were identified. Twelve of these events were classified as serious, but only two were assessed to be treatment-related. One patient on extended treatment with doxycycline developed diarrhea and chest pain. Extended ciprofloxacin therapy led to allergic interstitial nephritis and acute renal failure in another patient. No serious adverse events were associated with use of anthrax vaccine.

The authors conclude that two serious adverse events occurred in 1,727 persons receiving extended antibiotic treatment for anthrax exposure. Surveillance of participants is to be continued over an additional two years to monitor for any delayed adverse events.

Tierney BC, et al. Serious adverse events among participants in the Centers for Disease Control and Prevention's anthrax vaccine and antimicrobial availability program for persons at risk for bioterrorism-related inhalational anthrax. Clin Infect Dis October 1, 2003;37:905-11.

COPYRIGHT 2004 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group

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