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Anthrax

Updated : April 9, 2024





Background

Anthrax is an infectious disease. It is caused by Bacillus anthracis. It is a small aerobic rod and can form spores. The condition led to symptoms like fever, vomiting, nausea, and sweats. It also led to conditions like dyspnea, hemodynamic collapse, and respiratory failure.  

Anthrax word is originated from the Greek word anthrakis. Bacillus anthracis is known as a potential biological weapon. Anthrax condition can affect the skin or internal organs. The symptoms may see after several days of infection which makes difficult to track the organism effectively. 

Epidemiology

Anthrax is global disease. WHO has estimated around 2000 to 21000 cases of it. Anthrax outbreaks are generally uncommon in the United States but happened in North Dakota on ranches in 2000. 

Cutaneous anthrax is caused by skin contact. Pharyngeal, gastrointestinal, or inhalational anthrax is caused by spore ingestion. The Centers for Disease Control and Prevention have classified anthrax as a Category A priority disease.  

Anatomy

Pathophysiology

As we have discussed, Anthrax is an infectious disease. It is caused by Bacillus anthracis. It involves a complex pathophysiological process. It varies based on the route of exposure. The most common form is cutaneous anthrax. In that condition, the spores penetrate the kin and germinate into multiplication of active bacteria. This can lead to formation of an ulcer with a black eschar. Bacillus anthracis produces toxins like edema toxin, lethal toxin, and protective antigen. This plays an important role in the pathogenesis. 

The other condition is inhalation anthrax. In that, spores are inhaled into the lungs. Macrophages engulf them and transport them to lymph nodes. The spores germinate and cause systematic spread of bacteria. Tissue damage, edema, and hemorrhage occur sue to production of toxins. It results in severe respiratory distress. Gastrointestinal anthrax is caused due to consumption of contaminated meat. The spores germinate in the intestines and lead to diseases like ulcers, tissue necrosis. 

Cellular signalling pathways are disrupted by the toxins which is produced by Bacillus anthracis. This can lead to cell death and tissue damage. Edema toxin increases vascular permeability. Lethal toxins inhibit the immune cell function. The combined effect of both these toxins can lead to symptoms like fever, respiratory distress and hemodynamic collapse.  

Etiology

Bacillus anthracis is a spore form. It has great stability in environment. It can contaminate the soil, and this can cause herbivore infection during cropping. The spores remain viable for decades. This disease is more prevalent in summer and affect the domestic cattle, wild deer, and antelope. Human to animal transmission can happen while skin handling, butchering, or eating raw or undercooked meat. As there are no documented cases of human-to-human transmission. It is important to have knowledge of transmission mode and prevention action. 

Genetics

Prognostic Factors

Cutaneous anthrax is the primary cases of anthrax. The death rate of these cases is less than 2% when treated with antibiotics. 

Inhalation anthrax is a serious and severe fatal condition. The death rate of these cases is about 50%. It can sure by the right treatment and care. To improve the outcome and to reduce the death rate, it is necessary to detect it early.  

Clinical History

Inhalational anthrax is a disease caused by Bacillus anthracis. It often occurs from contaminated air or materials. It is dangerous for individuals who are working in animal products, laboratories, or areas with potential bioweapon exposure. The spores can remain dormant in the lungs. This can lead to infection.  

The incubation time for symptoms might vary from a few days to many weeks, and they can be subtle. Respiratory symptoms may get worse with the progression of disease. This includes severe dyspnea, chest discomfort, and coughing. Gastrointestinal symptoms may also appear. This includes nausea, vomiting, and abdominal pain. 

Cutaneous Anthrax 

Inhalational anthrax is a disease caused by Bacillus anthracis. It can often occur from contact with the infected animals or their byproducts. It occurs by handling meat, wool, or skins from infected animals. The onset action of cutaneous anthrax is the formation of small, papule painless at the infected site. This can progress into a vesicle and form a painless ulcer with a black eschar. The skin may appear red. The symptoms are like fever, malaise, and headache. 

GI Anthrax   

GI anthrax occur due to consumption of contaminated meat. This introduces Bacillus anthracis spores into digestive tract. Symptoms appear within a few days to weeks. The infection spread rapidly if it is left untreated. This can lead to conditions like gastrointestinal bleeding, tissue necrosis. This condition can be fatal if it is left untreated.  

Physical Examination

Cutaneous Anthrax 

This condition can lead eschar formation, a painless, elevated, blackened lesion. This condition can lead Lymphadenopathy. It can cause swelling in the lymph nodes. It can become tender and enlarged as the disease progression. This condition can also lead to edema on the nearby affected area. It contributes to skin rashes. 

Inhalational Anthrax 

Inhalational anthrax is a respiratory disease. It can lead to increased respiratory rate and difficulty in breathing. This can lead to conditions like hypotension, cardiovascular collapse, and multi-organ failure. At first patient may experience symptoms of fever. An examination of chest may reveal a abnormal sound of breath and mediastinal widening. This indicates more respiratory infection. A chest X-rays may reveal mediastinal widening. 

Gastrointestinal Anthrax 

Patients with GI anthrax may experience symptoms like abdominal tenderness and distension, fever, nausea, and vomiting, and diarrhea. This occurs due to inflammation and tissue damage. Abdominal distension occurs due to gas and fluid accumulation. A common symptom includes an increased level of body temperature. 

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

encephalopathy gangrenosum, ulcer glandular tularemia, pneumonic plague, influenza, spider bites, and community-acquired pneumonia 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

The treatment of anthrax disease involves the combinations of antibiotics. In severe or fatal cases, antitoxins are used for treatment. Antibiotics include ciprofloxacin, doxycycline, and levofloxacin. Antitoxins include anthrax immune globulin. It neutralizes the toxins in the body.  

The initiation of treatment is most important for a positive result. In inhalational anthrax, the antibiotics therapy may continue for 60 days. In cases of biological terrorism and populations at greater risks, vaccination is suggested. 

Role of Antibiotics in Anthrax 

Ciprofloxacin: The first line antibiotic to treat the anthrax is Ciprofloxacin. Ciprofloxacin is used for inhalational anthrax and cutaneous anthrax.  

Doxycycline: The first line antibiotic to treat the anthrax is Doxycycline. Doxycycline is used for prophylactic use after exposure.  

Levofloxacin: Levofloxacin is an alternative to ciprofloxacin and doxycycline. It could give depending on the how well patient can tolerate and sensitive. It is useful for the patient who can not tolerate tetracycline antibiotics.  

Role of Antitoxins 

Antitoxins include anthrax immune globulin. It is used to treat the adverse effects of anthrax toxins. It can often give with the antibiotics. It contains antibodies which can target the toxins and neutralize it. It prevents the cell and tissue from harmful effects. It is given in early infection of anthrax or to where there is a systemic toxicity is present. Anthrax antitoxins is also used as a part of post-exposure prophylaxis to those who are not showing up the symptoms. 

Role of Vaccination 

Vaccination is not advisable to the general population of US. It is suggested for those who are involved in the direct contact with animal skin and hair. People who are veterinarians, laboratory workers, and US military members may take the benefit of vaccination. In case of biological terrorism, vaccination is highly suggested to the community peoples.  

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

anthrax immune globulin 

Above 17 yrs: 420 units (7 vials) Intravenous; start intravenous therapy at 0.5 mL/min over 30 minutes; if tolerated, can increase the infusion rate with 0.5 mL/min every 30 minutes; should not exceed more than 2 mL/min.
Select the initial dosage based on the severity; adults with severe cases can warrant 14 vials (840 units).



anthrax vaccine adsorbed 

Prophylactic Measures Before Exposure:
First series: intramuscular 0.5 mL at 0, 1, and 6 months 0.5 mL intramuscularly, six and twelve months after the initial series, and then every twelve months after that is the booster series
Pre-exposure prophylaxis for individuals at risk of intramuscular injection hematomas:
Primary series: subcutaneous injection of 0.5 mL at 0, 2, 4, and 6 months 0.5 mL subcutaneously given as part of a booster series six and twelve months after the initial series and then every twelve months after that
Post-Exposure Prophylaxis: First series: 0.5 mL subcutaneous injection given in conjunction with antimicrobial therapy at 0, 2, and 4 weeks after exposure
indications: it is indicated inanthrax immunization



 

anthrax immune globulin 

Below 16 yrs: 60 to 420 units (1 to 7 vials) Intravenous; start intravenous therapy at 0.01 mL/kg/min over 30 minutes; if tolerated, can increase the infusion rate with 0.02 mL/kg/min every 30 minutes; should not exceed more than 0.04 mL/kg/min
Do not exceed the adult injection rate when starting (i.e., 0.5 mL/min) or when using the maximum rate (i.e., 2 mL/min)
Select the initial dosage based on the severity; pediatric patients with severe cases can warrant 2 to 14 vials (based on the weight) weighing above 5 kg
Vials required by the weight
Below 10 kg: 1 vial
10 to below 18 kg: 2 vials
18 to below 25 kg: 3 vials
25 to below 35 kg: 4 vials
35 to below 50 kg: 5 vials
50 to below 60 kg: 6 vials
Above 60 kg: 7 vials



 

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK507773/#article-17664.s9

Anthrax

Updated : April 9, 2024




Anthrax is an infectious disease. It is caused by Bacillus anthracis. It is a small aerobic rod and can form spores. The condition led to symptoms like fever, vomiting, nausea, and sweats. It also led to conditions like dyspnea, hemodynamic collapse, and respiratory failure.  

Anthrax word is originated from the Greek word anthrakis. Bacillus anthracis is known as a potential biological weapon. Anthrax condition can affect the skin or internal organs. The symptoms may see after several days of infection which makes difficult to track the organism effectively. 

Anthrax is global disease. WHO has estimated around 2000 to 21000 cases of it. Anthrax outbreaks are generally uncommon in the United States but happened in North Dakota on ranches in 2000. 

Cutaneous anthrax is caused by skin contact. Pharyngeal, gastrointestinal, or inhalational anthrax is caused by spore ingestion. The Centers for Disease Control and Prevention have classified anthrax as a Category A priority disease.  

As we have discussed, Anthrax is an infectious disease. It is caused by Bacillus anthracis. It involves a complex pathophysiological process. It varies based on the route of exposure. The most common form is cutaneous anthrax. In that condition, the spores penetrate the kin and germinate into multiplication of active bacteria. This can lead to formation of an ulcer with a black eschar. Bacillus anthracis produces toxins like edema toxin, lethal toxin, and protective antigen. This plays an important role in the pathogenesis. 

The other condition is inhalation anthrax. In that, spores are inhaled into the lungs. Macrophages engulf them and transport them to lymph nodes. The spores germinate and cause systematic spread of bacteria. Tissue damage, edema, and hemorrhage occur sue to production of toxins. It results in severe respiratory distress. Gastrointestinal anthrax is caused due to consumption of contaminated meat. The spores germinate in the intestines and lead to diseases like ulcers, tissue necrosis. 

Cellular signalling pathways are disrupted by the toxins which is produced by Bacillus anthracis. This can lead to cell death and tissue damage. Edema toxin increases vascular permeability. Lethal toxins inhibit the immune cell function. The combined effect of both these toxins can lead to symptoms like fever, respiratory distress and hemodynamic collapse.  

Bacillus anthracis is a spore form. It has great stability in environment. It can contaminate the soil, and this can cause herbivore infection during cropping. The spores remain viable for decades. This disease is more prevalent in summer and affect the domestic cattle, wild deer, and antelope. Human to animal transmission can happen while skin handling, butchering, or eating raw or undercooked meat. As there are no documented cases of human-to-human transmission. It is important to have knowledge of transmission mode and prevention action. 

Cutaneous anthrax is the primary cases of anthrax. The death rate of these cases is less than 2% when treated with antibiotics. 

Inhalation anthrax is a serious and severe fatal condition. The death rate of these cases is about 50%. It can sure by the right treatment and care. To improve the outcome and to reduce the death rate, it is necessary to detect it early.  

Inhalational anthrax is a disease caused by Bacillus anthracis. It often occurs from contaminated air or materials. It is dangerous for individuals who are working in animal products, laboratories, or areas with potential bioweapon exposure. The spores can remain dormant in the lungs. This can lead to infection.  

The incubation time for symptoms might vary from a few days to many weeks, and they can be subtle. Respiratory symptoms may get worse with the progression of disease. This includes severe dyspnea, chest discomfort, and coughing. Gastrointestinal symptoms may also appear. This includes nausea, vomiting, and abdominal pain. 

Cutaneous Anthrax 

Inhalational anthrax is a disease caused by Bacillus anthracis. It can often occur from contact with the infected animals or their byproducts. It occurs by handling meat, wool, or skins from infected animals. The onset action of cutaneous anthrax is the formation of small, papule painless at the infected site. This can progress into a vesicle and form a painless ulcer with a black eschar. The skin may appear red. The symptoms are like fever, malaise, and headache. 

GI Anthrax   

GI anthrax occur due to consumption of contaminated meat. This introduces Bacillus anthracis spores into digestive tract. Symptoms appear within a few days to weeks. The infection spread rapidly if it is left untreated. This can lead to conditions like gastrointestinal bleeding, tissue necrosis. This condition can be fatal if it is left untreated.  

Cutaneous Anthrax 

This condition can lead eschar formation, a painless, elevated, blackened lesion. This condition can lead Lymphadenopathy. It can cause swelling in the lymph nodes. It can become tender and enlarged as the disease progression. This condition can also lead to edema on the nearby affected area. It contributes to skin rashes. 

Inhalational Anthrax 

Inhalational anthrax is a respiratory disease. It can lead to increased respiratory rate and difficulty in breathing. This can lead to conditions like hypotension, cardiovascular collapse, and multi-organ failure. At first patient may experience symptoms of fever. An examination of chest may reveal a abnormal sound of breath and mediastinal widening. This indicates more respiratory infection. A chest X-rays may reveal mediastinal widening. 

Gastrointestinal Anthrax 

Patients with GI anthrax may experience symptoms like abdominal tenderness and distension, fever, nausea, and vomiting, and diarrhea. This occurs due to inflammation and tissue damage. Abdominal distension occurs due to gas and fluid accumulation. A common symptom includes an increased level of body temperature. 

encephalopathy gangrenosum, ulcer glandular tularemia, pneumonic plague, influenza, spider bites, and community-acquired pneumonia 

The treatment of anthrax disease involves the combinations of antibiotics. In severe or fatal cases, antitoxins are used for treatment. Antibiotics include ciprofloxacin, doxycycline, and levofloxacin. Antitoxins include anthrax immune globulin. It neutralizes the toxins in the body.  

The initiation of treatment is most important for a positive result. In inhalational anthrax, the antibiotics therapy may continue for 60 days. In cases of biological terrorism and populations at greater risks, vaccination is suggested. 

Role of Antibiotics in Anthrax 

Ciprofloxacin: The first line antibiotic to treat the anthrax is Ciprofloxacin. Ciprofloxacin is used for inhalational anthrax and cutaneous anthrax.  

Doxycycline: The first line antibiotic to treat the anthrax is Doxycycline. Doxycycline is used for prophylactic use after exposure.  

Levofloxacin: Levofloxacin is an alternative to ciprofloxacin and doxycycline. It could give depending on the how well patient can tolerate and sensitive. It is useful for the patient who can not tolerate tetracycline antibiotics.  

Role of Antitoxins 

Antitoxins include anthrax immune globulin. It is used to treat the adverse effects of anthrax toxins. It can often give with the antibiotics. It contains antibodies which can target the toxins and neutralize it. It prevents the cell and tissue from harmful effects. It is given in early infection of anthrax or to where there is a systemic toxicity is present. Anthrax antitoxins is also used as a part of post-exposure prophylaxis to those who are not showing up the symptoms. 

Role of Vaccination 

Vaccination is not advisable to the general population of US. It is suggested for those who are involved in the direct contact with animal skin and hair. People who are veterinarians, laboratory workers, and US military members may take the benefit of vaccination. In case of biological terrorism, vaccination is highly suggested to the community peoples.  

anthrax immune globulin 

Above 17 yrs: 420 units (7 vials) Intravenous; start intravenous therapy at 0.5 mL/min over 30 minutes; if tolerated, can increase the infusion rate with 0.5 mL/min every 30 minutes; should not exceed more than 2 mL/min.
Select the initial dosage based on the severity; adults with severe cases can warrant 14 vials (840 units).



anthrax vaccine adsorbed 

Prophylactic Measures Before Exposure:
First series: intramuscular 0.5 mL at 0, 1, and 6 months 0.5 mL intramuscularly, six and twelve months after the initial series, and then every twelve months after that is the booster series
Pre-exposure prophylaxis for individuals at risk of intramuscular injection hematomas:
Primary series: subcutaneous injection of 0.5 mL at 0, 2, 4, and 6 months 0.5 mL subcutaneously given as part of a booster series six and twelve months after the initial series and then every twelve months after that
Post-Exposure Prophylaxis: First series: 0.5 mL subcutaneous injection given in conjunction with antimicrobial therapy at 0, 2, and 4 weeks after exposure
indications: it is indicated inanthrax immunization



anthrax immune globulin 

Below 16 yrs: 60 to 420 units (1 to 7 vials) Intravenous; start intravenous therapy at 0.01 mL/kg/min over 30 minutes; if tolerated, can increase the infusion rate with 0.02 mL/kg/min every 30 minutes; should not exceed more than 0.04 mL/kg/min
Do not exceed the adult injection rate when starting (i.e., 0.5 mL/min) or when using the maximum rate (i.e., 2 mL/min)
Select the initial dosage based on the severity; pediatric patients with severe cases can warrant 2 to 14 vials (based on the weight) weighing above 5 kg
Vials required by the weight
Below 10 kg: 1 vial
10 to below 18 kg: 2 vials
18 to below 25 kg: 3 vials
25 to below 35 kg: 4 vials
35 to below 50 kg: 5 vials
50 to below 60 kg: 6 vials
Above 60 kg: 7 vials



https://www.ncbi.nlm.nih.gov/books/NBK507773/#article-17664.s9