ANTHRAX

Anthrax is a life-threatening infectious disease that normally affects animals, especially ruminants
(such as goats, cattle, sheep, and horses). Anthrax can be transmitted to humans by contact with
infected animals or their products. In recent years, anthrax has received a great deal of attention
as it has become clear that the infection can also be spread by a bioterrorist attack or by biological
warfare. Anthrax does not spread from person to person
Cutaneous infection- is usually acquired by contact with infected animals or spore-contaminated
animal products. Open wounds or abrasions increase susceptibility, but infection may occur when
skin is intact. Skin infection may be transmitted from person to person by direct contact or
fomites.
GI (including oropharyngeal)- infection may occur after ingestion of inadequately cooked meat
containing the vegetative forms of the organism, usually when a break in the pharyngeal or
intestinal mucosa facilitates invasion. Ingested anthrax spores can cause lesions from the oral
cavity to the cecum. Released toxin causes hemorrhagic necrotic ulcers and mesenteric
lymphadenitis, which may lead to intestinal hemorrhage, obstruction, or perforation.
Pulmonary infection (inhalation anthrax) - caused by inhaling spores, is almost always due to
occupational exposure to contaminated animal products (eg, hides) and is often fatal.
Pathophysiology:
-Infection by Bacillus anthracis in animals and humans
-results from accidental or intentional exposure, by oral, cutaneous or pulmonary routes, to
spores, which are normally present in the soil.
-Bacillus anthracis readily form spores when they dryan environmental condition unfavorable
for growth.
-Spores resist destruction and can remain viable in soil, wool, and animal hair for decades.
--Spores germinate and begin multiplying rapidly when they enter an environment rich in amino
acids and glucose (eg, tissue, blood).
-spore germination in macrophages
-biological effects of the secreted toxins on heart and blood vessels
-lead to improved management of infected animals and patients.
-Controlling germination will be feasible by inhibiting macrophage paralysis and cell death.
- the control of terminal hypotension might be achieved by inhibition of cardiomyocyte mitogenactivated protein kinase and stimulation of vessel cAMP.

Signs and Symptoms:

Cutaneous anthrax
raised, itchy bump resembling an insect bite
Swelling in the sore
lymph glands

Gastrointestinal anthrax
Vomiting(often bloody)
Loss of appetite
Fever
Severe, bloody diarrhea in the later stages of the disease
Sore throat
Swollen neck
Nausea
Inhalation (pulmonary) anthrax
Flu-like symptoms
Mild chest discomfort
High fever
Trouble breathing
Shock
Meningitis

Complications:
1. Antrax meningitis is the intense inflammation of the meninges of the brain and spinal
cord.
2. Anthrax sepsis - develops after the lymphohematogenous spread of B. anthracis from
primary lesion.
3. hemorrhagic meningitis
Periods:
The incubation period (the period between contact with anthrax and the start of symptoms) may
be relatively short, from one to five days. Like other infectious diseases, the incubation period for
anthrax is quite variable and it may be weeks before an infected individual feels sick.
Diagnostic Tests:

Anthrax blood tests

Skin tests
Respiratory secretion tests
Antibody blood test
Biopsy
Sputum culture
Stool Culture
Endoscopy
Chest Xray or Computed Tomography
Nasal swab testing may be conducted on several people to detect contamination by
anthrax in the environment, but this does not confirm infection by anthrax in an
individual.

DIFFERENT TREATMENTS
*Medications:

Many antibiotics are effective against B anthracis and include the following:
Doxycycline (Vibramycin)
Penicillin
Amoxicillin (Trimox, Amoxil, Biomox)
Ampicillin (Marcillin, Omnipen, Polycillin, Principen, Totacillin)
Ciprofloxacin (Cipro)
Levofloxacin (Levaquin)
Gatifloxacin (Tequin)
Chloramphenicol (Chloromycetin)
Treatment of cutaneous anthrax involves 60 days treatment using antibiotics
I.V. corticosteroids may be given to adjunct therapy in severe cases.
An anthrax vaccine has been available for veterinarians (not routinely used due to low
incidence of animal disease).

*Nursing Management:
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Monitor vital signs and hemodynamic parameters closely for circulatory collapse.
Monitor temperature for response to antibiotic therapy.
Auscultate chest for crackles, indicating need for better secretion mobilization.
Monitor oxygen saturation and arterial blood gases periodically to determine oxygenation
status and acid-base balance.
Monitor level of consciousness and for meningeal signs such as nuchial rigidity.
Provide supplemental oxygen or mechanical ventilation, as needed.
Position for maximum chest expansion and reposition frequently to mobilize secretions.
Suction frequently and provide chest physiotherapy to clear airways, prevent atelectasis,
and maximize oxygen therapy.
Administer I.V. fluids to encourage oral fluid intake to replace the fluid lost through
hyperthermia and tachypnea.
For G.I. anthrax, maintain G.I decompression, monitor emesis and liquid stool output,
and medicate for abdominal pain, as needed.
Advice the patient and family that anthrax is not transmitted person to person; one must
come in contact with the spores to contact infection.

Images:

Sources:
http://www.wrongdiagnosis.com/a/anthrax/tests.htm
http://www.emedicinehealth.com/anthrax/page7_em.htm#Anthrax Treatment
http://www.medicinenet.com/anthrax/page2.htm#7howis