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Anthrax

What is anthrax?

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus


anthracis. Anthrax most commonly occurs in wild and domestic lower vertebrates
(cattle, sheep, goats, camels, antelopes, and other herbivores), but it can also occur in
humans when they are exposed to infected animals or tissue from infected animals.

How common is anthrax and who can get it?

Anthrax is most common in agricultural regions where it occurs in animals. These


include South and Central America, Southern and Eastern Europe, Asia, Africa, the
Caribbean, and the Middle East. When anthrax affects humans, it is usually due to an
occupational exposure to infected animals or their products. Workers who are
exposed to dead animals and animal products from other countries where anthrax is
more common may become infected with B. anthracis (industrial anthrax).

How is anthrax transmitted?

Anthrax infection can occur in three forms: cutaneous (skin), inhalation, and
gastrointestinal. B. anthracis spores can live in the soil for many years, and humans
can become infected with anthrax by handling products from infected animals or by
inhaling anthrax spores from contaminated animal products. Anthrax can also be
spread by eating undercooked meat from infected animals. It is rare to find infected
animals in the United States.

What are the symptoms of anthrax?

Symptoms of disease vary depending on how the disease was contracted, but
symptoms usually occur within 7 days. Although incubation periods up to 60 days are
possible .

Cutaneous: Most (about 95%) anthrax infections occur when the bacterial spore
enters a cut or abrasion on the skin, such as when handling contaminated wool,
hides, leather or hair products (especially goat hair) of infected animals. Skin infection
begins as a raised itchy bump that resembles an insect bite but within 1-2 days

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develops into a vesicle and then a painless ulcer, usually 1-3 cm in diameter, with a
characteristic black necrotic (dying) area in the center. Edema or swelling of the
surrounding tissues may develop and lymph glands in the adjacent area may swell.
About 20% of untreated cases of cutaneous anthrax will result in death. Deaths are
rare with appropriate antimicrobial therapy.

Inhalation: Initial symptoms may resemble a common cold. After several days, the
symptoms may progress to severe breathing problems and shock. Inhalation anthrax
is usually fatal, and even with aggressive antibiotic and supportive therapy 45% of
inhalation anthrax cases were fatal.

Intestinal: The intestinal disease form of anthrax may follow the consumption of
contaminated meat and is characterized by an acute inflammation of the intestinal
tract. Initial signs include nausea, loss of appetite, vomiting, fever are followed by
abdominal pain, vomiting of blood, and severe diarrhea. Symptoms may also include
lesions and soreness in the throat, difficulty swallowing, marked swelling of the neck
and regional lymph glands. Intestinal anthrax results in death in 25% to 60% of cases.

How is anthrax diagnosed?

Anthrax is diagnosed by culture and isolation of the causative bacterium, B. anthracis;


by detecting the bacterial DNA or antigens; or by measuring specific antibodies in the
blood of persons with suspected cases. The bacteria can be cultured from the blood,
skin lesions, fluid from the lungs or respiratory secretions, spinal fluid, or other
affected tissues prior to the start of antibiotic treatment. Detection of the DNA or
antigens of the bacteria, and detection of antibodies in the blood of suspected cases,
are important tools for diagnosis because positive culture is unlikely after antibiotic
treatment has been started.

Susceptability:

There is some evidence of inapparent infection among people in frequent contact


with infectious agent ,second attacks can occure but reports are rare .

Where is anthrax usually found?

Anthrax can be found globally. It is more common in developing countries or


countries without veterinary public health programs. Certain regions of the world
(South and Central America, Southern and Eastern Europe, Asia, Africa, the
Caribbean, and the Middle East) report more anthrax in animals than others.

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Can anthrax be spread from person-to-person?

Person-to-person transmission is extremely unlikely and has only reported with


cutaneous anthrax, where discharges from skin lesions are potentially infectious.
Communicability is not a concern in managing or visiting with patients with inhalation
anthrax.

Methods of Control:

A- Preventive measures :

1) Immunization :

In countries where anthrax is common and vaccination levels of animal herds are low,
humans should avoid contact with livestock and animal products and avoid eating
meat that has not been properly slaughtered and cooked. Also, an anthrax vaccine
has been licensed for use in humans. The vaccine is reported to be 93% effective in
protecting against anthrax.

What is the anthrax vaccine?

The vaccine is a cell-free filtrate vaccine, which means it contains no dead or live
bacteria in the preparation. The final product contains no more than 2.4 mg of
aluminum hydroxide as adjuvant. Anthrax vaccines intended for animals should not
be used in humans.

Who should get vaccinated against anthrax?

The Advisory Committee on Immunization Practices has recommended anthrax


vaccination for the following groups:

Persons who work directly with the organism in the laboratory


Persons who work with imported animal hides or furs in areas where
standards are insufficient to prevent exposure to anthrax spores.
Persons who handle potentially infected animal products in high-
incidence areas. (Incidence is low in the United States, but veterinarians
who travel to work in other countries where incidence is higher should
consider being vaccinated.)
Military personnel deployed to areas with high risk for exposure to the
organism.

Pregnant women should be vaccinated only if absolutely necessary.

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What is the protocol for anthrax vaccination?

The immunization consists of three subcutaneous injections given 2 weeks apart


followed by three additional subcutaneous injections given at 6, 12, and 18 months.
Annual booster injections of the vaccine are recommended thereafter.

Are there adverse reactions to the anthrax vaccine?

Mild local reactions occur in 30% of recipients and consist of slight tenderness and
redness at the injection site. Severe local reactions are infrequent and consist of
extensive swelling of the forearm in addition to the local reaction. Systemic reactions
occur in fewer than 0.2% of recipients.

2)Educate employees who handle potentially contaminated articles about modes of


anthrax transmission, care of the skin abrasions and personal cleanliness .

3) Control dust and properly ventilatework area. Vaporized formaldehyde has been
used for disinfection of work places contaminated with B. Anthracis .

4) Wash, disinfect or sterilise hair,wool, and bone meal or other feed of animal origin
prior to processing .

5) Do not sell the hides of animales exposed to anthrax .

6) Immunize and annually re immunize all domestic animals at risk , treat


symptomatic animal with penicilline or tetracycline , immunize then after cessation of
treatment.

7) Do not necropsy the animal , if performed , autoclave, incinerate or chemically


disinfect all instrument or materials used .

B- Control of patient,contacts and the immediate envirument:

1) report to local health authority , also report to agriculture authority . Even a single
case of human anthrax especially of the inhalation type.

2) Isolation :standerd precaution for the duration of illness for cutaneous and
inhalation anthrax . Antibiotherapy sterilizes skin lesion withen 24 hours, but the
lesion progress to ulceration, sloughing , and resolution .

3) Concurrent disinfection: a 0.05% hypochlorite solution is sporicidal, hydrogen


peroxide, peracetic acid or glutaraldehyde may be alternative , ethylen oxide and
cobalt irradiation have been used , Anthrax spores are killed by boiling (100oC or

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212oF) for 30 minutes (the actual reported time is considerably less) . Spores require
steam.

Is there a treatment for anthrax?

To be effective, treatment should be initiated early. If left untreated, the disease can
be fatal. Antibiotics should be given to unvaccinated individuals exposed to inhalation
anthrax. Penicillin, tetracyclines and fluoroquinolones are effective if administered
before the onset of lymphatic spread or septicemia, estimated to be about 24 hours.
Antibiotic treatment is also known to lessen the severity of disease in individuals who
acquire anthrax through the skin. Inhalation anthrax was formerly thought to be
nearly 100% fatal despite antibiotic treatment, particularly if treatment is started
after symptoms appear. A recent Army study resulted in successful treatment of
monkeys with antibiotic therapy after being exposed to anthrax spores. The antibiotic
therapy was begun one day after exposure.