Anthrax
Clinical Description
Clinical Description
An illness with acute onset characterized by several distinct clinical forms, including the following:
Cutaneous: a skin lesion evolving during a period of 2-6 days from a papule, through a vesicular stage, to a depressed black eschar
Inhalation: a brief prodrome resembling a viral respiratory illness, followed by development of hypoxia and dyspnea, with radiographic evidence of mediastinal widening
Intestinal: severe abdominal distress followed by fever and signs of septicemia
Oropharyngeal: mucosal lesion in the oral cavity or oropharynx, cervical adenopathy and edema, and fever
Laboratory criteria for diagnosis of Anthrax
Laboratory criteria for diagnosis of Anthrax
Isolation of Bacillus anthracis from a clinical specimen, or
Anthrax electrophoretic immunotransblot (EITB) reaction to the protective antigen and/or lethal factor bands in one or more serum samples obtained after onset of symptoms, or
Demonstration of B. anthracis in a clinical specimen by immunofluorescence
What is anthrax?
What is Anthrax?
Bacillus anthracis, the etiologic agent of anthrax, is a large, gram-positive, non-motile, spore-forming rod-shaped bacteria. The three virulence factors of B. anthracis are edema toxin, lethal toxin, and a capsular antigen. Human anthrax has three major clinical forms: cutaneous, inhalation, and gastrointestinal. If left untreated, anthrax in all forms can lead to septicemia and death.
What is the difference between exposure to B. anthracis and disease caused by B. anthracis?
What is the difference between exposure to B. anthracis and disease caused by B. anthracis?
A person is exposed to B. anthracis when he or she comes in contact with the anthrax bacteria or is present in an environment that contains B. anthracis. A person can be exposed without having disease. Disease caused by B. anthracis occurs when there is some sign of illness, such as the skin lesion that occurs with cutaneous anthrax. A person who is exposed to B. anthracis but given appropriate antibiotics can avoid getting anthrax.
How much anthrax does it take to make someone sick?
How much anthrax does it take to make someone sick?
According to CDC, roughly 8,000-10,000 spores are needed to be inhaled to make a fatal exposure. However, other experts claim that there is no such thing as a "safe exposure limit" for today's dry, fine anthrax powder. According to them even few spores may make you sick.
How is anthrax diagnosed?
How is Anthrax diagnosed?
Anthrax is diagnosed by isolating B. anthracis from the blood, skin lesions, or respiratory secretions or by measuring specific antibodies in the blood of persons with suspected cases.
What are the signs and symptoms of anthrax?
What are the signs and symptoms of anthrax?
Anthrax exposures can be classified into three types based mainly on the route of entry of the anthrax into the human body and some of the clinical manifestations or the symptoms. Symptoms of disease vary depending on how the disease was contracted, but symptoms usually occur within 7 days.
Cutaneuous anthrax, where your skin surface is exposed to anthrax and you develop a skin lesion.
The incubation period ranges from 1-12 days. The skin infection begins as a small papule, progresses to a vesicle in 1-2 days followed by a necrotic ulcer. The lesion is usually painless, but patients also may have fever, malaise, headache, and regional lymphadenopathy. Most (about 95%) anthrax infections occur when the bacterium enters a cut or abrasion on the skin.
Skin infection begins as a raised bump that resembles a spider bite. It really looks like a swelling on the skin. It can appear anywhere on your body; but often appears on the arms or hands. Lymph glands in the adjacent area may swell. The swelling then develops a central area of ulceration of a depression, and then a scab or eschar, a very dark, blackish-brown scab (1-3 cm in diameter) forms over that central area. It can be painless and it may or may not been accompanied by a fever.
About 20% of untreated cases of cutaneous anthrax will result in death. Deaths are rare if patients are given appropriate antimicrobial therapy.
Inhalational anthrax is the most lethal form of anthrax and results from inhaling spores of the bacteria. The incubation period of inhalational anthrax among humans is unclear, but it is reported to range from 1 to 7 days, possibly ranging up to 60 days.
When a person inhales the spores, it become lodged in the lungs. There, they are picked up by immune-system cells called macrophages, which carry them to the lymph nodes. On the way, the spores mature into bacteria.
The bacteria multiply in the lymph nodes and then enter the bloodstream.
They produce a poison that causes the immune system to produce lethal doses of chemicals that are ordinarily useful to the body.
Initial symptoms of inhalational anthrax may resemble those of a common cold, such as sore throat, mild fever, muscle aches, and malaise. After several days, the symptoms may progress to severe breathing problems and shock, with meningitis frequently developing. Inhalation anthrax is often fatal.
Gastrointestinal anthrax usually follows the consumption of raw or undercooked contaminated meat and has an incubation period of 1-7 days.
Gastrointestinal anthrax is associated with severe abdominal distress followed by fever and signs of septicemia. It is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, and fever are followed by abdominal pain, vomiting of blood, and severe diarrhea.
Intestinal anthrax results in death in 25% to 60% of cases. The disease can take an oropharyngeal or abdominal form. Involvement of the pharynx is usually characterized by lesions at the base of the tongue, sore throat, dysphagia, fever, and regional lymphadenopathy. Lower bowel inflammation usually causes nausea, loss of appetite, vomiting and fever, followed by abdominal pain, vomiting blood, and bloody diarrhea.
What are the fatality rates for the various forms of anthrax?
What are the fatality rates for the various forms of Anthrax?
According to CDC, early treatment of cutaneous anthrax is usually curative, and early treatment of all forms is important for recovery.
Patients with cutaneous anthrax have reported fatality rates of 20% without antibiotic treatment. But the fatality rates drops to less than 1% with antibiotic treatment. So, it is very important that you get prompt treatment is you suspect exposure to anthrax bacteria.
We have incomplete information about the fatality rates in case of inhalational anthrax. Unfortunately, the fatality rate, in this case, is extremely high even when appropriate antibiotics are given. We also do not know the impact of the delay in post-exposure prophylaxis or treatment on survival in this type of exposure.
For gastrointestinal anthrax, the fatality rate is estimated to be 25%-60%. We do not know how early antibiotic treatment affects that fatality rate.
What is the average risk of contracting anthrax?
What is the average risk of contracting Anthrax?
The risk of any average individual in the USA contracting anthrax is infinitesimal. The risk is for people who have been in a place of known exposure. So far, the known places of exposures are one business place in Florida, a couple of locations in New York City, and a governmental office building in Washington. Few postal processing centers near Washington, DC are also affected. Persons who have not been in these circumstances are not at-risk.
If anthrax is on the ground, can I get it from kicking up dust?
If Anthrax is on the ground, can I get it from kicking up dust?
Probably not. The spores tend to clump together, so even if inhaled, they do not get deep into the lungs.
Some of the terrorist-manufactured anthrax, however, is very fine and may be chemically treated to prevent them from clumping together. In this case, the anthrax from the ground can be inhaled under optimum conditions. (Similar to what happened to the postal workers. If you were in the vicinity of anthrax contamination, you should immediately seek medical attention.
What can the average person do to protect himself/herself?
What can the average person do to protect himself/herself?
According to Dr. Jeffrey P. Koplan, Director of the Centers of Disease Control and Prevention in the USA, the best approach to take in dealing with anthrax, is to know a little bit more about anthrax. Here are some salient facts:
Anthrax is not contagious.
Anthrax doesn't spread from person-to-person.
It's a disease that, once exposed to, is treatable. A number of different antibiotics can be used to treat it.
Antibiotics are also very effective in preventing a person from ever getting the disease once exposed.
Cutaneous anthrax is readily treatable. Inhaled anthrax is more deadly.
The best defense is to have a good defense system in our body that wards off infections and entry of unwanted organisms into our body such as bacteria. We recommend that you take steps to boost your immune system. Natural remedies are available to do so and are covered in depth in holisticonline.com Nothing is going to prevent you from getting the intentional inflicting of biological agents such as is the case in bioterrorism. However, you may be able to buy enough time for you to seek medical treatment and also prevent you from having other complications.
Can a person get screened or tested for anthrax?
Can a person get screened or tested for Anthrax?
According to Dr. Jeffrey P. Koplan, Director of the Centers of Disease Control and Prevention in the USA, there is no screening test for anthrax. There is no test that a doctor can do that says a person has been exposed to anthrax or is carrying it.
The only way that anthrax exposure can be determined is through a public health investigation. And in those circumstances, for example, where people work in a given office or on a given floor have been exposed, the public health officials will inform people whether they have been exposed or not. They will also advise you whether you need the treatment with antibiotics.
You may have read, heard or seen reports of blood tests or nasal swabs or other tests for anthrax. According to Dr. Koplan, these are not tests to determine whether an individual should be treated. These nasal swabs and environmental tests are used to determine the extent of exposure in a given building or workplace.
Is Anthrax contagious?
Is Anthrax contagious?
Anthrax can not be spread from person-to-person. One person is not contagious to another person. We can only get it from the mechanisms of exposure to the skin, breathing it, or eating it.
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