Anthrax and     Anthrax Vaccine    Under Supervision of :Prof. Dr Ekram M. El-ShabrawyTeam Work :   Mostafa Emad Ahmed  ...
ContentsCausative            Laboratory Tests Organism.            VaccineDisease Exit.        TreatmentPathogenesis...
Causative OrganismScientific classification:-              • Bacteria    Kingom              • Firmicutes    Phylum       ...
Causative Organism    * Bacillus Species The genus bacillus includes large  aerobic. Gram-positive rods occurring in cha...
Causative OrganismB cereus can grow in foods and produce an enterotoxin or an emetic toxin and cause food poisoning.may ...
Causative Organism   * MorphologyThe typical cells, measuring 1 x 3 - 4 micron.have square ends and are arranged in long...
Causative Organism   IdentificationOn Culture:-Colonies of B anthraces are round and have a "cut glass" appearance.Haemo...
Causative Organism IdentificationGrowth in gelatine stabs resembles an inverted fir tree.
Causative Organism    Identification Gram-positive, spore-forming, non-motile  bacillus
Causative OrganismGrowth Characteristics:- The saprophytic bacilli utilize simple  sources of nitrogen and carbon for  en...
Disease Exit     Type :- Anthrax is primarily a Zoonotic disease ( eg. goats,  sheep, cattle, horses, etc;) other animal...
Disease Exit    Infection To Human Humans become infected incidentally by contact with infected animals or their products.
Disease ExitMode Of Transmision cutaneous anthrax  by the entry of spores  through injured skin. gastrointestinal  anthr...
Pathogenesis                   growth of                      the                   vegetative                   organisms...
PathogenesisB anthracis that does not produce a capsule is not virulent and does not induce anthrax in test animals. The...
Virulence Factors     Anthrax Toxin:-Toxin Structure:-  Anthrax toxin is made up of three proteins:- protective antigen (...
Virulence Factors    Anthrax Toxin:- EF is an adenylyl cyclase; with PA it forms a  toxin known as edema toxin. LF plus ...
Virulence FactorsAnthrax Toxin:-Lethal Factor     Protective Antigen   Edema Factor           Lethal Toxin          Edema ...
Virulence FactorsHow Toxin Work:-
clinical             formsCutaneous      GIT     Pulmonary
Clinical Findings In humans, approximately 95% of cases are  cutaneous anthrax and 5% are inhalation.  100%   90%   80%  ...
Clinical Findings Gastrointestinal anthrax is very  rare; it has been reported from Africa,  Asia, and the United States ...
Cutaneous Anthrax     Clinical Picture :- The lesions typically are 1–3 cm in diameter and have a  characteristic central...
Cutaneous Anthrax    Cutaneous Anthrax Vesicle Development Day 2        Day 4           Eschar Formation Day 6         ...
Cutaneous Anthrax   Sequelae :-1) Healing After 7–10 days the eschar is fully developed.  Eventually it dries, loosens, a...
Cutaneous Anthrax Sequelae :-2) Death In as many as 20%  of patients,  cutaneous anthrax  can lead to sepsis,  the conseq...
Cutaneous Anthrax
Inhalation Anthrax   Preview:- Incubation period: 1-7 days (range up to  43 days). Infection occure by inhalation of B.A...
Inhalation AnthraxClinical Picture:- The early clinical manifestations are associated  with marked hemorrhagic necrosis a...
Inhalation Anthrax   Clinical Picture:- Rapid deterioration with  fever, dyspnea, cyanosis  and shock. Hemorrhagic pleur...
Inhalation Anthrax                 Chest X-rays isChest X-Ray :-   advised as an initial                 method of inhala...
Inhalation AnthraxChest X-Ray :-                  Substernal pain                   may be prominent,                   a...
Gastrointestinal anthraxPreview:-Animals acquire anthrax through ingestion of spores and spread of the organisms from the...
Gastrointestinal anthraxClinical Picture :-Abdominal pain, vomiting, and bloody diarrhea are clinical signs.Sepsis occur...
Laboratory Diagnostic Tests    Specimens:- Specimens to be  examined are fluid  or pus from a local  lesion, blood, and  ...
Laboratory Diagnostic TestsDirect Examination : Stained smears from the local lesion or of  blood from dead animals often...
Laboratory Diagnostic TestsCulture : Nutrient broth non  motile on blood agar plates, the  organisms produce  nonhemolyt...
Laboratory Diagnostic Tests
Laboratory Diagnostic TestsLab Characters Virulent anthrax cultures kill mice upon  intraperitoneal injection. Demonstra...
Anthrax Vaccines   Development By Years 1881   Pasteur develops first live attenuated         veterinary vaccine for live...
Anthrax VaccinesPreparation: Immunization to prevent  anthrax is based on the  classic experiments of  Louis Pasteur. In...
Anthrax VaccinesPreparation: Four countries  produce vaccines for  anthrax. Russia and China  use attenuated spore-  bas...
Anthrax VaccinesPre-exposure VaccinationThe current US FDA approved  vaccine contains cell-free filtrates of  a toxigenic...
Anthrax VaccinesVaccination ScheduleInitial doses at 0, 2, and 4 weeks.Additional doses at 6, 12, and 18 months.Annual ...
Anthrax VaccinesPost-exposure Vaccination No efficacy data for postexposure  vaccination of humans. Postexposure vaccina...
Anthrax VaccinesPrecautions and ContraindicationsSevere allergic reaction to a vaccine component or following a prior dos...
Treatment Many antibiotics are  effective against anthrax  in humans, but  treatment must be  started early. Ciprofloxac...
Chemoprophylaxis prophylaxis with  ciprofloxacin or  doxycycline should be  continued for 4 weeks  while three doses of  ...
Epidemiology Soil is contaminated  with anthrax spores  from the carcasses of  dead animals. These spores remain  viable...
EpidemiologyGrazing animals infected through injured mucous membranes serve to perpetuate the chain of infection.
Prevention & ControlControl measures include :-(1) disposal of animal carcasses by burning or by deep burial in lime pits...
• By: El Omda
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Anthrax ..

  1. 1. Anthrax and Anthrax Vaccine Under Supervision of :Prof. Dr Ekram M. El-ShabrawyTeam Work : Mostafa Emad Ahmed Mohammed Bahaa El-Din Mostafa Abd-Elsamee Ahmed Mohamed Taha
  2. 2. ContentsCausative Laboratory Tests Organism. VaccineDisease Exit. TreatmentPathogenesis. ChemoprophylaxisVirulence Factors. Epidemiology.Clinical Forms. Prevention &Clinical Findings. Control
  3. 3. Causative OrganismScientific classification:- • Bacteria Kingom • Firmicutes Phylum • Bacilli Class • Bacillacea Family • Bacillus Genus • B. anthracis Species
  4. 4. Causative Organism * Bacillus Species The genus bacillus includes large aerobic. Gram-positive rods occurring in chains. Most members of this genus are saprophytic organisms prevalent in soil, water, and air and on vegetation. Spores may remain viable in soil for years
  5. 5. Causative OrganismB cereus can grow in foods and produce an enterotoxin or an emetic toxin and cause food poisoning.may occasionally produce disease in immunocompromised humans . B anthracis, which causes anthrax, is the principal pathogen of the genus.
  6. 6. Causative Organism * MorphologyThe typical cells, measuring 1 x 3 - 4 micron.have square ends and are arranged in long chains.spores are located in the center of the nonmotile bacilli.
  7. 7. Causative Organism IdentificationOn Culture:-Colonies of B anthraces are round and have a "cut glass" appearance.Haemolysis is uncommon with B anthraces.
  8. 8. Causative Organism IdentificationGrowth in gelatine stabs resembles an inverted fir tree.
  9. 9. Causative Organism Identification Gram-positive, spore-forming, non-motile bacillus
  10. 10. Causative OrganismGrowth Characteristics:- The saprophytic bacilli utilize simple sources of nitrogen and carbon for energy and growth. The spores are resistant to environmental changes, withstand dry heat and certain chemical disinfectants for moderate periods, and persist for years in dry earth
  11. 11. Disease Exit Type :- Anthrax is primarily a Zoonotic disease ( eg. goats, sheep, cattle, horses, etc;) other animals (eg, rats) are relatively resistant to the infection
  12. 12. Disease Exit Infection To Human Humans become infected incidentally by contact with infected animals or their products.
  13. 13. Disease ExitMode Of Transmision cutaneous anthrax by the entry of spores through injured skin. gastrointestinal anthrax (rarely) by the mucous membranes. inhalation anthrax :- by inhalation of spores into the lung .
  14. 14. Pathogenesis growth of the vegetative organisms via lymphaticsTo Man or Animal to the bloodstream From dead body to Env.
  15. 15. PathogenesisB anthracis that does not produce a capsule is not virulent and does not induce anthrax in test animals. The poly-D-glutamic acid capsule is antiphagocytic. The capsule gene is on a plasmid.
  16. 16. Virulence Factors Anthrax Toxin:-Toxin Structure:- Anthrax toxin is made up of three proteins:- protective antigen (PA). edema factor (EF). lethal factor (LF).
  17. 17. Virulence Factors Anthrax Toxin:- EF is an adenylyl cyclase; with PA it forms a toxin known as edema toxin. LF plus PA form lethal toxin, which is a major virulence factor and cause of death in infected animals. Toxins responsible for tissue damage and edema
  18. 18. Virulence FactorsAnthrax Toxin:-Lethal Factor Protective Antigen Edema Factor Lethal Toxin Edema Toxin Tissue damage, shock Edema
  19. 19. Virulence FactorsHow Toxin Work:-
  20. 20. clinical formsCutaneous GIT Pulmonary
  21. 21. Clinical Findings In humans, approximately 95% of cases are cutaneous anthrax and 5% are inhalation. 100% 90% 80% 70% 60% Column1 50% Series 2 40% 30% Series 1 20% 10% 0% cutanous Pulmonary GIT
  22. 22. Clinical Findings Gastrointestinal anthrax is very rare; it has been reported from Africa, Asia, and the United States following occasions where people have eaten meat from infected animals. The bioterrorism events in the fall of 2001 resulted in 22 cases of anthrax: 11 inhalation and 11 cutaneous. Five of the patients with inhalation anthrax died. All the other patients survived.
  23. 23. Cutaneous Anthrax Clinical Picture :- The lesions typically are 1–3 cm in diameter and have a characteristic central black eschar. Marked edema occurs. Lymphangitis and lymphadenopathy and systemic signs and symptoms of fever, malaise, and headache may occur.
  24. 24. Cutaneous Anthrax Cutaneous Anthrax Vesicle Development Day 2 Day 4 Eschar Formation Day 6  Day 10  Day 7
  25. 25. Cutaneous Anthrax Sequelae :-1) Healing After 7–10 days the eschar is fully developed. Eventually it dries, loosens, and separates. healing is by granulation and leaves a scar. It may take many weeks for the lesion to heal and the edema to subside.
  26. 26. Cutaneous Anthrax Sequelae :-2) Death In as many as 20% of patients, cutaneous anthrax can lead to sepsis, the consequences of systemic infection (including meningitis ) and death
  27. 27. Cutaneous Anthrax
  28. 28. Inhalation Anthrax Preview:- Incubation period: 1-7 days (range up to 43 days). Infection occure by inhalation of B.Anthrasis spores. Case-fatality: 1) without antibiotic treatment – 85%- 97% 2) with antibiotic treatment – 75% (45% in2001)
  29. 29. Inhalation AnthraxClinical Picture:- The early clinical manifestations are associated with marked hemorrhagic necrosis and edema of the mediastinum.
  30. 30. Inhalation Anthrax Clinical Picture:- Rapid deterioration with fever, dyspnea, cyanosis and shock. Hemorrhagic pleural effusions follow involvement of the pleura; cough is secondary to the effects on the trachea.
  31. 31. Inhalation Anthrax Chest X-rays isChest X-Ray :- advised as an initial method of inhalation anthrax detection, but it is sometimes not useful for patients without symptoms. Find a widened mediastinum and pleural effusion
  32. 32. Inhalation AnthraxChest X-Ray :-  Substernal pain may be prominent, and there is pronounced mediastinal widening visible on x-ray chest films
  33. 33. Gastrointestinal anthraxPreview:-Animals acquire anthrax through ingestion of spores and spread of the organisms from the intestinal tractThis is Rare in Humans, Gastrointestinal anthrax is Extremely Uncommon.
  34. 34. Gastrointestinal anthraxClinical Picture :-Abdominal pain, vomiting, and bloody diarrhea are clinical signs.Sepsis occurs, and there may be hematogenous spread to the gastrointestinal tract, causing bowel ulceration, or to the meninges, causing hemorrhagic meningitis.
  35. 35. Laboratory Diagnostic Tests Specimens:- Specimens to be examined are fluid or pus from a local lesion, blood, and sputum.Gram Stain :- Gram stain shows large gram-positive rods.
  36. 36. Laboratory Diagnostic TestsDirect Examination : Stained smears from the local lesion or of blood from dead animals often show chains of large gram-positive rods. Carbohydrate fermentation is not useful. . Anthrax can be identified in dried smears by immunofluorescence staining techniques. immunofluorescence staining of sporation
  37. 37. Laboratory Diagnostic TestsCulture : Nutrient broth non motile on blood agar plates, the organisms produce nonhemolytic gray to white colonies On Mixed Flora a rough texture and a ground- glass appearance. Comma-shaped outgrowths (Medusa head) may project from the colony.
  38. 38. Laboratory Diagnostic Tests
  39. 39. Laboratory Diagnostic TestsLab Characters Virulent anthrax cultures kill mice upon intraperitoneal injection. Demonstration of capsule requires growth on bicarbonate-containing medium in 5–7% CO2. Lysis by a specific anthrax -bacteriophage may be helpful in identifying the organism.
  40. 40. Anthrax Vaccines Development By Years 1881 Pasteur develops first live attenuated veterinary vaccine for livestock 1939 Improved live veterinary vaccine 1954 First cell-free human vaccine 1970 Improved cell-free vaccine licensed
  41. 41. Anthrax VaccinesPreparation: Immunization to prevent anthrax is based on the classic experiments of Louis Pasteur. In 1881 he proved that cultures grown in broth at 42–52 C for several months lost much of their virulence be injected live into sheep and cattle without causing Louis Pasteur disease; subsequently, such animals proved to be immune.
  42. 42. Anthrax VaccinesPreparation: Four countries produce vaccines for anthrax. Russia and China use attenuated spore- based vaccine administered by scarification. The US and Great Britain use a bacteria- free filtrate of cultures adsorbed to aluminum hydroxide
  43. 43. Anthrax VaccinesPre-exposure VaccinationThe current US FDA approved vaccine contains cell-free filtrates of a toxigenic nonencapsulated nonvirulent strain of B anthracis.The vaccine is available only to the US Department of Defense and to persons at risk for repeated exposure to B anthracis.
  44. 44. Anthrax VaccinesVaccination ScheduleInitial doses at 0, 2, and 4 weeks.Additional doses at 6, 12, and 18 months.Annual booster doses thereafter.Alternative schedules being investigated.
  45. 45. Anthrax VaccinesPost-exposure Vaccination No efficacy data for postexposure vaccination of humans. Postexposure vaccination alone not effective in animals Combination of vaccine and antibiotics appears effective in animal model
  46. 46. Anthrax VaccinesPrecautions and ContraindicationsSevere allergic reaction to a vaccine component or following a prior dose.Previous anthrax disease.Moderate or severe acute illness. • By: El Omda
  47. 47. Treatment Many antibiotics are effective against anthrax in humans, but treatment must be started early. Ciprofloxacin is recommended for treatment; penicillin G, along with gentamicin or streptomycin, has previously been used to treat anthrax. • By: El Omda
  48. 48. Chemoprophylaxis prophylaxis with ciprofloxacin or doxycycline should be continued for 4 weeks while three doses of vaccine are being given, or for 8 weeks if no vaccine is administered. In the setting of potential exposure to B anthracis as an agent of biologic warfare. • By: El Omda
  49. 49. Epidemiology Soil is contaminated with anthrax spores from the carcasses of dead animals. These spores remain viable for decades. Perhaps spores can germinate in soil at pH 6.5 at proper temperature.
  50. 50. EpidemiologyGrazing animals infected through injured mucous membranes serve to perpetuate the chain of infection.
  51. 51. Prevention & ControlControl measures include :-(1) disposal of animal carcasses by burning or by deep burial in lime pits,(2) decontamination of animal products.(3) protective clothing and gloves for handling potentially infected materials.(4) active immunization of domestic animals with live attenuated vaccines. Persons with high occupational risk should be immunized. • By: El Omda
  52. 52. • By: El Omda

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