Anthrax-awarness--Occupational disease


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Anthrax-awarness--Occupational disease

  1. 1. Anthrax Awareness  By  Dr.Ashok laddha  MBBS, PGDC ,PGDD, PGDEM, AFIH Dip. Workplace Health and safety, MBA-HA(In – Progress)
  2. 2. Overview  Anthrax in humans is rare unless the spores are spread on purpose. It became a concern in the United States in 2001, when 22 cases occurred as a result of bioterrorism. Most of those cases affected postal workers and media employees who were exposed to spores when handling mail.  Most cases of anthrax occur in livestock, such as cattle, horses, sheep, and goats. Anthrax spores in the soil can infect animals who eat plants growing in the soil. People can be exposed to spores in infected animal products or meat.  people can get anthrax from handling animal skins or products made out of animal skins from parts of the world where anthrax is more common
  3. 3. Anthrax  Anthrax is an infectious and potentially fatal disease caused      by the bacterium Bacillus anthracis. It spreads when the anthrax spores are inhaled, ingested, or come into contact with the skin lesion on a host. a German physician and scientist, Dr. Robert Koch, who proved that the anthrax bacterium was the cause of a disease that affected farm animals in his community anthrax organisms exist in a dormant form called spores These spores are very hard and difficult to destroy The spores have been known to survive in the soil for as long as 48 years. it affects both humans and animals.
  4. 4. Anthrax Facts  Anthrax is an infection by bacteria transmitted from       animals. Anthrax causes skin, lung, and bowel disease and can be deadly. Anthrax is diagnosed by cultures from infected tissues. Anthrax is treated by antibiotics. Anthrax can be prevented. Sadly, the greatest threat of anthrax today is through a bioterrorist attack. Federal, state, and local agencies are working hard to deal with this bioterrorist threat.
  5. 5. Bacteriology  Bacillus anthracis is a large, gram-positive, aerobic, spore-forming bacillus that measures 1.0 to 1.5 μm by 3.0 to 10.0 μm.1  Unlike other saprobic bacillus species (B. subtilis and B. cereus), it is nonmotile, is nonhemolytic on sheep's-blood agar, grows readily at a temperature of 37°C, and forms large colonies with irregularly tapered outgrowths (a “Medusa's head” appearance)
  6. 6. Pathogenesis  The principal virulence factors of B. anthracis are encoded on two plasmids — one involved in the synthesis of a polyglutamyl capsule that inhibits phagocytosis of vegetative forms and the other bearing the genes for the synthesis of the exotoxins.  B (binding) protein that is necessary for entry into the host cell and an A (enzymatically active) protein. The B component is known as the protective antigen and is common to both toxins.
  7. 7. Pathogenesis  The A component of the edema toxin is the edema factor, a calmodulin-dependent adenylate cyclase that is responsible for the prominent edema at sites of infection,  The A component of the second toxin, lethal toxin, is a zinc metalloprotease that inactivates mitogenactivated protein kinase kinase, leading to the inhibition of intracellular signaling. Lethal toxin stimulates the release by macrophages of tumor necrosis factor α and interleukin-1β — a mechanism that appears to contribute to the sudden death from toxic effects that occurs in animals with high degrees of bacteremia
  8. 8. Who is at Risk  People with Certain Jobs  Travelers  People Who Make or Play Animal Hide Drums
  9. 9. People with Certain Jobs  People with certain jobs may be at an increased risk of coming in contact with anthrax spores. These include:  Veterinarians  Laboratory professionals  Livestock producers  People who handle animal products  Mail handlers, military personnel, and response workers who may be exposed during a bioterror event involving anthrax spores
  10. 10. Travelers  Visitors to countries where anthrax is common can get sick      with anthrax if they have contact with infected animal carcasses or eat meat from animals that were sick when slaughtered. They can also get sick if they handle animal parts, such as hides, or products made from those animal parts, such as animal hide drums. Anthrax is most common in agricultural regions of Central and South America Sub-Saharan Africa Central and southwestern Asia Southern and eastern Europe The Caribbean
  11. 11. People Who Make or Play Animal Hide Drums  While the risk of exposure from handling an animal hide drum is low, drums made in countries where anthrax is common, or drums made from hides imported from those countries, have been known to make people sick.  No tests are available to determine if animal products are free from contamination with anthrax spores. Be sure that any hide used to make a drum has been removed and processed according to existing government regulations.
  12. 12. Incubation period  The incubation period (the period between contact with anthrax and the start of symptoms) may be relatively short  I to 7 days, although incubation periods up to 60 days are possible. (In the Sverdlovsk outbreak, incubation periods extended up to 43 days.)  incubation period for anthrax is quite variable and it may be weeks before an infected individual feels sick.
  13. 13. Types of Anthrax   Cutaneous anthrax  Inhalation anthrax  Gastrointestinal anthrax 
  14. 14. Epidemiology--Mortality  Inhalational 86-100% (despite treatment)  Era of crude intensive supportive care  Cutaneous <5% (treated) – 20% (untreated)  GI approaches 100%
  15. 15. Cutaneous Anthrax  This form accounts for over 95% of anthrax case  1-The cutaneous (skin) form of anthrax starts as a red-brown raised spot that enlarges with considerable redness around it, blistering, and hardening.  2-The center of the spot then shows an ulcer crater with bloodtinged drainage and the formation of a black crust called an eschar.  3-Local lymphadenpathy  4-. Symptoms include muscle aches and pain, headache, fever, nausea, and vomiting. The illness usually resolves in about six weeks, but deaths may occur if patients do not receive appropriate antibiotics.  This form accounts for over 95% of anthrax case
  16. 16. Mode of transmission  By contact with tissues of animals such as cattle, horses, pigs and others dying of the disease, or in processing after death  By contact with contaminated hair, wool, hides or products made from them (Hideporter’s disease)  By contact with soil associated with infected animals and contaminated bone meal used in some gardening products possibly by biting flies that have fed on infected animals
  17. 17. Stages of Cutaneous Anthrax  papular stage  vesicular stage with a blister that often becomes haemorrhagic  eschar stage that appears two to six days after the haemorrhagic vesicle dries to become a depressed black scab (malignant pustule) which may have surrounding redness and extensive oedema (swelling).
  18. 18. Ulcer and Vesicle ring Cutaneous Anthrax
  19. 19. Black Eschars Cutaneous Anthrax .
  20. 20. Pulmonary Anthrax  The first symptoms are subtle, gradual and flu-like (influenza). In a few days, however, the illness worsens and there may be severe respiratory distress. Shock, coma, and death follow. Inhalation anthrax does not cause a true pneumonia. In fact, the spores get picked in the lungs up by scavenger cells called macrophages. Most of the spores are killed. Unfortunately, some survive and are transported to glands in the chest called lymph nodes. In the lymph nodes, the spores that survive multiply, produce deadly toxins, and spread throughout the body. Severe hemorrhage and tissue death (necrosis) occurs in these lymph nodes in the chest. From there, the disease spreads to the adjacent lungs and the rest of the body.  Inhalation anthrax is a very serious disease, and unfortunately, most affected individuals will die even if they get appropriate antibiotics. Why is this so? The antibiotics are effective in killing the bacteria, but they do not destroy the deadly toxins that have already been released by the anthrax bacteria.
  21. 21. Pulmonary anthrax (‘wool sorter's disease’)-Mode of Transmission  By inhalation of aerosolized spores in industries that inadvertently may deal with contaminated tissues or products such as tanning hides, processing wool or bone products, or by accident in laboratory workers  By intentional release of spores using a variety of aerosol devices including mailitems.  Rare (<5%)  Most likely encountered in bioterrorism event
  22. 22. Woolsorter’s Disease Inhalation(Pulmonary ) Anthrax Woolsorter’s Disease (AFIP)
  23. 23. Gastrointestinal Anthrax  Now rare less than 5%  Mode of transmission-Ingestion  Anthrax of the bowels (gastrointestinal anthrax) is the result of eating undercooked, Contaminated meat.  The symptoms of this form of anthrax include nausea, loss of appetite, bloody diarrhea and fever followed by abdominal pain.  The bacteria invade through the bowel wall. Then the infection spreads throughout the body through the bloodstream (septicemia) with deadly toxicity.
  24. 24. Complications of Gastrointestinal Anthrax  Acute gastro-enterities ,Abdominal pain, Prostration  Intestinal Obstruction-Hage mesentric lymph nodes  Intestinal lesion edematous—with black eschar  Often Fatal
  25. 25. Anthrax Meningitis  Complication of anthrax septicemia  Subarachnoid Hemorrhage is common feature  Usually Fatal
  26. 26. Diagnosis  Early diagnosis is difficult  Non specific symptoms  Initially mild  No readily available rapid specific tests
  27. 27. Diagnosis  The history, including the occupation of the person, is important.  The bacteria may be found in cultures or smears in cutaneous (skin) anthrax and in throat swabs and sputum in pulmonary anthrax.  Chest X-rays may also show characteristic changes in and between the lungs. Once the anthrax is disseminated, bacteria can be seen in the blood using a microscope.
  28. 28. Laboratory Identification-1  bamboo stick’ appearance-The ends of the bacilli are truncated or of-ten concave and somewhat swollen so that a chain of bacilli presents a ‘bamboo stick’ appearance.  M’Fadyean’s reaction-When blood films con-taining anthrax bacilli are stained with polychromemethylene blue for a few seconds and examined under the microscope, an amorphous purplish material is no-ticed around the bacilli.
  29. 29. Laboratory Identification-2  Frosted glass appearance- On agar plates, irregularly round colonies are formed .raised, dull, opaque, greyish white, with a frosted glass appearance.  ‘Medusa head appearance-Under the low power microscope, the edge of the colony is composed of long, interlacing chains of bacilli, resem-bling locks of matted hair.
  30. 30. Laboratory Identification-3  Characteristic ‘inverted fir tree’ appearance  ‘String of pearls reaction-seen when B. anthracisis grown on the surface of a solid medium containing 0.05-0.5 units of penicillin ml, in 3-6 hours the cells become large, spherical, and occur in chains on the surface of the agar, resembling a string of pearls.
  31. 31. Treatment-1  Immediately treat presumptive cases  Prior to confirmation  Rapid antibiotics may improve survival  Differentiate between cases and exposed  Cases  Potentially exposed with any signs/symptoms  Exposed  Potentially exposed but asymptomatic  Provide Post-Exposure Prophylaxis
  32. 32. Treatment-2  Hospitalization  IV antibiotics  Empiric until sensitivities are known  Intensive supportive care  Electrolyte and acid-base imbalances  Mechanical ventilation  Hemodynamic support
  33. 33. Treatment-3  In most cases, early treatment can cure anthrax. The cutaneous (skin) form of anthrax can be treated with common antibiotics such as penicillin, tetracycline, erythromycin, and ciprofloxacin (Cipro).  The pulmonary form of anthrax is a medical emergency. Early and continuous intravenous therapy with antibiotics may be lifesaving. In a bioterrorism attack, individuals exposed to anthrax will be given antibiotics before they become sick
  34. 34. Treatment-4  Antibiotic selection  Naturally occurring strains  Rare penicillin resistance, but inducible β-lactamase  Penicillins, aminoglycosides, tetracyclines, erythromycin, chloramphenicol have been effective  Ciprofloxacin very effective in vitro, animal studies  Other fluoroquinolones probably effective  Engineered strains  Known penicillin, tetracycline resistance  Highly resistant strains = mortality of untreated
  35. 35. Treatment  Cases of gastrointestinal and cutaneous anthrax can be treated with ciprofloxacin or doxycycline for 60 days.  Penicillin such as amoxicillin or amoxicillinclavulanate may be used to complete the course if the strain is susceptible.
  36. 36. Treatment  Individuals with inhalational anthrax should receive a multidrug regimen of either ciprofloxacin or doxycycline along with at least one more agent, including a quinolone, rifampin, tetracycline, vancomycin, imipenem, meropenem, chloramphenicol, clindamycin, or an aminoglycoside.  After susceptibility testing and clinical improvement, the regimen may be altered.
  37. 37. Effect of Treatment delay  Delays of only a few days may make the disease untreatable and treatment should be started even without symptoms if possible contamination or exposure is suspected. Animals with anthrax often just die without any apparent symptoms. Initial symptoms may resemble a common cold—sore throat, mild fever, muscle aches and malaise. After a few days, the symptoms may progress to severe breathing problems and shock and ultimately death. Death can occur from about two days to a month after exposure with deaths apparently peaking at about 8 days after exposure. Antibiotic-resistant strains of anthrax are known
  38. 38. Antidote- Raxibacumab  Raxibacumab is a recombinant human IgG1gamma monoclonal antibody directed at the protective antigen of Bacillus anthracis.  It is indicated for treatment of inhalational anthrax in adults and children and used in combination with appropriate antibacterial drugs.  It is also indicated for prophylaxis of inhalational anthrax when alternative therapies are not available or are not appropriate.
  39. 39. Prevention  Public-health measures to prevent contact with infected animals are invaluable.  There is a vaccine available for people at high  To prevent a bioterrorist attack and to be prepared to deal with the consequences if one occurs. For anthrax and other infectious diseases, vaccines with greater efficacy and fewer side effects are under development.  Currently, most vaccines are given by injection into fat or muscle below the skin. Early studies in experimental animals are showing promise for an oral vaccine for anthrax. Obviously, a pill is easier to take than a shot, and the pill may even be a safer and more effective route of administration.
  40. 40. Vaccine  Vaccines against anthrax for use in livestock and humans have     had a prominent place in the history of medicine, from Pasteur’s pioneering 19th century work with cattle (the second effective vaccine ever) to the controversial 20th century use of a modern product (BioThrax). Human anthrax vaccines were developed by the Soviet Union in the late 1930s and in the US and UK in the 1950s. The current FDA-approved US vaccine was formulated in the 1960s. Currently administered human anthrax vaccines include acellular (USA) and live spore (Russia) varieties. All currently used anthrax vaccines show considerable local and general reactogenicity (erythema, induration, soreness, fever) and serious adverse reactions occur in about 1% of recipients.[ New second-generation vaccines currently being researched include recombinant live vaccines and recombinant sub-unit vaccines
  41. 41. Prophylaxis-1  If a person is suspected as having died from anthrax, every precaution should be taken to avoid skin contact with the potentially contaminated body and fluids exuded through natural body openings.  The body should be put in strict quarantine and then burnt. A blood sample taken in a sealed container and analyzed in an approved laboratory should be used to ascertain if anthrax is the cause of death.  Microscopic visualization of the encapsulated bacilli, usually in very large numbers, in a blood smear stained with polychrome methylene blue (McFadyean stain) is fully diagnostic, though culture of the organism is still the gold standard for diagnosis. Full isolation of the body is important to prevent possible contamination of others. Protective, impermeable clothing and equipment such as rubber gloves, rubber apron, and rubber boots with no perforations should be used when handling the body
  42. 42. Prophylaxis-2  Disposable personal protective equipment is preferable, but if not available, decontamination can be achieved by autoclaving. Disposable personal protective equipment and filters should be autoclaved, and/or burned and buried.. Anyone working with anthrax in a suspected or confirmed victim should wear respiratory equipment capable of filtering this size of particle or smaller.) approved high efficiencyrespirator, such as a half-face disposable respirator with a high-efficiency particulate air (HEPA) filter, is recommended
  43. 43. Prophylaxis-3  contaminated bedding or clothing should be isolated in double plastic bags and treated as possible bio-hazard waste. The victim should be sealed in an airtight body bag. Dead victims that are opened and not burned provide an ideal source of anthrax spores. Cremating victims is the preferred way of handling body disposal. No embalming or autopsy should be attempted without a fully equipped biohazard laboratory and trained and knowledgeable personnel.
  44. 44. Is anthrax contagious?  No. Spreading anthrax from person to person is extremely unlikely to occur. It also requires a relatively large dose to infect a person - one would have to inhale 8,000 to 50,000 spores.
  45. 45. Anthrax –as a weapon  Anthrax can also be used as a weapon. This happened in the United States in 2001. Anthrax was deliberately spread through the postal system by sending letters with powder containing anthrax. This caused 22 cases of anthrax infection.
  46. 46. Question No-1       What type of vaccine is the anthrax vaccine? A) Attenuated bacteria B) Inactivated toxin (toxoid) C) Killed whole bacterial cells D) Recombinant E) Acellular
  47. 47. Question-2       How do the endospores that cause cutaneous anthrax enter the body? A) Through breathing B) By consuming contaminated foods C) Through small cuts or abrasions in the skin D) Through sexual activity E) Through insect vectors
  48. 48. Question-3  Most naturally occurring cases of anthrax      occur in which group of people? Daycare workers News reporters The elderly Textile workers Infants
  49. 49. Question-4  What is the primary habitat for many Bacillus      species? Select Two A) Humans and other large primates B) Dust C) Water D) Herbivores E) Soil
  50. 50. Question-5  Which type of anthrax is most common ?  A)Pulmonary Anthrax  B) Gastrointestinal anthrax  C) Cutaneous anthrax
  51. 51. Question-6  Spreading anthrax from person to person is extremely common  A)True  B) False
  52. 52. QUESTION-7  Anthrax symptoms may include all of the     following EXCEPT A-Fever B-Abdominal pain C-Dyspnoea D-Rhinorrhoea
  53. 53. Question-8  In Anthrax bioterrorism the post exposure prophylaxis is available?  True  False
  54. 54. Question-9  Which is true of endotoxins?  They are disease-specific.  They are produced by gram-positive bacteria.  They increase blood pressure.  They are released upon cell lysis.  They are proteins.
  55. 55. Question-10  All of the following are true of A-B exotoxins     except: The A portion of the toxin is the active component. They are only produced by gram-negative bacteria. They consist of two polypeptide components. The B portion of the toxin binds to surface receptors on host cells.
  56. 56. Question-11  Which of the following is a true of cutaneous anthrax?  1) causes a black eschar which overlies pus 2) lesions are usually painful and tender 3) lesions are associated with marked edema 4) Mortality is approximately 20% despite antibiotic therapy 5) Is very likely to occur in subjects exposed to anthrax spores
  57. 57. Question-12  Anthrax is caused by  A)Fungi  b) Bacteria  c) Protozoa  d) Virus
  58. 58. Question-13  Subarachnoid Hemorrhage is common feature in Anthrax meningitis  A)True  B)False
  59. 59. Question-14  Symptoms of Cutaneous Anthrax includes all     except A small, raised bump that might itch. The bump becomes a painless, fluid-filled blister and later forms a black center of dying tissue. Swollen lymph nodes, headache, and fever also may occur. Difficulty in breathing
  60. 60. Question-15  who are at higher risk for Anthrax exposure?  Veterinarians  Laboratory professionals  Livestock producers  People who handle animal products  Mail handlers, military personnel, and response workers who may be exposed during a bioterror event involving anthrax spores  All of the above
  61. 61. Question-16  Which component is known as the protective antigen?  A)A component  B)B component
  62. 62. Question-17  ____ What changes of myelin basic protein     can be studied under these conditions? A. Its phosphorylation B. Its dephosphorylation C. Its degradation D. Its ubiquitination
  63. 63. Question-18  True or False -Anthrax is an Occupational diseases  A)True  B) False
  64. 64. Question-19  Anthrax is reportable diseases?  A)True  B)False
  65. 65. QUESTION-20  Treatment for pulmonary Anthrax-Select one  A)Multi drug Regime  B)Ciprofloxacin  C)Penicillin  D) Multi drug Regime with at least one more agent