1) Anthrax is caused by the bacterium Bacillus anthracis. It can cause serious illness in humans and animals. 2) There are three main types of anthrax disease in humans - cutaneous, inhalation, and gastrointestinal. Cutaneous anthrax is the most common, usually occurring after exposure to infected animals or contaminated products. 3) Anthrax bacteria produce toxins that are major virulence factors. The anthrax toxins are composed of three proteins that combine to cause tissue damage and edema. 4) Diagnosis involves lab tests of samples from lesions, blood, or sputum to identify B. anthracis. Treatment involves antibiotics such as

1. Anthrax and
Anthrax Vaccine
Under Supervision of :
Prof. Dr Ekram M. El-Shabrawy
Team Work :
 Mostafa Emad Ahmed
 Mohammed Bahaa El-Din
 Mostafa Abd-Elsamee
 Ahmed Mohamed Taha

2. Contents
Causative Laboratory Tests
Organism. Vaccine
Disease Exit. Treatment
Pathogenesis. Chemoprophylaxis
Virulence Factors. Epidemiology.
Clinical Forms. Prevention &
Clinical Findings. Control

3. Causative Organism
Scientific classification:-
• Bacteria
Kingom
• Firmicutes
Phylum
• Bacilli
Class
• Bacillacea
Family
• Bacillus
Genus
• B. anthracis
Species

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. 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. 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. Causative Organism
Identification
On Culture:-
Colonies of B anthraces are
round and have a "cut glass"
appearance.
Haemolysis is uncommon with
B anthraces.

8. Causative Organism
Identification
Growth in
gelatine stabs
resembles an
inverted fir
tree.

9. Causative Organism
Identification
 Gram-positive, spore-forming, non-motile
bacillus

10. Causative Organism
Growth 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. 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. Disease Exit
Infection To Human
 Humans become infected incidentally by
contact with infected animals or their
products.

13. Disease Exit
Mode 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. Pathogenesis
growth of
the
vegetative
organisms
via lymphatics
To Man or Animal to the bloodstream
From
dead
body to
Env.

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. Virulence Factors
Anthrax Toxin:-
Toxin Structure:-
Anthrax toxin is made up of three proteins:-
 protective antigen (PA).
 edema factor (EF).
 lethal factor (LF).

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. Virulence Factors
Anthrax Toxin:-
Lethal Factor Protective Antigen Edema Factor
Lethal Toxin Edema Toxin
Tissue damage, shock Edema

19. Virulence Factors
How Toxin Work:-

21. clinical
forms
Cutaneous GIT Pulmonary

22. 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

23. 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.

24. 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.

25. Cutaneous Anthrax
Cutaneous Anthrax Vesicle Development
 Day 2 Day 4 Eschar Formation
 Day 6  Day 10
 Day 7

26. 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.

27. 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

28. Cutaneous Anthrax

29. 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% in
2001)

30. Inhalation Anthrax
Clinical Picture:-
 The early clinical manifestations are associated
with marked hemorrhagic necrosis and edema
of the mediastinum.

31. 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.

32. Inhalation Anthrax
Chest X-rays is
Chest 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

33. Inhalation Anthrax
Chest X-Ray :-
 Substernal pain
may be prominent,
and there is
pronounced
mediastinal
widening visible on
x-ray chest films

34. Gastrointestinal anthrax
Preview:-
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.

35. Gastrointestinal anthrax
Clinical 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.

36. 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.

37. Laboratory Diagnostic Tests
Direct 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

38. Laboratory Diagnostic Tests
Culture :
 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.

39. Laboratory Diagnostic Tests

40. Laboratory Diagnostic Tests
Lab 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.

41. 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

42. Anthrax Vaccines
Preparation:
 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.

43. Anthrax Vaccines
Preparation:
 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

44. Anthrax Vaccines
Pre-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.

45. Anthrax Vaccines
Vaccination 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.

46. Anthrax Vaccines
Post-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

47. Anthrax Vaccines
Precautions 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

48. 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

49. 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

50. 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.

51. Epidemiology
Grazing animals infected through
injured mucous membranes serve to
perpetuate the chain of infection.

52. Prevention & Control
Control 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

53. • By: El Omda