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Anthrax is a potentially lethal disease caused by Bacillus anthracis bacteria. It can affect both humans and animals through contact with infected animals, animal products, or inhalation of spores. There are four types of anthrax disease in humans - cutaneous, inhalation, gastrointestinal, and meningeal. While anthrax infections can be deadly, prompt antibiotic treatment and vaccination can effectively treat and prevent the disease.
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Anthrax_D Dutta
- 2. Anthrax is an acute disease causedby the bacterium Bacillus anthracis. Most forms of the disease are lethal, and it affects both humans and animals. There are now effective vaccines against anthrax, and some forms of the disease respond well to antibiotic treatment.
- 3. Cutaneous Anthrax: An acuteillness, or post-mortem examination revealing a painless skin lesion developing over 2 to 6 days from a papular through a vesicular stage into a depressed black eschar with surrounding edema. Fever, malaise and lymphadenopathy may accompany the lesion. Inhalation Anthrax: An acute illness, or post-mortem examination revealing a prodrome resembling a viral respiratory illness, followed by hypoxia, dyspnea or acute respiratory distress with resulting cyanosis and shock. Radiological evidence of mediastinal widening or pleural effusion is common. Gastrointestinal Anthrax: An acute illness, or post-mortem examination revealing severe abdominal pain and tenderness, nausea, vomiting, hematemesis, bloody diarrhea, anorexia, fever, abdominal swelling and septicemia. Meningeal Anthrax: An acute illness, or post-mortem examination revealing fever, convulsions, coma, or meningeal signs. Signs of another form will likely be evident as this syndrome is usually secondary to the above syndromes. Definition Contd……..
- 4. Originates fromGreek for black or coal because of black eschar (characteristic of cutaneous form of anthrax) It is principally disease of herbivorous e.g. cattle, goat, sheep, cow but it has the potential to affect other mammals also. Human infection results from direct and indirect exposure to infected animals or occupational exposure to infected or contaminated animal products/ Also known as Wool Sorter`s Disease or Malignant pustule
- 5. Anthrax Global DistributionAnthraxGlobal Distribution 20,000 to 100,000 cases estimated globally/year20,000 to 100,000 cases estimated globally/year http://www.vetmed.lsu.edu/whocc/mp_world.htmhttp://www.vetmed.lsu.edu/whocc/mp_world.htm
- 6. Bacillus anthracis -Gram positive non- motile, spore forming rod with a diameter of 1.5 µm and length of 5 µm , found in soil, herbs, vegetation, etc. Spores can remain viable for decades so used as bio-weapon. They are also resistant to heat, UV ray, radiation and most disinfectants. Spores are the predominant form in the environment.
- 7. It is aZoonosis. Human infection occur as a result of contact with the infected animal or animal products e.g.- goat hair in textile mills, animal skin and contaminated articles. Modes: Inoculation of spores in breaks of skin, Inhalation of spores, Ingestion of contaminated food mainly meat. Human to Human Transmission are extremely rare.
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- 10. Cutaneous Contact withinfected tissues, wool, hide, soil Biting flies Inhalational Tanning hides, processing wool or bone Direct inhalation of spores from contaminated articles (used for bioterrorism) Gastrointestinal Undercooked meat specially
- 11. Tanneries Textilemills Wool sorters Bone processors Slaughterhouses Laboratory workers Bio weapon
- 12. Bacteria presentin hemorrhagic exudates from mouth, nose, anus Inhalation: ◦ Spores form ◦ Soil contamination Sporulation does not occur in a closed carcass Spores viable for decades
- 13. Ingestion ◦ Mostcommon ◦ Herbivores Contaminated soil Heavy rainfall, drought ◦ Carnivores Contaminated meat Inhalation Mechanical (insects)
- 14. Mainly threetypes :- 1. Cutaneous Anthrax 2. Pulmonary Anthrax 3. Gastro – intestinal Anthrax
- 15. Commonest form :over 95% of all cases Incubation period : 2 -6 days Papule, Vesicle, Ulcer followed by coaled black necrotic Escher Lesion – painless & non purulent Resolution of eschar occurs over 6 weeks and is not hastened by treatment Self limiting – over 90% resolve without complication.
- 19. Occur due toinhalation of spores from contaminated animal hides and products. Common among workers exposed occupationally to high concentration of viable spores Incubation period – 1 day to 8 weeks. Clinical Presentation – Malaise, Fever, Cough, Nausea, drenching sweats, shortness of breath,
- 20. In severe form– rapidly developed hypotension,cyanosis and death. CFR – Case fatality rate in unintervention is 100%. Survival was reported when antibiotic was given in prodromal period & multidrug regimen used.
- 21. Following ingestionof organism in contaminated food Incubation Period : 2 to 5 days Two clinical forms - Intestinal anthrax and Oropharyngeal anthrax Intestinal :- nausea, vomiting, fever, abdominal pain, diarrhoea, haemetemesis, ascites , may be fatal. Oropharyngeal – sore throat, dysphagia, fever, lymphadenopathy in neck etc
- 22. Anthrax Meningitis: - it is haemorrhagic also. - may develope in 30-40% cases. - 100% Mortality.
- 23. Anthrax and BiologicalWarfare Countries > 10 countries in the world Clouds of spores of Anthrax bacilli – aerosol ( war heads filled with anthrax spores) - Through dried spores in envelops September 9/11 WTC attack Postal workers affected – Inhalation anthrax US – Columbia, Florida, New Jersey, N. York Other parts of the world
- 24. 22 cases(11 inhalation, 11 cutaneous) in 4 states and DC B. anthracis sent through U.S. mail Most exposures occurred in mail sorting facilities and sites where mail was opened
- 25. 50 kgof spores ◦ Urban area of 5 million ◦ Estimated impact 250,000 cases of anthrax 100,000 deaths 100 kg of spores ◦ Upwind of Washington D.C. ◦ Estimated impact 130,000 to 3 million deaths
- 26. Do notopen suspicious mail ◦ inappropriate or unusual labeling ◦ strange or no return address ◦ postmark different from return address ◦ excessive packaging material Keep mail away from face No not blow or sniff mail or mail contents Wash hands after handling Avoid vigorous handling (tearing, shredding) Discard envelopes
- 27. Clinical and Historyof exposure. Bacteriology – Gram Stain & Culture Serology – ELISA for anthrax antibodies, - Detection indicates past infection or vaccination while a four fold rise in titers indicate recent infection. PCR
- 28. SPECIMEN TO COLLECT( HUMAN ANTHRAX) Cutaneous anthrax: Vesicular exudate – swabs and capillary tube aspirate Intestinal anthrax: - Stool sample - isolate – guinea pig inoculation - Blood( venipuncture) smear examination for bacilli - Peritoneal fluid for culture - Paired sera for Ab Pulmonary anthrax: If mild disease ( No sample) Severely ill – Blood , sputum, serum samples for Ab
- 29. Prompt andtimely antibiotic therapy Penicillin is yet the antibiotic of choice Other antibiotics – Chloramphenicol, Tetracycline, Doxycycline, Fluoroquinolones, Erythromycin
- 30. During theBioterrorism attack in 2001 in USA, it was found that using two or more antibiotics intravenously improved survival. CDC protocols issued after the bioterrorism attacks recommend ciprofloxacin 400 mg BD or Doxycycline 100 mg BD for a total of 60 days Treatment remains same for pregnant women and immunocompromised individuals.
- 31. Preliminary disinfection 10% formaldehyde 4%glutaraldehyde (pH 8.0-8.5) Cleaning Hot water, scrubbing, protective clothing Final disinfection: one of the following 10% formaldehyde 4% glutaraldehyde (pH 8.0-8.5) 3% hydrogen peroxide, 1% peracetic acid
- 32. Vaccination –restricted to those who are at occupational risk. Vaccination by 6 subcutaneous doses at 0, 2 and 4 weeks followed by 6, 12 and 18 months. Chemoprophylaxis – US Army recommends Ciprofloxacin or Doxycycline for four weeks for unimmunized high risk individuals. A longer duration of chemoprophylaxis is required for complete clearance of spores from lung.
- 33. Integrated planof control activities with Health, Animal husbandry, PRI and other related sectors Screening of animals Control of the disease in animals is key to prevention of anthrax in humans Quartantine the area Vaccination of susceptible animals Correct disposal of infected carcasses by deep burial Proper disinfection, decontamination and disposal of contaminated materials.
- 34. Early diagnosisand prompt treatment (both for human and animals). Chemoprophylaxis of contacts with specific antibiotics (Doxycycline, Ciprofloxacin) Awareness campaign (IEC and BCC) - prompt information sharing - seeking health advice - proper handling of animals in slaughter house, tanning industry, etc - not to kill sick animals for consumption, proper cooking of specially meat products, deep burial of the dead animals.
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Editor's Notes
- #11 There are three main routes of anthrax transmission in humans. Cutaneous anthrax may occur when handling infected tissues, wool, hides, soil, and products made from contaminated hides or hair, such as drums, rugs, or brushes. Biting flies are also suspected of being mechanical vectors of anthrax to humans under certain conditions. Inhalational anthrax has been associated with tanning hides and processing wool or bone. Gastrointestinal anthrax occurs when individuals eat undercooked contaminated meat from animals that have died of anthrax. Laboratory acquired cases have also occurred. [The top image shows wool hanging outdoors. Bottom image: Cattle hides. Source (for both): pixabay.com-public domain]
- #12 People with occupational exposure to animal products are at risk of anthrax infection. This includes workers in tanneries, textile mills, wool sorters, and others. In the 1960s, unvaccinated mill workers were ‘chronically exposed’ to anthrax; case rates of 0.6 to 1.4% were observed. B. anthracis was recovered from the nose and pharynx of 14% of healthy workers in one study; in another study, workers were inhaled 600 to 1300 spores during the working day with no ill effect. A well-documented outbreak of pulmonary anthrax occurred in one mill with a similar level of contamination. [Photo shows two men shearing sheep. Source: geograph.org.uk-creative-commons]
- #13 In infected animals, large numbers of bacteria are present in hemorrhagic exudates from the mouth, nose, and anus. When they are exposed to oxygen, these bacteria form spores and contaminate the soil. Sporulation also occurs if a carcass is opened and oxygen exposure occurs – sporulation does not occur inside a closed carcass. Anthrax spores can remain viable for decades in the soil or animal products, such as dried or processed hides and wool. Spores can survive for two years in water, 10 years in milk, and up to 71 years on silk threads. Vegetative organisms are thought to be destroyed within a few days during the decomposition of unopened carcasses.
- #14 In animals, transmission occurs by ingestion and possibly inhalation of spores, although entry through skin lesions has not been ruled out. Herbivores usually become infected when they ingest sufficient numbers of spores in soil or on plants in pastures. Outbreaks are often associated with heavy rainfall, flooding, or drought. Contaminated bone meal and other feed can also spread this disease. Carnivores usually become infected after eating contaminated meat. Vultures and flies may disseminate anthrax mechanically after feeding on infected carcasses. [This photo shows cattle grazing in a pasture. Source: U.S. Department of Agriculture, NRCS]
- #26 Previous acts of biological terrorism have been small in scale. It is estimated that in a city of 5 million people, a release of 50 kg of anthrax spores (10 km upwind and 2 km wide) would extend over 20 km in 2 hours. This would result in 500,000 people placed at risk. There would be an estimated 250,000 illness and 125,000 deaths. A 1993 report by the U.S. Congressional Office of Technology Assessment estimated that 130,000 to 3 million deaths may occur following the aerosolized release of 100 kg of anthrax spores upwind of Washington D.C.
- #32 Where practical, cleaning of all surfaces should be done by straightforward washing and scrubbing using ample hot water. Protective clothing should be worn. For final disinfection, one of the following disinfectants should be applied at a rate of 0.4 liters per square meter for an exposure time of at least 2 hours: 10% formaldehyde (approximately 30% formalin), 4% glutaraldehyde (pH 8.0-8.5), 3% hydrogen peroxide, or 1% peracetic acid. Hydrogen peroxide and peracetic acid are not appropriate if blood is present. When using glutaraldehyde, hydrogen peroxide, or peracetic acid, the surface should be treated twice with an interval of at least one hour between applications. Formaldehyde and glutaraldehyde should not be used at temperatures below 10oC. After the final disinfection, closed spaces, such as rooms or animal houses, should be well ventilated before use. The effectiveness of the disinfection procedure cannot be assumed, and attempts should be made to confirm it has been adequate by means of swabs and culture.