antrax

Anthrax The Disease An acute, infectious disease Can infect animals herbivores Cattle Sheep

Can infect humans usually via occupation Infects herbivores Infect humans

US Forest Service

www.nps.gov/public_health/info/ppt/basicanthrax.ppt

Causative Agent - Anthrax B. anthracis (Gk: anthrakis coal) Large, spore-forming bacterium Gram-stain positive Rod-shaped bacillus Non-motile

Two states Vegetative - causes infection via toxin production Spores Protective in adverse environments May subsist for years


Historical Aspects of Anthrax Disease of antiquity Biblical days Fifth Plague Anthrax in cattle? Sixth Plague Anthrax in humans?

Black Bane (Europe 1600) Anthrax?

Important disease in Public Health History Robert Koch 1st disease to satisfy postulates Firmly established microbial etiology (1876) First immunization for bacterial disease (1881)


Historical Aspects of Anthrax Outbreaks 6,000 cases

(continued)

Zimbabwe Outbreak (October 1979 March 1980)

Paraquay 1987 25 cases of cutaneous anthrax Associated with slaughter of a single, infected cow

Russia (Sverdlovsk) 77 cases 66 deaths (primarily inhalational)

Note: few cases have occurred in the US in last centurywww.nps.gov/public_health/info/ppt/basicanthrax.ppt

Forms of Anthrax-Routes of Entry


Inhalational Anthrax - Symptoms Initial symptoms Mild, non-specific (e.g., flu-like) Fever Malaise Mild cough, chest pain

Acute symptoms Respiratory distress Shock Mediastinal widening on chest X-ray

Fatalities can occur (80-90%)


Cutaneous Anthrax - Symptoms Itching of skin Lesion - progression spider bite-like pustule Vesicle (blisters) black lesion - eschar

Lesion location Head Arms Hands

Moderate to severe swelling around lesion Lymph nodes Secondary infection

Fatalities can occur


G.I. Anthrax - Symptoms May resemble food-borne disease Abdominal distress Fever

Septicemia (toxins in blood) Fatalities can occur


Public Health Geographic Distn B. anthracis found globally Central and South America Southern and Eastern Europe Asia Africa Middle East

Countries with poor veterinary medicine & public health programs Occurs in animals in United Stateswww.nps.gov/public_health/info/ppt/basicanthrax.ppt

Public Health Popn at Risk No person-to-person transmission Historically associated with occupational exposures Animal handling Rendering plants Preparing animal hides Woolsorters Disease

Accidental exposures have occurred Russian experience (Sverdlovsk) Biological weapons production Laboratory exposures

Bioterrorism recent eventswww.nps.gov/public_health/info/ppt/basicanthrax.ppt

Public Health - General Incubation period 2-60 days Mean incubation 7 days

Susceptibility and Resistance Uncertain Some inapparent infections Second attacks can occur (rare)


Factors That Influence Natural History of Disease Occupation Amount of organisms Infectious Dose: 8,00010,000 spores (est.)

Host FactorsGeneral health Age Pre-existing conditions Immunization status Hygienic practices

Spore size 2-6 um diameter May bind to larger particles (static charge?)

TreatmentPrompt Appropriate


Tests For Anthrax Nasal swabs epidemiological tool Not diagnostic for disease Determines Zone(s) of Exposure

Cultures Blood Exudates

Antibody tests antibodies to anthrax Polymerase Chain Reaction (PCR) DNA amplification

Environmental tests Swabs Wipeswww.nps.gov/public_health/info/ppt/basicanthrax.ppt

Tests for Anthrax Antibody tests Quick antibody test strips ELISA test (lab) Blood test

Microscopic analysis Bacterial culture DNA test PCR Environmental samples Swabs Wipes


Medical Prevention and Treatment All forms of anthrax Floroquinolones-oral (Ciprofloxacin)* Doxycycline-oral** 100 mg BID for adults 1mg/pound BID for children (less than 100 pounds)

Penicillin Others available

Antibiotics effective for exposed persons Antibiotics effective early

* Drug of choice ** Approved by FDA for Anthrax on 18 October 2001www.nps.gov/public_health/info/ppt/basicanthrax.ppt

Anthrax Vaccine Adsorbed (AVA) Licensed by FDA in 1970 Vaccine consists of: Noninfectious sterile filtrate from B. anthracis culture Adsorbed to aluminum hydroxide adjuvant Formaldehyde stabilizer (

antrax

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