ANTHRAX

DEFINITION
• Is a highly infectious disease which affects animals as
well as humans.
CAUSATIVE ORGANISM
• Rod shaped Bacterium called Bacillus Anthracis, which
rests in endospore form in the soil, and can survive for
decades in the soil.
VECTOR
• Humans and animals
INCUBATION PERIOD

• The incubation period ranges from a few

hours to 3 weeks, most often 2 to 6 days.
MODE OF TRANSMISSION

• Ingestion of infected animals (animal to

animal or humans to animals)
• Direct contact of humans with diseased
animals (inoculation of infected blood to
broken skin) or by consumption of a
diseased animal’s flesh.
• Indirect by spores which can be transported by
clothing or shoes.
DISEASE DISTRIBUTION
• Dormant endospores can be found anywhere in the
world even the Antarctica.
• Commonly infects wild and domesticated
herbivorous mammals that ingest or inhale the
spores while grazing.
• Rare in dogs and cats.
• More common in countries without widespread
veterinary or human public health programs.
• Still a problem in less developed countries.
• Because of their long lifespan, spores are present
globally and they remain at the burial sites of
animals killed by anthrax for many decades.
PATHOPHYSIOLOGY

• The infected host sheds the vegetative

bacilli onto the ground and these sporulate
on exposure to the air.
• The spores, which can persist in soil for
decades, wait to be taken up by another
host, which germination and multiplication
can again take place upon infection.
• When the spores are inhaled they are
transported into the alveoli where macrophages
in the lungs pick them and transport them
through the lymphatic to the lymph nodes in the
central chest (mediastinum).
• Damage caused by the spores in the central chest
cavity can cause chest pain and dyspnoea
• Once in the lymph nodes, the spores
germinate into active bacilli that multiply
and burst the macrophages releasing many
more bacilli into the bloodstream to be
transferred to the entire body
CLINICAL MANIFESTATIONS
CUTANEOUS ANTHRAX
• Accounts for > 95% of human cases worldwide.
• The lesions (eschars) are generally found on
exposed regions of the body mostly on the face,
neck, hands and wrists.
• Generally cutaneous lesions are single, but
sometimes two or more lesions are present.
• The incubation period ranges from as little as 9
hours to 3 weeks, mostly 2 to 6 or 7 days.
Day 0
• Entry of the infecting B. anthracis (usually as
spores) through a skin lesion (cut, abrasion, etc.)
or (possibly as vegetative) by means of a fly-bite.
 Days 2–3
• A small pimple or papule appears
Days 3–4
• A ring of vesicles develops around the
papule.
• Vesicular fluid may be exuded
 Days 5–7
• The original papule ulcerates to form the
characteristic eschar.
• Oedema extends some distance from the
lesion.
• Systemic symptoms are low-grade fever,
malaise and headache
 Day 10 (approx.)
• The eschar begins to resolve; resolution
takes several weeks and is not hastened by
treatment.
• Time to resolution will depend on the size,
location and local severity of the lesion.
INGESTION OR ORAL ROUTE
ANTHRAX
takes two forms
• – oropharyngeal, in which the lesion is
localized in the buccal cavity or on the
tongue, tonsils or posterior pharyngeal wall.
• Less commonly seen.
• In some cases, lesions may be present at
two or more sites along the gastrointestinal
tract.
• The oral lesion is generally 2–3 cm in
diameter and covered with a grey pseudo-
membrane surrounded by extensive
oedema.
• The overt infection leads to toxaemia, acute
respiratory distress and alteration in mental
state.
• The patient develops acute respiratory
distress syndrome and may require
respiratory support.
 GASTROINTESTINAL
• Lesion may occur anywhere within the
gastrointestinal tract, but mostly in the ileum and
caecum.
• Lesions are ulcerative, usually multiple and
superficial, surrounded by oedema, may bleed,
where haemorrhage may be massive and fatal, and
in some cases with stomach infection
 GIT SYMPTOMS
• nonspecific and include nausea,
• vomiting
• anorexia
• mild diarrhoea
• fever
• These may be mild but are occasionally
severe, progressing to haematemesis,
bloody diarrhoea and massive ascites
• PULMONARY ANTHRAX
• Symptoms prior to the onset of the final
hyperacute phase are nonspecific:
• fever or chills
• Sweats
• fatigue or malaise
• non-productive cough
• Dyspnoea
• changes in mental state including confusion,
nausea or vomiting.
• Chest X-rays reveal, infiltrates, pleural effusion
and mediastinal widening and
lymphadenopathy
MENINGITIS (HAEMORRHAGIC
LEPTOMENINGITIS)
• Serious and may follow any of the other
three forms of anthrax.
The clinical signs:
• Neck pain with or without flexion
Intense inflammation of the meninges,
with oedema resulting in a markedly
elevated (CSF) pressure
• Blood in the CSF.
DIAGNOSIS

• PCR – polymerase chain reaction

• Gamma Bacteriophage Testing
• Enzyme Linked Immunosorbent assay to
detect antibodies
• Ascoli test
Management
• Initial treatment in severe cases
Benzylpenicillin 1-2MU qid im/iv initially then
Procaine penicillin 3gm im od 7-10days
Less severe cases
Doxycycline 200mg first dose then 100mg od for 7days
NB Doxycycline is contraindicated in pregnancy and
children
PUBLIC HEALTH EDUCATION

• Notification of anthrax cases to health

authorities.
• Public not eat domestic animals that would
have died without on their own.