Anthrax

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Anthrax

• Bacillus anthracis
• Spore forming gm() rod
• Sheep, goats, cattle
• Eat contaminated soil
• Transmission to humans
• Inhalation of aerosolized spores (extremely rare
  in past)
• Cutaneous contact with spores (endemic in
  ranchers and skin handlers)
• Ingestion of contaminated food (extremely rare)

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Anthrax why it kills

• Produces 3 substances
• Protective antigen (PA)
• Edema factor (EF)
• Lethal factor (LF)
• PA just gets other toxins into the cell

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Anthrax pulmonary

• Technically not a lung infection (classic
  teaching)????
• Pulmonary refers to port of entry
• Better term inhalational
• Target organs
• Blood
• Lymph nodes (Mediastinitis)
• Meninges (approx 5 of inhalational cases)

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Recent cases

• Clinical presentation different than previously
  taught
• 40 mortality 100 if diagnosed on day 5 0
  if diagnosed in first few days
• Most patients had mediastinal abnormalities early
  in course
• All had positive blood cultures, which were
  rapidly positive
• Leukocytosis and hemoconcentration common
• Pneumonia and pleural effusion were common
• Most had GI symptoms

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Cutaneous anthrax

• Pruritic maculeProgresses to
• Round ulcer by second day
• 1-3 mm vesicles may appear, surrounding central
  eschar (coal appearance anthrax)
• Relatively painless
• Extensive edema/erythema around lesion

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Cutaneous anthrax

• 1-2 weeks dries, eschar loosens

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Cutaneous anthrax

• Frequently no scar
• Antibiotics cut systemic symptoms
• Antibiotics dont alter lesion course

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Anthrax prophylaxis

• If exposure confirmed
• Rx for 8 weeks
• Rx with vaccine

Cipro 3 - 4.50 / 500 mg Doxy. 0.04 / 100 mg
Cipro now reduced to 0.95
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Botulism most potent toxin known to man

• Clostridium botulinum
• Spores ubiquitous
• Gm bacillus
• Produces potent neurotoxin
• Toxin releases acetylcholine
• Results in flaccid paralysis

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Botulism

• Food-born disease most common
• Improper canning
• Infantile botulism
• Inhalation disease also possible
• NOT transmitted from person to person

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Botulism clinical features

• Food-borne accompanied by GI sx
• Both forms share
• Responsive patient, no fever
• Symmetric cranial neuropathies
• Blurred vision diplopia
• Respiratory dysfunction (paralysis)
• No sensory deficit

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Botulism mode of transmission

• Toxin-contaminated food
• Aerosolized bioterrorism form
• Incubation period
• GI form 12-36 hours
• Inhaled form 24-72 hours

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Botulism confirmation

• Clinically compatible case
• Laboratory
• Detection of botulinum toxin in serum, stool or
  food

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Plague

• Yersinia pestis
• Gm(-) rod
• Bubonic and pulmonic variants

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Plague clinical features

• Fever, cough, chest pain
• Hemoptysis
• Muco-purulent watery sputumgm- rods on gm stain
• X-ray - bronchopneumonia

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Plague mode of transmission

• Normally fleas from infected rodents
• Bioterrorism aerosolized
• Person-to-person transmission possibleLarge
  aerosol droplets
• Required for transmission100-500 organisms

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Plague black lesions bubos
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Smallpox

• Variola virus
• Can be transmitted via airborne route
• Single case is a public health emergency
• Required fortransmission10-100 organisms

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Smallpox Mode of transmission

• Large Small droplets
• Patient-to-patient transmission likely
• More infectious if coughing or bleeding

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Smallpox incubation period

• 7-17 days
• 12 day average
• NOT contagious until rash present
• Patients generally very ill when rash occurs
• India strain

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Smallpox progression

• All lesions progress simultaneously

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Smallpox prevention

• Vaccine available
• No longer recommendedlast case 20 years ago
• Immunization does not confer lifelong immunity??
• CDC has 10-15M doses
• Plans to increase

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Smallpox Vaccine reactions
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Smallpox Infection Control

• Prevent inhalation of particles 5µ or smaller
• Strict Universal Precautions
• Transfer to appropriate isolation room
• In large epidemic, may cohort patients
• Limit transportation (but use mask on patient if
  necessary)

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Smallpox post exposure management

• Decontamination not indicated
• Post exposure immunization effective
• Vaccination alone if lt 3 days
• ??India strain
• IGG also if gt 3 days
• Vaccination contraindicated
• Pregnancy
• Immunocompromised patient