Anthrax Medical Briefing

1
Anthrax Medical Briefing

• Dr. Coleen Baird Weese, MD, MPH, FACOEM
• 6 November 2001

2
Purpose

• Review general medical information about Anthrax
• Review Types of infections
• Discuss Protective Measures
• Outline treatment prophylaxis requirements

3
Anthrax Basics

• Anthrax Infections are caused by the
  spore-forming bacterium Bacillus anthracis
• Spore coat protects bacteria for decades in
  environment
• Large spores (10E12) in a gram of powder

4
Anthrax Basics

• Aerosolized spores remain airborne up to two
  weeks
• Spores can be spread on clothes and can cross
  contaminate mail other material

5
Cutaneous Anthrax

• Spores enter thru cut in skin
• Infection begins as a raised itchy bump that
  resembles an insect bite
• Within 1-2 days, sore usually develops into a
  fluid-filled blister and then a painless ulcer

6
Cutaneous Anthrax

• Ulcer size 1-3 cm in diameter with a
  characteristic black center area
• Lymph glands in the adjacent area may swell
• Deaths are rare with treatment

7
Inhalational Anthrax

• Caused by breathing in spores
• Low risk - two weeks after discovery of source
  material
• Initial symptoms resemble flu - fever, tiredness,
  body aches
• After several days, symptoms may progress to
  severe breathing problems and shock

8
Inhalational Anthrax

• Usually fatal if not diagnosed treated early
• Prophylaxis must be started when determination of
  credible exposure made

9
Gastrointestinal Anthrax

• GI form usually caused by eating contaminated
  meat
• See acute inflammation of the GI tract
• Early signs of infection
• Nausea, loss of appetite, vomiting, and fever

10
Gastrointestinal Anthrax

• Later signs of infection
• Pain, vomiting blood, severe diarrhea
• May result in death if not treated early

11
Diagnosis of Anthrax Disease

• Isolation of B. anthracis from the blood, skin
  lesions, or respiratory secretions
• Gram stain, culture and sensitivities done
• Measuring specific antibodies in the blood of
  persons with suspected cases
• Nasal swabs done to determine the extent of
  environmental exposure, not for clinical case
  mgmt

12
Anthrax Precautions

• Get flu shot to reduce chances of getting flu
• Workers sampling at some increased risk require
  prophylaxis
• Respiratory protection required to prevent
  Inhalational Anthrax

13
Anthrax Precautions

• Respirator wearers need
• Medical clearance enrollment in RPP
• Training
• Fit testing
• Early symptoms require immediate evaluation
  treatment

14
Prophylactic Treatment for Anthrax

• Both doxycycline ciprofloxacin effective
• Physician prescribes prophylaxis
• Meds should be started prior to sampling
• Discontinue prophylaxis when environmental
  sampling confirms no Anthrax spores present
• Continue prophylaxis for 60 days if
  environmental samples test positive for Anthrax

15
References

• Centers for Disease Control and Prevention
• http//www.cdc.gov
• U.S. Army Institute of Infectious Diseases
• http//www.usamriid.army.mil/
• U.S. Army Center for Health Promotion and
  Preventive Medicine
• http//www.chppm-www.apgea.army.mil/