ANTHRAX

Etiology:
Bacillus anthracis
(Zoonosis)
 Clinical findings

• Symptoms and signs

– 1. Cutaneous anthrax

– 2. Inhalational anthrax

– 3. Gastrointestinal anthrax
 Clinical findings
• 1. Cutaneous anthrax
– Incubation period 2 weeks
– The initial lesion is an erythematous papule, often on an
exposed area of skin that vesiculated and then ulcerated and
undergoes necrosis, ultemately progressing to a purple to black
schar:
• Painless  pain indicates secondary infection
• The surrounding area is edematous and vesicular but not purulent
– Regional adenopathy, …
– Fever
– Malaise
– Headache
– Nausea and vomiting
 Clinical findings
• 2. Inhalational anthrax
– Two stages
• Begins on average 10 days after exposure. Although a longer incubation
period of up to 6 weeks
– Nonspecific viral-like symptoms:
» Fever
» Malaise
» Headache
» Dyspnea
» Cough
» Congestion of the nose, throat and larynx
– Anterior chest pain  is an early symptom of mediastinitis
• Whithin hours to a few days, progression to the fulminant stage of infection
occurs in which signs and symptoms of sepsis predominate:
– Delirium, obtudation, or meningeal irritation suggest an accopanying hemorrhagic
meningitis
• 3. Gastrointestinal anthrax …
 Clinical findings
• 3. Gastrointestinal anthrax
– Symptoms begin 2-5 days after ingestion of meat contaminated with
anthrax spores:
• Fever
• Diffuse abdominal pain
• Rebound abdominal tenderness
• Vomiting
• Constipation or diarrhea
• Emesis is blood-tinged or coffee-ground
• The stool may be blood tinged or melenic
• Bowel perforation
• 4. The oropharyngeal form of the disease is characterized by:
– Local lymphadenopathy
– Cervical edema
– Dysphagia
– Upper respiratory tract obstruction
 Differential diagnosis
Types of anthrax DD
-Cutaneous anthrax -Ecthyma gangrenosum, rat bite fever,
ulceroglandular tularemia, plague,
glanders, rickettsialpox, orf, cutaneous
mycobacterial infection

-Inhalational anthrax -mediastinitis

-Gastrointestinal anthrax -Bowel obtruction, perforates

viscus,peritonitis, gastroenteritis, peptic
ulcer disease
 Treatment
Antimicrobial Recommended dosee
agents
First-line agents - Ciprofloxacin, 2 x 500 mg daily orally or 2 x 400
mg/ 12 hours intravenously (IV)  DOC
- Docycycline, 100 mg every 12 hours orally or IV

Second-line agents - Amoxicillin 3 x 500 mg daily orally

- Penicillin G, 2 mU every 4 hours intravenously

Alternative agents - Rifampin, 10 mg/kg/d orally or intravenously

with in vitro activity - Clindamycin, 450-600 mg every 8 hours orally/iv
- Clarithromycin, 500 mg twice daily
- Erythromycin, 500 mg mg every 6 hours iv
- Vancomycin, 1 g every 12 hours
- Imipenem, 500 mg every 6 hours iv