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anthraxGreek, anthrax, a burning coal, charbon, milzbrand Infectious disease An often fatal bacterial infection which occurs when Bacillus anthracis endospores, primarily of grazing herbivore–cattle, sheep, horses, mules–origin enter via skin abrasions, inhalation, or orally Pathogenesis Anthrax endospores germinate within macrophages, become vegetative bacteria, multiply within the lymphatics, enter the bloodstream and cause massive septicemia Clinical URI-like symptoms, followed by high fever, vomiting, joint pain, SOB, internal and external hemorrhage, hypotension, meningitis, pulmonary edema, shock sudden death; intestinal anthrax is caused by ingestion of contaminated meat; cutaneous anthrax is rare Diagnosis ELISA for capsule antigens–95+% senstivity, for protective antigen–72% sensitivity; detection of exotoxins in blood is unreliable Prevention Prophylaxis–6 wks with doxycycline or ciprofloxacin; vaccination, with anthrax vaccine absorbed; decontamination with aerosolized formalin Management Penicillin, doxycycline; if allergic to penicillin, chloramaphenicol, erythromycin, tetracycline, ciprofloxacin See Bacillus anthracis, Cutaneous anthrax, Industrial anthrax, Inhalation anthrax.
Anthrax, clinical forms
- Almost universally fatal–due to inhalation of anthrax spores which germinate and produce toxins resulting in pleural effusions, hemorrhage, cyanosis, SOB, stridor, shock, death
- Anthrax pneumonia, inhalational anthrax, pulmonary anthrax An almost universally fatal form due to inhalation of 1 to 2 µm pathogenic endospores which are deposited in alveoli, engulfed by macrophages and germinate en route to the mediastinal and peribronchial lymph nodes, produce toxins Clinical Mediastinal widening, pleural effusions, fever, nonproductive cough, myalgia, malaise, hemorrhage, cyanosis, SOB, stridor, shock, death, often accompanied by mesenteric lymphadenitis, diffuse abdominal pain, fever
- Once common among handlers of infected animals, eg farmers, woolsorters, tanners, brushmakers and carpetmakers in an era when brushes were from animals Clinical Carbuncle–a cluster of boils, that later ulcerates, resulting in a hard black center surrounded by bright red inflammation; rare cases which become systemic are almost 100% fatal
- After ingesting contaminated meat–2 to 5 days; once ingested spores germinate, causing ulceration, hemorrhagic and necrotizing gastroenteritis Clinical Fever, diffuse abdominal pain with rebound tenderness, melanic stools, vomit, fluid and electrolyte imbalances, shock; death is due to intestinal perforation or anthrax toxemia
- Uncommon, follows ingestion of contaminated meat Clinical Cervical edema, lymphadenopathy–causing dysphagia, respiratory difficulty
- Anthrax meningitis
- A rare, usually fatal complication of GI or inhalation anthrax with death occurring 1 to 6 days after onset of illness Clinical Meningeal symptoms, nuchal rigidity, fever, fatigue, myalgia, headache, N&V, agitation, seizures, delirium, followed by neurologic degeneration and death
Patient discussion about inhalation
Q. How can I know the inhaler is empty? My 8 years-old boy has asthma and he takes steroids with inhaler. Every time it runs out of med we get a prescription for a new one. Is that OK? A friend that her son is treated with similar inhaler told me that towards the end it no longer delivers enough medication. How can I know I should get a new one?
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Q. What are the side effects for the regular asthma inhalers? I am taking an inhaler (non-steroid one) for my asthma and I wanted to know what can be possible side effects to this treatment.
Q. Is a Proventil Inhaler cheaper by you than Secirity Blue? I pay $60. with Security Blue now. Is it cheaper with you for a three months supply ?
but i couldn't find there that other drug you were talking about....is that it's name?