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Anthrax as a weapon
Causes and symptoms
Anthrax in humans usually occurs as a malignant pustule or malignant edema of the skin. In rare instances it can affect the lungs if the spores of the bacillus are inhaled, or it can involve the intestinal tract when infected meat is eaten. The condition often is accompanied by hemorrhage, as the exotoxins from the bacillus attack the endothelium of small blood vessels. The condition is treated by the use of antibiotics such as penicillin and the tetracyclines. The malignant edema can be treated with intravenous hydrocortisone. The disorder is also known by a variety of names, including woolsorters' disease, ragpickers' disease, and charbon.
anthraxAn often fatal bacterial infection that occurs when Bacillus anthracis endospores (primarily of grazing herbivorous—cattle, sheep, horses, mules—origin) enter via skin abrasions, inhalation or orally.
ELISA for capsule antigens (95+% senstivity) and protective antigens (72% sensitivity); detection of exotoxins in blood is unreliable.
Prophylaxis (six weeks) with doxycycline or ciprofloxacin; vaccination with anthrax vaccine absorbed; decontamination with aerosolised formalin.
Penicillin, doxycycline; chloramphenicol, erythromycin, tetracycline, ciprofloxacin if (allergic to penicillin).
Anthrax, clinical forms
Inhalation (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 mediasitinal and peribronchial lymph nodes, producing toxins.
Mediastinal widening, pleural effusions, fever, nonproductive cough, myalgia, malaise, haemorrhage, cyanosis, SOB, stridor, shock, death; often accompanied by mesenteric lymphadenitis, diffuse abdominal pain and fever.
Once common among handlers of infected animals (e.g., farmers, wool-sorters, tanners, brushmakers and carpetmakers).
Carbuncle, a cluster of boils that later ulcerates, resulting in a hard black centre surrounded by bright red inflammation; rare cases that become systemic are almost 100% fatal.
After ingesting contaminated meat (2 to 5 days); once ingested, spores germinate, causing ulceration, haemorrhagic and necrotising gastroenteritis.
Fever, diffuse abdominal pain with rebound tenderness, melanic stools, coffee grounds vomit, fluid and electrolyte imbalances, shock; death is due to intestinal perforation or anthrax toxemia.
Uncommon; follows ingestion of contaminated meat.
Cervical oedema, lymphadenopathy (causing dysphagia), respiratory difficulty.
A rare, usually fatal complication of GI or inhalation anthrax, with death occurring 1 to 6 days after onset of illness.
Meningeal symptoms, nuchal rigidity, fever, fatigue, myalgia, headache, nausea, vomiting, agitation, seizures, delirium, followed by neurologic degeneration and death.
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
anthrax(an'thraks?) [Gr. anthrax, coal, carbuncle]
The anthrax bacillus has been prepared in aerosol form for use in biological warfare. As a result, some American troops have been vaccinated against the disease during their military training with one of several evolving vaccines. The effectiveness of the vaccine in disease prevention remains uncertain. Vaccination is also given to patients affected by active anthrax to prevent relapses.biological warfare;
Diagnosis is made by isolating B. anthracis from blood, sputum, or skin lesion cultures.
Signs and symptoms usually occur within 1 to 7 days after exposure, but can take up to 60 days. Early treatment helps to reduce fatalities. Cutaneous anthrax presents with small, pruritic lesions similar to insect bites that progress to malignant pustules (large, painless boils), vesicles, or skin ulcers with necrotic centers and surrounding brawny edema, usually on an exposed body surface, such as the skin of the hand. Mortality is about 20% from untreated cutaneous anthrax and is less than 1% when treated with an antibiotic (penicillin, doxycycline, ciprofloxacin). GI anthrax involves acute inflammation of the intestinal tract from ingestion of anthrax spores. Symptoms include nausea and vomiting, decreased appetite and fever, progressing to abdominal pain, vomiting blood, and severe to bloody diarrhea. Antibiotic therapy limits mortality to from 25% to 60%. Inhalation anthrax (also called pulmonary anthrax or Woolsorter's disease) is marked by flulike symptoms progressing to fevers, sweats, cough, weakness, and rapidly developing respiratory failure, septic shock, and/or meningitis. Infection of the lungs may be suggested by the rapid onset of respiratory symptoms and chest x-ray or CT findings that may include widening of the mediastinum with hemorrhagic lymph nodes, hilar fullness, and pleural effusion. The disease is often fatal even with the appropriate antibiotic therapy.
Persons exposed to anthrax (e.g., after its dissemination by bioterrorists) should receive a 60- to 100-day course of preventive therapy with ciprofloxacin, doxycycline, or penicillin G procaine. Individuals who have active infection with anthrax should receive two of the following antibiotics for a 60-day period: aminoglycosides, penicillin G (or amoxicillin), chloramphenicol, ciprofloxacin, doxycycline, imipenem or meropenem, rifampin, tetracycline, or vancomycin. Patients with pleural effusion benefit from drainage of the effusion with a chest tube.
Health supervision is provided to at-risk employees, along with prompt medical care of all lesions. Terminal disinfection of textile mills contaminated with B. anthracis is supervised, using vaporized formaldehyde or other recommended treatment. All cases of anthrax (in livestock or people) are reported to local health authorities. Isolation procedures (mask, gown, gloves, hand hygiene, and incineration of contaminated materials) are maintained to protect against drainage secretions for the duration of illness in inhalation, GI, and cutaneous anthrax. For patients with inhalation anthrax, vital signs are monitored and respiratory support is provided. For patients with cutaneous anthrax, lesions are kept clean and covered with sterile dressings. Prescribed antibiotics are administered and the patient is assessed for desired and adverse effects. Frequent oral hygiene and skin care are provided. Oral fluid intake and frequent small, nutritious meals are encouraged.