inhalational anthrax


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Related to inhalational anthrax: Anthrax disease, woolsorters disease

anthrax

 [an´thraks]
an infectious disease seen most often in cattle, horses, mules, sheep, and goats, due to ingestion of spores of Bacillus anthracis. It can be acquired by humans through contact with infected animals or their byproducts, such as carcasses or skins.

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.
cutaneous anthrax anthrax due to lodgment of the causative organisms in wounds or abrasions of the skin, producing a black crusted pustule on a broad zone of edema.
gastrointestinal anthrax anthrax due to ingestion of poorly cooked meat contaminated with Bacillus anthracis, with deposition of spores in the submucosa of the intestinal tract, where they germinate, multiply, and produce toxin, resulting in massive edema, which may obstruct the bowel, hemorrhage, and necrosis.
inhalational anthrax a usually fatal form of anthrax due to inhalation of dust containing anthrax spores, which are transported to the regional lymph nodes where they germinate, multiply, and produce toxin, and characterized by hemorrhagic edematous mediastinitis, pleural effusions, dyspnea, cyanosis, stridor, and shock. It is usually an occupational disease, such as in persons who handle or sort contaminated wools and fleeces. Antimicrobial prophylaxis is used to prevent the condition. The Centers for Disease Control and Prevention has published interim guidelines for investigation and response to Bacillus anthracis infection. The evaluation of risk for exposure to aerosolized spores is of highest priority. Obtaining adequate samples, avoiding cross-contamination, and insuring proficient testing and evaluation of test results are all recommended.
meningeal anthrax a rare, usually fatal form of anthrax resembling typical hemorrhagic meningitis due to spread through the bloodstream of Bacillus anthracis from a primary focus of infection; manifestations include cerebrospinal fluid that is hemorrhagic and neurological signs and symptoms.
pulmonary anthrax inhalational anthrax.

inhalational anthrax

a form of anthrax acquired by breathing in spores of Bacillus anthracis in airborne particles less than 5 mcg. The spores are then phagocytized in lung alveoli by macrophages and carried to lymph nodes in the mediastinum where hemorrhage mediastinitis ensues. The classic radiographic finding in inhalational anthrax is a widened mediastinum on plain chest radiograph or chest CT scan. Early diagnosis of inhalational anthrax is difficult because initial symptoms are nonspecific chills, fever, muscle aches, cough. After 1-3 days, dyspnea, hypotension, high fever, and stridor become the primary symptoms. Mortality for inhalational anthrax approaches 100%, even with treatment.

anthrax

An 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.

Diagnosis
ELISA for capsule antigens (95+% senstivity) and protective antigens (72% sensitivity); detection of exotoxins in blood is unreliable.
 
Prevention
Prophylaxis (six weeks) with doxycycline or ciprofloxacin; vaccination with anthrax vaccine absorbed; decontamination with aerosolised formalin.
 
Management
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.
 
Clinical
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.
 
Cutaneous
Once common among handlers of infected animals (e.g., farmers, wool-sorters, tanners, brushmakers and carpetmakers).
 
Clinical
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.
 
Gastrointestinal
After ingesting contaminated meat (2 to 5 days); once ingested, spores germinate, causing ulceration, haemorrhagic and necrotising gastroenteritis.
 
Clinical
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.

Oropharyngeal
Uncommon; follows ingestion of contaminated meat.
 
Clinical
Cervical oedema, 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, nausea, vomiting, agitation, seizures, delirium, followed by neurologic degeneration and death.

in·ha·la·tion·al an·thrax

(inhă-lāshŭn-ăl anthraks)
Disease acquired by breathing in spores of Bacillus anthracis in airborne particles less than 5 mcg. Early diagnosis of inhalational anthrax is difficult because initial symptoms are nonspecific chills, fever, muscle aches, cough. After 1-3 days, dyspnea, hypotension, high fever, and stridor become the primary symptoms; mortality nears 100%, even with treatment.
References in periodicals archive ?
The pathogenesis of inhalational anthrax involves phagocytosis of B anthracis spores by pulmonary dendritic cells, transport of the spores within them to the tracheobronchial lymph nodes where the spores germinate, and replication of vegetative bacilli that secrete edema toxin and lethal toxin.
No cases of inhalational anthrax have been reported in the UK since 1974
Before the 2001 attacks, inhalational anthrax was so rare in the United States that only 18 cases had been diagnosed nationwide in the entire preceding century.
(According to virologist Alexis Shelokov, who was part of a 1992 investigational team that studied the notorious 1979 outbreak of inhalational anthrax in the Russian city of Sverdlovsk, the range of victims was extremely skewed: Of the 68 people who died, the overwhelming majority were heavy smokers over 40, probably with damaged lungs, and in generally poor health.) It is thus quite possible that smallpox would not cause the damage in America that it once did--and might again--in, say, Calcutta or Bangladesh.
For initial treatment of cutaneous or inhalational anthrax, the dosing recommendations for adults are 500 mg ciprofloxacin taken orally twice a day or 100 mg of doxycycline taken orally twice a day for 14 days.
Communicability is not a concern in managing or visiting with patients with inhalational anthrax.
Dr Larry Bush had never seen a case of inhalational anthrax - the last one in the US was in 1978.
Inhalational anthrax is a deadly disease and a significant biological threat to our nation, said BARDA Director Rick Bright, Ph.D.
Raxibacumab is a fully human monoclonal antibody, which received approval from the US Food and Drug Administration for the treatment and prophylaxis of inhalational anthrax due to Bacillus anthracis.
For every suspected anthrax case-patient, appropriate clinical specimens were required to be collected before treatment, including blood for all patients, vesicular fluid for patients with cutaneous anthrax, stools for patients with intestinal anthrax, and sputum or respiratory secretions for patients with inhalational anthrax. Every local CDC (county or prefecture) was required to examine stained smears of clinical specimens by microscopy.
Also consistent with previous reports of biomarkers measured in patients with sepsis and in animal models of inhalational anthrax, there were increased plasma levels of endothelin-1 (ET-1), tissue inhibitor of metalloproteinase 1 (TIMP-1), macrophage inflammatory protein-1a, and macrophage inflammatory protein-1[beta] Possibly explaining the numerous immature, eosinophilic leukocytes observed in the spleen tissue collected at autopsy, eotaxin-1, a chemoattractant of eosinophils, was elevated (approximately 5-fold).