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Bacillus anthracis
Gram positive rods
Capsulated ( Protein) Capsule form in animal tissue and in special
laboratory condition ( 5% CO2)
Forms endospore, centrally located, do not form in animal tissues
MacFadyean ( Polychrome methylene blue) stain blue bacilli
with purple capsule
Aerobic/ Facultative anerobe
Epiedemiology
Distribution worldwide
Not common in West. Common in Africa ( Zimbabwe),
S.E. Asia, China, South America, Turkey, Pakistan, India
Human to human or animal to animal transmission is rare
( not contagious)
Grazing animals become infected through ingestion of
spores in the soil ( Carcasses become the source)
Epidemic : A. Spread to contiguous geographic areas by
infected animal
B. Non contiguous geographic areas by
- biting flies ( Zimbabwe)
- Contaminated surface water pool
BImal K Das, Microbiology, AIIMS
Pathogenesis
Endospores
(Abrasion, inhalation, ingestion)
Death
Introduced
Septicemia
Phagocytosed by Macrophages
10 7 to 10 8/ml
Regional LNs
Blood stream
Multiply in Lymphatics
Release
Vegetative Forms
Cutaneous Anthrax
Mainly in professionals( Veterinarian, butcher, Zoo keeper
Spores infect skin- a characteristic gelatinous edema develops at the
site (Papule- Vesicle-Malignant Pustule- Necrotic ulcer)
80-90% heal spontaneously ( 2-6wks)
0-20% progressive disease develop septicemia
95-99% of all human anthrax occur as cutaneous anthrax
Intestinal Anthrax
Due to in ingestion of infected carcasses
Mucosal lesion to the lymphatic system
Rare in developed countries
Extremely high mortality rate
PULMONARY ANTHRAX
Require very high infective dose ( > 10,000 spores)
Acquired through inhalation of spores ( Bioterrorism - aerosol)
Present with symptoms of severe respiratory infection( High fever &
Chest pain)
Haemorrhagic mediastinitis
Progress to septicemia very rapidly
10 7 to 10 9 bacilli/ ml of blood at the time of death
Mortality rate is very high > 95%
BImal K Das, Microbiology, AIIMS
Meningitis
Meningitis has been reported in association with cutaneous, inhalation,
and gastrointestinal anthrax cases
About one-half of patients with inhalation anthrax will develop
hemorrhagic meningitis
VIRULENCE FACTORS
Anthrax Toxin Complex of proteins ( all the components thermolabile)
A. Protective antigen
B. Edema factor
C. Lethal Factor
Protein capsule Poly D Glutamic acid capsule
- Inhibits phagocytosis ( Unencapsulated strains
nonpathogenic)
LABORATORY DIAGNOSIS
Few points to remember
Anthrax is not highly contagious
Cutaneous anthrax is not lethal and is readily treated with
common antibiotics
ID for human pulmonary / intestinal infection is > 10,000 spores
SPECIMEN TO COLLECT ( HUMAN ANTHRAX)
Disposable gloves, masks, overalls, boots, head gear and dust mask
Disposable items Autoclave and incinerate
Cutaneous anthrax: Vesicular exudate swabs and capillary tube aspirate
Intestinal anthrax: - Stool sample - isolate guinea pig inoculation
- Blood( venipuncture) smear examination for bacilli
- Peritoneal fluid for culture
- Paired sera for Ab
Pulmonary anthrax:
Specimens of blood obtained prior to antimicrobial therapy should be sent
for routine culture and for polymerase chain reaction (PCR) testing at a
Laboratory Response Network (LRN) laboratory
Pleural fluid, if present, for Gram stain, culture, and PCR
Cerebrospinal fluid, in patients with meningeal signs, for Gram stain,
culture, and PCR
Acute and convalescent serum samples for serologic testing
Pleural and/or bronchial biopsies for immunohistochemistry, if other tests
are negative
TREATMENT
Antibiotics should be given to unvaccinated individuals exposed to inhalation
anthrax.
Penicillin, tetracyclines and fluoroquinolones are effective if administered before the
onset of lymphatic spread or septicemia
Antibiotic treatment is effective in cutaneous anthrax
Inhalation anthrax can be effectively treated with antibiotics administered prior to
lymphatic spread or septicemia
INITIAL THERAPY
Adults
Ciproflox
( 400mg iv BDX60days)
Children Ciproflox
20-30mg/kgbodywt ivX60days
OPTIMAL THERAPY
Penicillin G 4 mu iv qdsX60days
Doxycycline 100mg iv BDX60 days
Penicllin G 50,000 u/kg X 60 days
- Professionals ( Veternarians, butcher, Zoo keeper, Wild life workers, Forest guards)
- Military personnels