Anthrax: Difference between revisions

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*Gram positive rod, Bacillus anthracis, which is capable of surviving inhospitable condition through the formation of endospores. tough spores
*Gram positive rod, Bacillus anthracis, which is capable of surviving inhospitable condition through the formation of endospores. tough spores
*Incubation period is 10 days with no ability for human to human transmission and therefore, no need for respiratory isolation
*Incubation period is 10 days with no ability for human to human transmission and therefore, no need for respiratory isolation
**Though human to human transmission does not occur, potential harbors of spores (patient clothes) need to be isolated and decontaminated with 10% bleach<ref>Heninger SJ et al. Decontamination of Bacillus anthracis Spores: Evaluation of Various Disinfectants. Appl Biosaf. 2009 Jan 1; 14(1): 7–10.</ref>
*In general there is cutaneous, inhalational, and gastrointesinal anthrax.  
*In general there is cutaneous, inhalational, and gastrointesinal anthrax.  
===Inhalational===
===Inhalational (5%)===
*Biphasic course
====Prodrome Period====
====Prodrome Period====
*Early prodromal period often appears as an influenza like illness
*Early prodromal period often appears as an [[flu-like illness]]
====Inhalational (5%)====
*[[Fever]], dry [[cough]], [[myalgia]], malaise
*Severe respiratory distress with symptoms consisting of:
*Transient clinical improvement followed by rapid decline
**Hypoxia
====Acute phase====
**Dyspnea
*Severe [[respiratory distress]] with symptoms consisting of<ref>[http://emedicine.medscape.com/article/212127-overview Medscape: Anthrax]</ref>:
**Mediasitinits
**[[Hypoxia]], tachypnea, cyanosis
**Pneumonia-like: Fever, cough, chills
**Severe dyspnea, chest pain
**[[Shock]]
**[[Mediastinitis]]


===Cutaneous (95%)===
===Cutaneous (95%)===
[[File:Cutaneous_anthrax.png|thumb|Cutaneous anthrax]]
[[File:Cutaneous_anthrax.png|thumb|Cutaneous anthrax]]
*The disease will start as an area of errythema and edema and progress to a vesicle which ruptures forming a central black eschar
*The disease will start as an area of erythema and edema and progress to a vesicle which ruptures forming a central black eschar
*Total course of lesion evolution occurs over 1 week
*Total course of lesion evolution occurs over 1 week


===Gastrointestinal===
===Gastrointestinal===
*Over the course of 7 days, nonspecific abdominal pain, nausea and vomitting with progress to severe abdominal pain, bloody emesis and diarrhea (usually bloody)<ref> CDC. Gastrointestinal anthrax after an animal-hide drumming event - New Hampshire and Massachusetts, 2009. MMWR Morb Mortal Wkly Rep. 2010 Jul 23;59(28):872-7. http://www.ncbi.nlm.nih.gov/pubmed/20651643</ref>
*Over the course of 7 days, nonspecific [[abdominal pain]], [[nausea and vomiting]] with progress to severe abdominal pain, [[hematemesis|bloody emesis]] and [[diarrhea]] (usually bloody)<ref> CDC. Gastrointestinal anthrax after an animal-hide drumming event - New Hampshire and Massachusetts, 2009. MMWR Morb Mortal Wkly Rep. 2010 Jul 23;59(28):872-7. http://www.ncbi.nlm.nih.gov/pubmed/20651643</ref>


==Differential Diagnosis==
==Differential Diagnosis==
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*[[Plague]]
*[[Plague]]
*[[Glanders]] (Pseudomonas peudomallei)
*[[Glanders]] (Pseudomonas peudomallei)
*Rickettsialpox (Rickettsia akari)
*[[Rickettsia]]l pox (Rickettsia akari)
*Orf (parapox virus)
*Orf (parapox virus)
*[[Staph]] [[lymphadenitis]]
*[[Staph]] [[lymphadenitis]]
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*Acute bacterial [[mediastinitis]]
*Acute bacterial [[mediastinitis]]
*[[Mycoplasma]]
*[[Mycoplasma]]
*[[Legionnaire's]]
*[[Legionella|Legionnaire's]]
*[[Psittacosis]]
*[[Psittacosis]]
*[[Tularemia]]
*[[Tularemia]]
*[[Q fever]] (Coxiella burnetti)
*[[Q fever]] (Coxiella burnetti)
*Viral pneumonia
*Viral [[pneumonia]]
*[[Histoplasmosis]]
*[[Histoplasmosis]]
*[[Coccidiomycosis]]
*[[Coccidiomycosis]]
*Ruptured [[Aortic Dissection]]
*Ruptured [[Aortic Dissection]]
*[[SVC syndrome]]
*[[SVC Syndrome|SVC syndrome]]
*[[Silicosis]]
*[[Pneumoconiosis|Silicosis]]
*[[Sarcoidosis]]
*[[Sarcoidosis]]


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{{Bioterrorism agents}}
{{Bioterrorism agents}}


==Diagnosis==
==Evaluation==
CXR/CT- Widened mediastinum representing hemorrhagic mediastinitis
*[[CXR]]/CT
**Widened mediastinum representing hemorrhagic mediastinitis
**Infiltrate, pleural effusion
**Hyperdense mediastinal lymphadenopathy


==Treatment==
==Management==
'''Contact CDC Emergency Hotline 1-707-488-7100 for all suspected bioterrorism cases'''
'''Contact CDC Emergency Hotline 1-707-488-7100 for all suspected bioterrorism cases'''


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[[Category:ID]]
[[Category:ID]]
[[Category:Tox]]
[[Category:Toxicology]]

Revision as of 15:45, 14 September 2019

Background

  • Gram positive rod, Bacillus anthracis, which is capable of surviving inhospitable condition through the formation of endospores. tough spores
  • Incubation period is 10 days with no ability for human to human transmission and therefore, no need for respiratory isolation
    • Though human to human transmission does not occur, potential harbors of spores (patient clothes) need to be isolated and decontaminated with 10% bleach[1]
  • In general there is cutaneous, inhalational, and gastrointesinal anthrax.

Inhalational (5%)

  • Biphasic course

Prodrome Period

Acute phase

Cutaneous (95%)

Cutaneous anthrax
  • The disease will start as an area of erythema and edema and progress to a vesicle which ruptures forming a central black eschar
  • Total course of lesion evolution occurs over 1 week

Gastrointestinal

Differential Diagnosis

Cutaneous (painless)

Inhalational

Lower Respiratory Zoonotic Infections

Bioterrorism Agents[4]

Category A

Category B

  • Ricin
  • Brucellosis
  • Epsilon toxin
  • Psittacosis
  • Q Fever
  • Staph enterotoxin B
  • Typhus
  • Glanders
  • Melioidosis
  • Food safety threats
  • Water safety threats
  • Viral encephalitis

Category C

Evaluation

  • CXR/CT
    • Widened mediastinum representing hemorrhagic mediastinitis
    • Infiltrate, pleural effusion
    • Hyperdense mediastinal lymphadenopathy

Management

Contact CDC Emergency Hotline 1-707-488-7100 for all suspected bioterrorism cases

Postexposure Prophylaxis

Patient should be vaccinated at day #0, #14, #28

Cutaneous Anthrax (not systemically ill)

  • Ciprofloxacin 500mg PO q12hrs x 60 days
  • Doxycycline 100mg PO q12hrs x 60 days

Inhalation or Cutaneous with systemic illness

Pediatric Postexpsoure Prophylaxis

Pediatric Cutaneous Anthrax (not ill)

  • Same as post exposure dosing and duration

Pediatric Inhalational or Cutaneous (systemically ill

Disposition

  • Admit

See Also

References

  1. ↑ Heninger SJ et al. Decontamination of Bacillus anthracis Spores: Evaluation of Various Disinfectants. Appl Biosaf. 2009 Jan 1; 14(1): 7–10.
  2. ↑ Medscape: Anthrax
  3. ↑ CDC. Gastrointestinal anthrax after an animal-hide drumming event - New Hampshire and Massachusetts, 2009. MMWR Morb Mortal Wkly Rep. 2010 Jul 23;59(28):872-7. http://www.ncbi.nlm.nih.gov/pubmed/20651643
  4. ↑ https://www.niaid.nih.gov/topics/biodefenserelated/biodefense/pages/cata.aspx Accessed 02/26/16
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