Anthrax: Didi Candradikusuma
Anthrax: Didi Candradikusuma
Anthrax: Didi Candradikusuma
DIDI CANDRADIKUSUMA
DIVISI PENYAKIT TROPIK INFEKSI
LAB/SMF ILMU PENYAKIT DALAM
FKUB - RSSA
History
Bio Terrorism
Aum Shinrikyo
Japanese religious cult
Supreme truth
1993
Unsuccessful attempts
at biological terrorism
Released anthrax from office building
Vaccine strain used not toxic
No human injuries
Anthrax
From the Greek word anthrakos for coal
Caused by spores
Primarily a disease of domesticated & wild
animals
Herbivores such as sheep, cows, horses, goats
Natural reservoir is soil
Does not depend on an animal reservoir
making it hard to eradicate
Cannot be regularly cultivated from soils
where there is an absence of endemic anthrax
Anthrax zones
Soil rich in organic matter (pH < 6.0)
Dramatic changes in climate
Where is Anthrax?
http://www.vetmed.lsu.edu/whocc/mp_world.htm
Bacillus anthracis
Gram + rod
Facultative anaerobe
1 - 1.2m in width x 3 - 5m
in length
http://www.bact.wisc.edu/Bact
330/lectureanthrax
Endospore
Pathogenesis
The infectious dose of B.
anthracis in humans by
any route is not precisely
known.
Rely on primate data
Minimum infection dose
of ~ 1,000-8,000 spores
LD50 of 8,000-10,000
spores for inhalation
Virulence depends on 2
factors
Capsule
3 toxins
http://www.kvarkadabra.net/index.html?/biologija/teksti/biolosko
_orozje.htm
B. Anthracis cycle
Clinical Information
Infection
Symptoms (1st and 2nd phase)
Three forms of Anthrax infection
and their Pathology
Diagnosis
Infection of Anthrax
The estimated number of naturally
occurring human cases of anthrax in the
world is 20,000 to 100,000 per year.
Humans are infected through contact with
infected animals and their products because
of human intervention.
Anthrax spores contaminate the ground
when an affected animal dies and can live
in the soil for many years.
Infection of Anthrax
Anthrax can also be spread by eating
undercooked meat from infected animals.
Anthrax is NOT transmitted from person to
person.
Humans can be exposed but not be
infected.
Cutaneous Anthrax
http://science.howstuffworks.com/anthrax1.htm
Cutaneous Anthrax
The most common naturally occurring
form of anthrax.
Ulcers are usually 1-3 cm in diameter.
Incubation period:
Usually an immediate response up to
1 day
Case fatality after 2 days of infection:
Untreated (20%)
With antimicrobial therapy (1%)
Cutaneous Anthrax
Inhalation Anthrax
The infection begins with the
inhalation of the anthrax
spore.
Spores need to be less than 5
microns (millionths of a meter)
to reach the alveolus.
Macrophages lyse and destroy
some of the spores.
Survived spores are
transported to lymph nodes.
At least 2,500 spores have to
be inhaled to cause an
infection.
Inhalation Anthrax
Disease immediately follows
germination.
Spores replicate in the lymph
nodes.
The two lungs are separated
by a structure called the
mediastinum, which contains
the heart, trachea,
esophagus, and blood
vessels.
Bacterial toxins released
during replication result in
mediastinal widening and
pleural effusions
(accumulation of fluid in the
Inhalation Anthrax, Introduction, DRP, Armed
Forces
Institute of
pleural
space).
Pathology
Inhalation Anthrax
Death usually results 2-3 days after the onset of
symptoms.
Natural infection is extremely rare (in the US, 20
cases were reported in last century).
Inhalation Anthrax is the most lethal type of
Anthrax.
Incubation period:
17 days
Possibly ranging up to 42 days (depending on
how many spores were inhaled).
Case fatality after 2 days of infection:
Untreated (97%)
With antimicrobial therapy (75%)
Gastrointestinal Anthrax
GI anthrax may follow
after the consumption
of contaminated,
poorly cooked meat.
There are 2 different
forms of GI anthrax:
1) Oral-pharyngeal
2) Abdominal
Abdominal anthrax is
more common than the
oral-pharyngeal form.
http://science.howstuffworks.com/anthrax1.htm
GastrointestinaI Anthrax
Oral-pharyngeal form - results from the
deposition and germination of spores in the
upper gastrointestinal tract.
Local lumphadenopathy (an infection of the
lymph glands and lymph channels), edema,
sepsis develop after an oral or esophageal ulcer.
Abdominal form - develops from the deposition
and germination of spores in the lower
gastrointestinal tract, which results in a primary
intestinal lesion.
Symptoms such as abdominal pain and vomiting
appear within a few days after ingestion.
Gastrointestinal Anthrax
GI anthrax cases are uncommon.
There have been reported outbreaks in Zimbabwe, Africa
and northern Thailand in the world.
GI anthrax has not been reported in the US.
Incubation period:
1-7 days
Case fatality at 2 days of infection:
Untreated (25-60%)
With antimicrobial therapy (undefined) due to the rarity
Diagnosis
Gram stain
Culture of B. anthracis from the blood, skin
lesions, vesicular fluid, or respiratory
secretions
X-ray and Computed Tomography (CT) scan
Rapid detection methods
- PCR for detection of nucleic acid
- ELISA assay for antigen detection
- Other immunohistochemical and
immunoflourescence examinations
- These are available only at certain labs
Treatment
Before 2001, 1st line of
treatment was penicillin G
Stopped for fear of
genetically engineered
resistant strains
60 day course of antibiotics
Ciprofloxacin
fluoroquinolone
500 mg tablet every 12h
or 400 mg IV every 12h
Inhibits DNA synthesis
Treatment
Doxycycline
6-deoxy-tetracycline
100 mg tablet every
12h or 100 mg IV
every 12h
Inhibits protein
synthesis
For inhalational, need
another antimicrobial
agent
clindamycin
rifampin
chloramphenicol
Treatment
Penicillin and doxycycline
Intravenous administration
inhalational, gastrointestinal, and meningeal anthrax
Cutaneous anthrax with signs of systemic
involvement
Cutaneous anthrax: oral penicillin
Chloramphenicol, erythromycin, tetracycline, or
ciprofloxacin (allergic to penicillin)
Doxycycline and tetracycline :not for pregnant women
or children
Treatment
IV penicillin G :4 million units every 4 to 6 hrs
continued for 7 to 10 ds
Streptomycin had a synergistic effect with
penicillin in experiments
Ciprofloxacin :400 mg iv every 8 to 12 hrs
Doxycycline :200 mg iv then 100 mg iv every 8
~12 hrs
Prophylaxis:Ciprofloxacin 500 mg or Doxycycline
100 mg by mouth twice a day for at least 6 wks
Systemic corticosteroids for cervical edema and
meningitis