ANTHRAX

• Anthrax


  Also known as Wool-sorter's Disease or Ragpicker's Disease
• Anthrax


  • An acute bacterial disease usually affecting the skin but which may very rarely involve the oropharynx, lower respiratory tract, mediastinum or intestinal tract
• Etiologic Agent


  Bacillus anthracis
• Cutaneous infection transmission


  1. Contact with tissues of animals dying of the disease

  2. Contact with contaminated hair, wool, or products made from them such as drums or brushes

  3. Contact with soil associated with infected animals or contaminated bone meal used in gardening
• Incubation Period


  Inhalation Anthrax (1 to 7 days) usually within 48 hours<|>Cutaneous anthrax (1 to 7 days rarely up to 7 weeks<|>Ingestion (1 to 7 days)
• Cutaneous Anthrax


  • Most common (over 90% of cases)
  • Infection is through the skin
  • Over a few days a sore, which begins as a pimple, grows, ulcerates and forms a black scab, around which are purplish vesicles
  • Systemic symptoms may include rigors' headache and vomiting
  • The sore is usually diagnostic: 20% cases are fatal
• Inhalational Anthrax


  • Spores are inhaled with subsequent invasion of mediastinal lymph nodes
  • Abrupt onset of flu-like illness, rigors, dyspnea and cyanosis followed by shock and usually death over the next 2-6 days
  • Most Fatal
• Intestinal Anthrax


  • Occurs following ingestion of meat from infected animals and is manifested as violent gastroenteritis with fever, vomiting, bloody stools and then septicemia
  • Poor prognosis
• Diagnostic Tests


  • Polymerase Chain Reaction (PCR)
  • Swabs from cutaneous lesions
  • Blood cultures
  • Lymph node or spleen aspirates
  • CSF shows characteristic bacilli on staining with polychrome methylene blue
  • Chest radiology may show fluid surrounding the lungs or widening of the mediastinum
• Treatment Modalities


  • Penicillin
  • Ciprofloxacin (DOC)
  • Doxycycline
• Treatment of cutaneous anthrax

  Oral antibiotic for 7 to 10 days
• Length of treatment for GI anthrax

  60 days, but safety has not been evaluated beyond 14 days
• Complications of Cutaneous Anthrax

  • Septicemia
• Complications of Inhalational Anthrax

  • Hemorrhagic meningitis
  • Pleural Effusions
  • Mediastinitis
  • Shock
  • Acute Respiratory Distress Syndrome
• Complications of GI Anthrax

  • Hemorrhage
  • Shock
• Nursing Considerations


  1. Obtain culture specimens before starting antibiotic therapy

  2. Supportive measures are geared toward the type of anthrax exposure

  3. Teach the patient and family that anyone who has been exposed to anthrax must see a doctor immediately

  4. Instruct the patient to take antibiotics as prescribed and until completed

  5. Instruct the patient with cutaneous anthrax not to scratch at the lesions

  6. Alcohol-based hand sanitizers do not kill anthrax spores; wash hands with soap and water
• Prevention


  1. Pretreatment of animal product and good occupational health cover are the mainstays of control

  2. Animals believed to have died of anthrax should be disposed of under supervision

  3. Mass vaccination of animals may reduce disease spread

  4. Non-cellular vaccines for human use are available for individuals at risk from occupational exposure

  5. Workers handling potentially infectious raw materials should be aware of the risks