Anthrax: Difference between revisions

No edit summary
 
(42 intermediate revisions by 13 users not shown)
Line 1: Line 1:
==Background ==
==Background==
*Gram positive rod, Bacillus anthracis, which is capable of surviving inhospitable conditions through the formation of endospores
*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.


==Clinical Features==
[[File:Cutaneous anthrax lesion on the neck. PHIL 1934 lores.jpg|thumb|Cutaneous anthrax lesion on neck.]]
[[File:Cutaneous_anthrax.png|thumb|Cutaneous anthrax]]
[[File:Anthrax PHIL 2033.png|thumb|A skin lesion with black eschar characteristic of anthrax]]
[[File:PMC3493280 1756-0500-5-464-1.png|thumb|Cutaneous anthrax with associated marked edema.]]
[[File:PMC3291463 05-1407-F.png|thumb|Initial skin lesion with black eschar and red border. By the time the picture was taken, the massive associated edema of hand and arm had subsided.]]
===Inhalational (5%)===
*Biphasic course


Gm positive rod, tough spores
====Prodrome Period====
Inhalational Anthrax: Russian accident at Sverdlovsk
*Early prodromal period often appears as an [[flu-like illness]]
-Incubation Period is 10 days
*[[Fever]], dry [[cough]], [[myalgia]], malaise
-No one < 24 died
*Transient clinical improvement followed by rapid decline
==Ddx==


====Acute phase====
*Severe [[respiratory distress]] with symptoms consisting of<ref>[http://emedicine.medscape.com/article/212127-overview Medscape: Anthrax]</ref>:
**[[Hypoxia]], tachypnea, cyanosis
**Severe dyspnea, chest pain
**[[Shock]]
**[[Mediastinitis]]


Cutaneous (painless):
===Cutaneous (95%)===
-Ecthyma gangrenosum
*The disease will start as an area of erythema and edema and progress to a vesicle which ruptures forming a central black eschar which eventually falls off
-Rat-bite fever (Streptobacillus monilifomis and Spirillum minus)
*Total course of lesion evolution occurs over 1 week
-Ulceroglandular tularemia
*Small minority of untreated patients develop rapidly fatal bacteremia <ref>Gordon, David. "Zoonotic Infections." Tintinalli's Emergency Medicine Manual, 8e Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH.</ref>
-Plague
-Glanders (Pseudomonas peudomallei)
-Rickettsialpox (Rickettsia akari)
-Orf (parapox virus)
-Staph lymphadenitis
-TB
-Leprosy
-Buruli ulcer (Mycobact ulcerans)
Inhalational:
-Acute bacterial mediastinitis
-Mycoplasma
-Legionnaire's
-Psittacosis
-Tularemia
-Q fever (Coxiella burnetti)
-Viral pneumonia
-Histoplasmosis
-Coccidiomycosis
-Ruptured aortic aneurysm
-SVC syndrome
-Silicosis
-Sarcoidosis
==Imaging==


===Gastrointestinal===
*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>
*May present as oropharyngeal ulcers with [[dysphagia]]


CXR/CT- Widened mediastinum representing hemorrhagic mediastinitis
==Differential Diagnosis==
===Cutaneous (painless)===
==Treatment==
*Ecthyma gangrenosum
*[[Rat-bite fever]] (Streptobacillus monilifomis and Spirillum minus)
*Ulceroglandular [[tularemia]]
*[[Plague]]
*[[Glanders]] (Pseudomonas peudomallei)
*[[Rickettsia]]l pox (Rickettsia akari)
*Orf (parapox virus)
*[[Staph]] [[lymphadenitis]]
*[[TB]]
*[[Leprosy]]
*[[Buruli ulcer]] (Mycobact ulcerans)


===Inhalational===
*Acute bacterial [[mediastinitis]]
*[[Mycoplasma]]
*[[Legionella|Legionnaire's]]
*[[Psittacosis]]
*[[Tularemia]]
*[[Q fever]] (Coxiella burnetti)
*Viral [[pneumonia]]
*[[Histoplasmosis]]
*[[Coccidiomycosis]]
*Ruptured [[Aortic Dissection]]
*[[SVC Syndrome|SVC syndrome]]
*[[Pneumoconiosis|Silicosis]]
*[[Sarcoidosis]]


Cipro 500 mg bid or 30 mg/kg div q12
{{Lower respiratory zoonotic infections}}
Levo 500 mg qd
Doxycycline 100 mg bid
x 60 days
PLUS vaccine: inactivated, cell-free immediately, 2 wks and then 4 wks
==Source ==


{{Bioterrorism agents}}


7/2/09 PANI
==Evaluation==
[[File:Anthrax - inhalational.jpg|thumb|[[CXR]] of inhalational anthrax showing mediastinal widening.]]
*[[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'''
 
{{Anthrax antibiotics}}
 
==Disposition==
*Admit
 
==See Also==
*[[Bioterrorism]]
 
==References==
<references/>
 
[[Category:ID]]

Latest revision as of 18:20, 21 September 2022

Background

  • Gram positive rod, Bacillus anthracis, which is capable of surviving inhospitable conditions through the formation of endospores
  • 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.

Clinical Features

Cutaneous anthrax lesion on neck.
Cutaneous anthrax
A skin lesion with black eschar characteristic of anthrax
Cutaneous anthrax with associated marked edema.
Initial skin lesion with black eschar and red border. By the time the picture was taken, the massive associated edema of hand and arm had subsided.

Inhalational (5%)

  • Biphasic course

Prodrome Period

Acute phase

Cutaneous (95%)

  • The disease will start as an area of erythema and edema and progress to a vesicle which ruptures forming a central black eschar which eventually falls off
  • Total course of lesion evolution occurs over 1 week
  • Small minority of untreated patients develop rapidly fatal bacteremia [3]

Gastrointestinal

Differential Diagnosis

Cutaneous (painless)

Inhalational

Lower Respiratory Zoonotic Infections

Bioterrorism Agents[5]

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 of inhalational anthrax showing mediastinal widening.
  • 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. ↑ Gordon, David. "Zoonotic Infections." Tintinalli's Emergency Medicine Manual, 8e Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH.
  4. ↑ 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
  5. ↑ https://www.niaid.nih.gov/topics/biodefenserelated/biodefense/pages/cata.aspx Accessed 02/26/16
Retrieved from "https://www.wikem.org/w/index.php?title=Anthrax&oldid=366378"