Anthrax. Department of Child Health Medical Faculty University of Sumatera Utara

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Griffin Gibbs
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1 Anthrax Malignant pustule, malignant edema, Woolsorters Disease, Ragpickers Disease, Maladi Charbon, Splenic Fever Infectious and Tropical Pediatric Division Department of Child Health Medical Faculty University of Sumatera Utara

2 Overview Organism History Epidemiology Transmission Disease in Human

3 The Organism

4 The Organism Bacillus anthracis Large, gram positive non-motile rod Vegetative form and spores Nearly worldwide distribution Over 1,200 strains

5 The Spore Sporulation requires Poor nutrient conditions Presence of oxygen Spores Very resistant to extremes Survive for decades Taken up by host and germinate Lethal dose 2,500 to 55,000 spores

6 History

7 Sverdlovsk, Russia, people sick 64 died Soviets blamed contaminated meat Denied link to biological weapons 1992 Soviet President Yeltsin admits outbreak related to military facility Western scientists find victim clusters downwind from facility Caused by faulty exhaust filter

8 South Africa, Anthrax used by Rhodesian and South African apartheid forces Thousands of cattle died 10,738 human cases 182 known deaths Black Tribal lands only White populations untouched

9 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 Successful attempt in 1995 Sarin gas release in Tokyo subway 1,000 injured 12 deaths

10 2001 Anthrax Letters

12 Anthrax Cases, cases 11 cutaneous 11 inhalation 5 deaths (all inhalation) Index case in Florida 2 postal workers in Maryland Hospital supply worker in NYC Elderly farm woman in Connecticut Center for Food Security and Public Health Iowa State University

13 Anthrax Cases, month old boy Visited ABC Newsroom Cutaneous lesion Initial diagnosis: spider bite Punch biopsies confirmed anthrax

14 Anthrax Cases, 2001 CDC survey of health officials following ,000 reports regarding anthrax 4,800 phone follow-ups 1,050 led to lab testing Less than 180 anthrax inquiries

15 Anthrax Cases, 2001 Antimicrobial prophylaxis Ciprofloxacin 5,342 prescribed 60 day regime 44% compliance 57% suffered side effects

16 Transmission

17 Human Transmission Industry Tanneries Textile mills Wool sorters Bone processors Slaughterhouses

18 Human Transmission Cutaneous Contact with infected tissues, wool, hide, soil Biting flies Inhalational Tanning hides, processing wool or bone Gastrointestinal Undercooked meat

19 Animal Transmission Most commonly infected by ingestion from contaminated soil or contaminated feed or bone meal

20 Epidemiology

20,000-100,000 cases estimated globally/year

21 20, ,000 cases estimated globally/year

22 Anthrax in U.S. Cutaneous anthrax Early 1900 s: 200 cases annually Late 1900 s: 6 cases annually Inhalation anthrax 20 th century: 18 cases/16 fatal

23 Anthrax in the U.S. Outbreaks in soil endemic areas Alkaline soil Wet spring that leads to grass kill followed by hot, dry period in summer or fall Anthrax weather Grass or vegetation damaged by flood-drought sequence

24 Disease in Human

25 Human Disease Three forms Cutaneous Inhalation Gastrointestinal

26 Cutaneous Anthrax 95% of all cases globally Incubation: 3-5 days (up to 12 days) Spores enter skin through open wound or abrasion Papule progresses to black eschar Severe edema Fever and malaise

27 Day 2 Day 4 Day 6

28 Day 4 Day 6

29 Cutaneous Anthrax Case fatality rate 5-20% Untreated septicemia and death Edema can lead to death from asphyxiation Day 10

30 Cutaneous Anthrax farms quarantined 157 animals died 67 yr. old man in North Dakota Helped in disposal of 5 cows that died of anthrax Developed cutaneous anthrax Recovered with treatment

31 Gastrointestinal Anthrax Severe gastroenteritis Incubation: 2-5 days after consumption of undercooked, contaminated meat Case fatality rate: 25-75% GI anthrax never documented in U.S. Suspected cases in 2000

32 Minnesota, 2000 Downer cow approved for slaughter by local vet 5 family members ate meat 2 developed GI signs Diarrhea, abdominal pain, fever 4 more cattle die B. anthracis isolated from farm but not from humans

33 Inhalation Anthrax Incubation: 1-7 days Initial phase Nonspecific - Mild fever, malaise Second phase Severe respiratory distress Dyspnea, stridor, cyanosis, mediastinal widening, death in hours Case fatality: 75-90% (untreated)

35 Diagnosis in Humans Isolation of B. anthracis Blood, skin Respiratory secretions Serology ELISA Nasal swabs Screening tool

36 Diagnosis in Humans Anthrax quick ELISA test New test approved by FDA on June 7 th, Detects antibodies produced during infection with Bacillus anthracis Quicker and easier to interpret than previous antibody testing methods Results in less than ONE hour

37 Treatment Penicillin Has been the drug of choice Some strains resistant to penicillin and doxycycline Ciprofloxacin Chosen as treatment of choice in 2001 No strains known to be resistant Doxycycline may be preferable

39 Vaccination Cell-free filtrate Licensed in 1970 At risk Wool mill workers Veterinarians Lab workers Livestock handlers Military personnel

40 Vaccine Side Effects Injection site reactions Mild: 30% men, 60% women Moderate:1-5% Large local:1% 5-35% experience systemic effects Muscle or joint aches, headache, rash, chills, fever, nausea, loss of appetite, malaise No long-term side effects noted

41 Vaccine Schedule 3 injections at two-week intervals 3 injections 6 months apart Annual booster

ANTHRAX (Malignant Edema, Malignant Pustule, Woolsorter's Disease, Charbon, Ragpicker's Disease)

ANTHRAX (Malignant Edema, Malignant Pustule, Woolsorter's Disease, Charbon, Ragpicker's Disease) REPORTING INFORMATION Class A: Report immediately via telephone the case or suspected case and/or a positive