ANTHRAX

Etiology:Bacillus anthracis

(Zoonosis)

Clinical findings

• Symptoms and signs

– 1. Cutaneous anthrax

– 2. Inhalational anthrax bioterrorism

– 3. Gastrointestinal anthrax

CUTANEUS ANTRAKS

Clinical findings• 1. Cutaneous anthrax

– Incubation period 2 weeks

– The initial lesion is an erythematous papule, often on an

exposed area of skin that vesiculated and then ulcerated and

undergoes necrosis, ultemately progressing to a purple to black

schar:

• Painless pain indicates secondary infection

• The surrounding area is edematous and vesicular but not purulent

Clinical findings

• 1. Cutaneous anthrax cont.– Regional adenopathy, …

– Fever

– Malaise

– Headache

– Nausea and vomiting

Clinical findings• 2. Inhalational anthrax

– Two stages

• Begins on average 10 days after exposure. Although a longer incubation

period of up to 6 weeks

– Nonspecific viral-like symptoms:

» Fever

» Malaise

» Headache

» Dyspnea

» Cough

» Congestion of the nose, throat and larynx

Clinical findings• 2. Inhalational anthrax cont.

– Two stages

– Anterior chest pain is an early symptom of mediastinitis

• Whithin hours to a few days, progression to the fulminant stage of

infection occurs in which signs and symptoms of sepsis

predominate:

– Delirium, obtudation, or meningeal irritation suggest an

accopanying hemorrhagic meningitis• 3. Gastrointestinal anthrax …

INHALATION ANTRAKS

Clinical findings• 3. Gastrointestinal anthrax

– Symptoms begin 2-5 days after ingestion of meat contaminated with

anthrax spores:

• Fever

• Diffuse abdominal pain

• Rebound abdominal tenderness

• Vomiting

• Constipation or diarrhea

• Emesis is blood-tinged or coffee-ground

• The stool may be blood tinged or melenic

• Bowel perforation

Clinical findings•

• 4. The oropharyngeal form of the disease is characterized by:

– Local lymphadenopathy

– Cervical edema

– Dysphagia

– Upper respiratory tract obstruction

GASTROINTESTINAL ANTRAKS

A. Suatu edema berat pada lengkungan duodenum pada intestinal anthrax dengan suatu pembesaran limfonodus ( di antara jari dokter bedah di atas ).

B. Segmen usus yang sama setelah dibuka. Terdapat edema, nekrosis, dan mukosa hemoragik. Sebuah eschar sentral ( pada tanda panah ) dan tersisa nodul kecil yang mengelilingi pada lesi cutaneus anthrax

Differential diagnosis

Types of anthrax DD-Cutaneous anthrax -Ecthyma gangrenosum, rat bite fever,

ulceroglandular tularemia, plague, glanders, rickettsialpox, orf, cutaneous mycobacterial infection

-Inhalational anthrax -mediastinitis

-Gastrointestinal anthrax -Bowel obtruction, perforates viscus,peritonitis, gastroenteritis, peptic ulcer disease

TreatmentAntimicrobial

agentsRecommended dosee

First-line agents - Ciprofloxacin, 2 x 500 mg daily orally or 2 x 400 mg/ 12 hours intravenously (IV) DOC- Docycycline, 100 mg every 12 hours orally or IV

Second-line agents - Amoxicillin 3 x 500 mg daily orally- Penicillin G, 2 mU every 4 hours intravenously

Alternative agents with in vitro activity

- Rifampin, 10 mg/kg/d orally or intravenously- Clindamycin, 450-600 mg every 8 hours orally/iv- Clarithromycin, 500 mg twice daily- Erythromycin, 500 mg mg every 6 hours iv - Vancomycin, 1 g every 12 hours - Imipenem, 500 mg every 6 hours iv