Anthrax

Anthrax
Anthrax is an acute infectious disease in humans and animals that is caused by the bacterium Bacillus anthracis and is highly lethal in some forms. Anthrax is one of only a few bacteria that can form long lived spores. When the bacteria’s life cycle is threatened by factors such as lack of food caused by their host dying or change of temperature, the bacteria turn themselves into more or less dormant spores to wait for another host to continue their life cycle. On breathing, ingesting or getting anthrax spores in a cut in the skin these spores reactivate themselves and multiply in their new host very rapidly. The anthrax spores in the soil are very tough and can live many decades and perhaps centuries and are known to occur on all continents except Antarctica. Anthrax most commonly occurs in wild and domestic grass eating mammals (ruminants) who ingest or breathe in the spores while eating grass. Anthrax can also be caught by humans when they are exposed to dead infected animals, eat tissue from infected animals, or are exposed to a high density of anthrax spores from an animals fur, hide, or wool. Anthrax spores can be grown outside the body and used as a biological weapon. Anthrax cannot spread directly from human to human; but anthrax spores can be transported by human clothing, shoes etc. and if a person dies of anthrax their body can be a very dangerous source of anthrax spores. The word anthrax is derived from the Greek word anthrakis, or "coal", in reference to the black skin lesions victims develop in a cutaneous skin infection.

Mode of infection



Anthrax can enter the human body through the intestines (ingestion), lungs (inhalation), or skin (cutaneous) and causes distinct clinical symptoms based on its site of entry. An infected human will generally be quarantined. However, anthrax does not usually spread from an infected human to a noninfected human. But if the disease is fatal the person’s body and its mass of anthrax bacilli becomes a potential source of infection to others and special precautions should be used to prevent more contamination. Unfortunately inhalation anthrax, if left untreated until obvious symptoms occur, will usually result in death--treatment was started too late.

Anthrax is usually contracted by handling infected animals or their wool, germ warfare/terrorism or laboratory accidents.

Treatment and prevention


Direct person-to-person spread of anthrax is extremely unlikely; but a patient’s clothing and body may be contaminated with anthrax spores. Effective decontamination of people can be accomplished by a thorough wash down with anti-microbe effective soap and water. Waste water should be treated with bleach or other anti-microbal agent. Effective decontamination of articles can be accomplished by boiling contaminated articles in water for 30 minutes or longer and using common disinfectants. Chlorine is effective in destroying spores and vegetative cells on surfaces. Burning clothing is also effective. After decontamination, there is no need to immunize, treat or isolate contacts of persons ill with anthrax unless they also were also exposed to the same source of infection . Early antibiotic treatment of anthrax is essential–delay seriously lessens chances for survival. Treatment for anthrax infection and other bacterial infections includes large doses of intravenous and oral antibiotics, such as fluoroquinolones, like ciprofloxacin (cipro), doxycycline, erythromycin, vancomycin or penicillin. In possible cases of inhalation anthrax exposure to unvaccinated personnel early antibiotic prophylaxis treatment is crucial to prevent possible death. If death occurs from anthrax the body should be isolated to prevent possible spread of anthrax germs. Burial does not kill anthrax spores.

If a person is suspected as having died from anthrax every precaution should be taken to avoid skin contact with the potentially contaminated body and fluids exuded through natural body openings. The body should be put in strict quarantine. A blood sample taken in a sealed container and analyzed in an approved lab should be used to ascertain if anthrax is the cause of death. Microscopic visualisation of the encapsulated bacilli, usually in large numbers, in a blood smear stained with polychrome methylene blue (M'Fadyean reaction) is fully diagnostic. Full isolation of the body is important to prevent possible contamination of others. Protective, impermeable clothing and equipment such as rubber gloves, rubber apron, and rubber boots with no perforations should be used when handling the body. No skin, especially that which is has any wounds or scratches, should be exposed. Disposable personal protective equipment is preferable, but if not available, decontamination can be achieved by washing any exposed equipment in hot water, bleach and detergent. Disposable personal protective equipment and filters should be burned and buried. Bacillus anthracis bacillii range from 0.5-5.0 um in size. Anyone working with anthrax in a suspected or confirmed victim should wear respiratory equipment capable of filtering this size of particle or smaller. A National Institute for Occupational Safety and Health (NIOSH) and Mine Safety and Health Administration (MSHA) approved high efficiency-respirator, such as a half-face disposable respirator with a high-efficiency particulate air (HEPA) filter, is recommended. All possibly contaminated bedding or clothing should be isolated in double plastic bags and treated as possible bio-hazard waste. The victim should be sealed in an air tight body bag. Dead victims that are opened and not burned provide an ideal source of anthrax spores. Cremating victims is the preferred way of handling body disposal. No embalming or autopsy's should be attempted without a fully equipped bio hazard lab and trained and knowledgable personnel.

Delays of only a few days may make the disease untreatable and treatment should be started even without symptoms if possible contamination or exposure is suspected. Animals with anthrax often just die without any apparent symptoms. Initial symptoms may resemble a common cold – sore throat, mild fever, muscle aches and malaise. After a few days, the symptoms may progress to severe breathing problems and shock and ultimately death. Death can occur from about two days to a month after exposure with deaths apparently peaking at about 8 days after exposure. [7] Antibiotic-resistant strains of anthrax are known.

Aerial spores can be trapped by a simple HEPA or P100 filter.[citation needed] Inhalation of anthrax spores can be prevented with a full-face mask using appropriate filtration. Unbroken skin can be decontaminated by washing with simple soap and water.[citation needed] All of these procedures do not kill the spores which are very hard to kill and require extensive treatment to eradicate them. Filters, clothes, etc. exposed to possible anthrax contaminated environments should be treated with chemicals or destroyed by fire to minimize the possibility of spreading the contamination.

In recent years there have been many attempts to develop new drugs against anthrax; but the existing supply still works fine if treatment is started soon enough.
Prevention can also be accomplished through early detection. In response to the anthrax attacks of October, 2001 utilizing the United States Postal Service(USPS), the USPS has installed BioDetection Systems(BDS)in their large scale mail cancellation facilities. BDS response plans have been formulated by the USPS in conjunction with local responders including fire, police, hospitals and public health. Employees of these facilities have been educated on Anthrax, response actions and prophylactic medication. Because of the time delay inherent in getting final verification that anthrax has been used, prophylactic antibiotic use should be started to possibly exposed personnel as soon as possible.

The ultimate in prevention is vaccination against infection but this has to be done well in advance of exposure.