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Anthrax Malignant Pustule, Malignant Edema, Woolsorters Disease, Ragpickers Disease, Maladi Charbon, Splenic Fever.

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Presentation on theme: "Anthrax Malignant Pustule, Malignant Edema, Woolsorters Disease, Ragpickers Disease, Maladi Charbon, Splenic Fever."— Presentation transcript:

1 Anthrax Malignant Pustule, Malignant Edema, Woolsorters Disease, Ragpickers Disease, Maladi Charbon, Splenic Fever

2 Center for Food Security and Public Health Iowa State University - 2004 Overview Organism History Epidemiology Transmission Disease in Humans Disease in Animals Prevention and Control

3 The Organism

4 Center for Food Security and Public Health Iowa State University - 2004 The Organism Bacillus anthracis Large, gram positive non-motile rod Vegetative form and spores Nearly worldwide distribution Over 1,200 strains

5 Center for Food Security and Public Health Iowa State University - 2004 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 Center for Food Security and Public Health Iowa State University - 2004 Sverdlovsk, Russia, 1979 94 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 Center for Food Security and Public Health Iowa State University - 2004 South Africa, 1978-1980 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 Center for Food Security and Public Health Iowa State University - 2004 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 Center for Food Security and Public Health Iowa State University - 2004 2001 Anthrax Letters

11 Center for Food Security and Public Health Iowa State University - 2004

12 Anthrax Cases, 2001 22 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

13 Center for Food Security and Public Health Iowa State University - 2004 Anthrax Cases, 2001 7 month old boy Visited ABC Newsroom Cutaneous lesion Initial diagnosis: spider bite Punch biopsies confirmed anthrax

14 Center for Food Security and Public Health Iowa State University - 2004 Anthrax Cases, 2001 CDC survey of health officials following 9-11-01 7,000 reports regarding anthrax 4,800 phone follow-ups 1,050 led to lab testing 1996-2000 Less than 180 anthrax inquiries

15 Center for Food Security and Public Health Iowa State University - 2004 Anthrax Cases, 2001 Antimicrobial prophylaxis Ciprofloxacin 5,342 prescribed 60 day regime 44% compliance 57% suffered side effects

16 Transmission

17 Center for Food Security and Public Health Iowa State University - 2004 Human Transmission Industry Tanneries Textile mills Wool sorters Bone processors Slaughterhouses

18 Center for Food Security and Public Health Iowa State University - 2004 Human Transmission Cutaneous Contact with infected tissues, wool, hide, soil Biting flies Inhalational Tanning hides, processing wool or bone Gastrointestinal Undercooked meat

19 Center for Food Security and Public Health Iowa State University - 2004 Animal Transmission Most commonly infected by ingestion from contaminated soil or contaminated feed or bone meal

20 Epidemiology

21 Center for Food Security and Public Health Iowa State University - 2004 20,000-100,000 cases estimated globally/year http://www.vetmed.lsu.edu/whocc/mp_world.htm

22 Center for Food Security and Public Health Iowa State University - 2004 Anthrax in U.S. Cutaneous anthrax Early 1900s: 200 cases annually Late 1900s: 6 cases annually Inhalation anthrax 20 th century: 18 cases/16 fatal

23 Center for Food Security and Public Health Iowa State University - 2004 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 Humans

25 Center for Food Security and Public Health Iowa State University - 2004 Human Disease Three forms Cutaneous Inhalation Gastrointestinal

26 Center for Food Security and Public Health Iowa State University - 2004 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 Center for Food Security and Public Health Iowa State University - 2004 Day 2 Day 6 Day 4

28 Center for Food Security and Public Health Iowa State University - 2004 Day 4 Day 6

29 Center for Food Security and Public Health Iowa State University - 2004 Cutaneous Anthrax Case fatality rate 5-20% Untreated – septicemia and death Edema can lead to death from asphyxiation Day 10

30 Center for Food Security and Public Health Iowa State University - 2004 Cutaneous Anthrax 2000 32 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 Center for Food Security and Public Health Iowa State University - 2004 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 Center for Food Security and Public Health Iowa State University - 2004 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 Center for Food Security and Public Health Iowa State University - 2004 Inhalation Anthrax Incubation: 1-7 days Initial phase Nonspecific - Mild fever, malaise Second phase Severe respiratory distress Dyspnea, stridor, cyanosis, mediastinal widening, death in 24-36 hours Case fatality: 75-90% (untreated)

34 Center for Food Security and Public Health Iowa State University - 2004

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

36 Center for Food Security and Public Health Iowa State University - 2004 Diagnosis in Humans Anthrax quick ELISA test New test approved by FDA on June 7 th, 2004. 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 Center for Food Security and Public Health Iowa State University - 2004 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

38 Center for Food Security and Public Health Iowa State University - 2004

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

40 Center for Food Security and Public Health Iowa State University - 2004 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 Center for Food Security and Public Health Iowa State University - 2004 Vaccine Schedule 3 injections at two-week intervals 3 injections 6 months apart Annual booster

42 Center for Food Security and Public Health Iowa State University - 2004 Protection Against Inhalational Anthrax No human post exposure trials have been documented 21 monkeys vaccinated at 0 and 2 weeks. o Challenged by anthrax spores at 8 week and 38 week later: All survived o Challenged at 100 weeks: 88% survived The two doses of vaccine (0 and 2 weeks) provided protection for most animals for almost two years

43 Center for Food Security and Public Health Iowa State University - 2004 Vaccination

44 Animals and Anthrax

45 Center for Food Security and Public Health Iowa State University - 2004 Clinical Signs in Animals Signs differ by species Ruminants at greatest risk Three forms of illness Peracute Ruminants (cattle, sheep, goats, antelope) Acute Ruminants and equine Subacute-chronic Swine, dogs, cats Copyright WHO

46 Center for Food Security and Public Health Iowa State University - 2004 Ruminants Peracute infection Rapid onset Sudden death Bloody discharge from body orifices Incomplete rigor mortis Rapidly bloat

47 Center for Food Security and Public Health Iowa State University - 2004 Ruminants Acute infection: 1-3 days Fever, anorexia Decreased rumination Muscle tremors Dyspnea Abortions Disorientation Bleeding from orifices Hemorrhages on internal organs

48 Center for Food Security and Public Health Iowa State University - 2004 Ruminants Chronic infection Pharyngeal and lingual edema Ventral edema Death from asphyxiation Treatment successful if started early

49 Center for Food Security and Public Health Iowa State University - 2004 Differential Diagnosis Blackleg Botulism Poisoning Plants, heavy metal, snake bite Lightening strike Peracute babesiosis

50 Center for Food Security and Public Health Iowa State University - 2004 Equine Ingestion Enteritis, severe colic, high fever, weakness, death within 48-96 hours Insect bite/vector Hot, painful swelling Spreads to throat, sternum, abdomen, external genitalia Death Copyright WHO

51 Center for Food Security and Public Health Iowa State University - 2004 Swine Sudden death without symptoms Localized swelling of throat Death by asphyxiation Ingestion of spores Anorexia, vomiting, enteritis

52 Center for Food Security and Public Health Iowa State University - 2004 Dogs & Cats Relatively resistant Ingestion of contaminated raw meat Clinical signs Fever, anorexia, weakness Necrosis and edema of upper GI tract Lymphadenopathy and edema of head and neck Death Due to asphyxiation, toxemia, septicemia

53 Center for Food Security and Public Health Iowa State University - 2004 Diagnosis and Treatment Necropsy not advised! Do not open carcass! Samples of peripheral blood needed Cover collection site with disinfectant soaked bandage to prevent leakage Treatment Penicillin, tetracyclines Reportable disease

54 Center for Food Security and Public Health Iowa State University - 2004 Dogs/Pigs Inhalational Anthrax Experimental studies - 1968 14 dogs and 14 pigs infected 8/14 pigs had transient fevers 3/14 dogs significant temp elevations B. anthracis Isolated from lungs and pulmonary lymph nodes of dogs Never isolated from blood

55 Center for Food Security and Public Health Iowa State University - 2004 Case-Report Mississippi, 1991 Golden retriever, 6 yrs old 2 days ptyalism and swelling of RF leg Temp 106°F, elevated WBC Died same day Necropsy Splenomegaly, friable liver, blood in stomach 2x2 cm raised hemorrhagic leg wound Some pulmonary congestion

56 Center for Food Security and Public Health Iowa State University - 2004 Case-Report Mississippi, 1991 Source of exposure in question Residential area 1 mile from livestock No livestock deaths in area Dove hunt on freshly plowed field 6 days prior to onset Signs consistent with ingestion but cutaneous exposure not ruled out

57 Center for Food Security and Public Health Iowa State University - 2004 Animal Anthrax Vaccine Recommended for livestock in endemic areas Sterne strain Live encapsulated spore vaccine Immunity in 7-10 days Other countries use in pets and exotics No safety or efficacy data Adjuvant may cause reactions Working dogs may be at risk

58 Center for Food Security and Public Health Iowa State University - 2004 Animal Disease Summary Anthrax should always be high on differential list when High mortality rate in group of herbivores Sudden death with unclotted blood from orifices Localized edema Especially neck of pigs or dogs

59 Prevention and Control

60 Center for Food Security and Public Health Iowa State University - 2004 Prevention and Control Report to authorities Quarantine the area Do not open carcass Minimize contact Wear protective clothing Latex gloves, face mask Vaccination of susceptible animals

61 Center for Food Security and Public Health Iowa State University - 2004 Prevention and Control Burn or bury carcasses, bedding, other materials Decontaminate soil Remove organic material and disinfect structures

62 Center for Food Security and Public Health Iowa State University - 2004 Disinfection Effective disinfection can be difficult Prevention of sporulation best High pressure cleaners discouraged Soil 5% lye or quicklime Hydrogen peroxide, peracetic acid or gluteraldehyde Bleach 1:10 dilution May be corrosive

63 Center for Food Security and Public Health Iowa State University - 2004 Disinfection Preliminary disinfection 10% formaldehyde 4% glutaraldehyde (pH 8.0-8.5) Cleaning Hot water, scrubbing, protective clothing Final disinfection: one of the following 10% formaldehyde 4% glutaraldehyde (pH 8.0-8.5) 3% hydrogen peroxide, 1% peracetic acid

64 Center for Food Security and Public Health Iowa State University - 2004 Biological Terrorism: Estimated Effects 50 kg of spores Urban area of 5 million 250,000 cases of anthrax 100,000 deaths 100 kg of spores Upwind of Wash D.C. 130,000 to 3 million deaths

65 Center for Food Security and Public Health Iowa State University - 2004 Acknowledgments Development of this presentation was funded by a grant from the Centers for Disease Control and Prevention to the Center for Food Security and Public Health at Iowa State University.

66 Center for Food Security and Public Health Iowa State University - 2004 Acknowledgments Author: Co-authors: Radford Davis, DVM, MPH Jamie Snow, DVM, MPH Katie Steneroden, DVM, MPH


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