1. By
Susan Kahumburu
ANTHRAX

2. Introduction
Is a zoonotic disease caused by the bactreria Bacillus anthracis which is a sporeforming G+ve bacilli.
It is transmitted by the spores of the bacilli which are shed in large nos in the terminal stages of infection hence spread only by a dying or dead host.
Causative agent may survive for long time in the environment.

3. Distribution of anthrax in the world

4. Epidemiology Disease of domestic herbivores occurs worldwide.
Domestic carnivores maybe infected by eating contaminated carcasses
Human disease mostly occurs in endemic regions eg Iran central america S. america Russia by direct contact with infected carcasses
Industrial cases may occur anywhere and reflect exposure to imported animal carcass products(hides or bonemeal)

5. Risks
Humans acquire infection by direct inoculation of spores through breaks in the skin causing cutaneous anthrax
Inhalation of spores (5%)
Ingestion of contaminated meat (rare <1%)
Direct person to person spread has also been documented

6. Clinical presentation Cutaneous anthrax
Described as Malignant pustule. Lesion is common in the head neck and exposed arms
Occurs 2-3 days after inoculation of spores into surface cuts or abrasions.
Coagulation necrosis of the centre causes a dark coloured eschar which is surrounded by a ring of vesicles
Lesion is painless and doesn’t discharge pus but causes oedema and lymphadenopathy

7. Pulmonary anthrax Wool-sorters disease: Caused by inhalation of spores
Carries a high mortality due to intense inflammation haemorrhage and septicemia
Presents with fever chills cyanosisand shortness of breath.
Diagnosis is rarely made before death

8. Intestinal anthrax Consuption of cntaminated meat. Common in Africa
Presents with vomiting diarrhoea and fever occasionally dysentry with heamatemesis
Autopsy eschar may be found in the gut but most patients recover spontaneously

9. Other sites
Oropharynx after eating contaminated meat may present with oedema which may be lifethreatening
Meningeal coz of bacteremia

10. Lab diagnosis
Gram stain of clinical samples (skin lesion, blood, pleural fluid, CSF) 
Culture
Adjunct Assays
PCR
Serology (PA based ELISA)
Immunohistochemistry

11. Treatment DOC Penicillin
In severe illness human anthrax immune globulin from vaccinated or recovered individuals
Strains resistant to penicillins are used in germ warfare use FLUOROQUINOLONES
Prolong antibiotics coz non-germinated spores remain in alveoli for weeks

12. Control
Prompt diagnosis and isolation in animals. Cases reported to the public health officers
Animals at risk should be vaccinated
Carcasses of infected animals should be buried deeply or cremated
Humans treated in isolation from other patients
Vaccination of those handling animals

13. Vaccination against anthrax is not recommended for travelers.
Travelers are warned against having direct or indirect contact with carcasses of animals found in anthrax-endemic regions or consuming meat from animals that were not determined by health officials to be healthy at the time of slaughter.

14. The risk of acquiring anthrax from playing with or handling an animal-skin drum is very low. In recent years there have been a few cases of anthrax among animal-skin drum makers. Some of these cases have been fatal. Travelers who wish to bring back animal hides from anthrax-endemic regions for the purpose of drum making should strongly consider the health risks before importing animal skins.

15. Currently, no tests are offered or available to determine if animal products are either contaminated with or free of B. Anthracis spores. Animal-skin drum owners or players should report any unexplained fever or new skin lesions to their health-care provider and describe their recent contact with animal-skin drums.

16. Animal vaccine
The first animal vaccines were developed around 1880 by Pasteur, Toussaint, and Greenfield.
In 1935 Sterne developed an attenuated live animal vaccine that is still in use and derivatives account for almost all vaccines used in the world today.

17. Being a live bacteria, its most significant problem is that it retains some of its virulence. Goats, llamas, and occasionally other animals may die following vaccination.
However, the benefits far outway the losses, and the vaccine, combined with improved animal husbandry and industrial hygiene, have led to the almost total dissappearence of anthrax in developed countries.

18. Human vaccines
There are three vaccines that are commercially available at this time: the georgian/russian, the UK, and the US vaccines.
All three are derived from an avirulent strain of bacillus anthracis called the sterne strain. This strain lacks the plasmid px02 which encodes the protecive coating of the bacteria.

19. The Georgian/Russian vaccine, consists of live spores from the Sterne strain administered in the shoulder by scarification. Its efficacy is unknown but it is reputed to have a high number of side effects and contraindications.
The UK and US vaccines consist of alum-precipitated cell-free filtrates of bacilli i.e the protective antigen PA.

20. Vaccination consists of six initial doses at 0, 2, and 4 weeks and 6, 12, and 18 months followed by a yearly booster. In the UK the first three doses are three weeks apart. As expected, both vaccines manage to increase the bodies response to PA in the form of increased IgG.

21. However, despite the name of protective antigen, high antibody levels do not correlate with an immune state. In fact the actual correlate of immunity for anthrax is not known at this time. Antibodies are important but haven't been the deciding factor in animal models.
The immunization schedule demonstrates that the vaccine is poor in generating immunological memory.

22. Bioterrorism THANKYOU
Most suitable for germ warfare coz it is easy to grow in bulk, survives well in spore form and can be delivered with a suitable carrier as a powder on fomites and by airborne route.
Inhalational anthrax is fatal!
THANKYOU