Anthrax meningitis

Children have been diagnosed with anthrax, with several cases reported from the Middle East and France in the past 10 years or so. In most instances, the source of the anthrax was contaminated meat (White et al., 2002), and the infection resulted in anthrax meningitis, intestinal anthrax, and cutaneous anthrax (from a wool thread tied around the umbilicus after birth). Refer to White, Henretig, and Dukes (2002) for further details. 

There is limited clinical experience for treating patients with anthrax meningitis (Sejvar et al, 2005). However, the recommended therapy is also a multidrug treatment, including the use of a fluoroquinolone and two additional drugs with excellent CNS penetration. The fluoroquinolone that is recommended for use is ciprofloxacin. The ciprofloxacin... 

Sejvar, J.J., Tenover, F.C., Stephens, D.S. (2005). Management of anthrax meningitis. Lancet. Infectious Diseases 5 287-95. 

Neither doxycycline nor a fluoroquinolone may reach therapeutic levels in the cerebrospinal fluid. Therefore, ciprofloxacin augmented with chloramphenicol, rifampin, or penicillin is the treatment of choice for suspected or confirmed anthrax meningitis (4). 

B. anthracis typically is susceptible to penicillin, amoxicillin, erythromycin, doxycycline, ciprofloxacin, and chloramphenicol. The bioterrorism-related strain was susceptible to the fluoroquinolones, rifampin, tetracycline, vancomycin, imipenem, meropenem, chloramphenicol, clindamycin, and the aminoglycosides. However, the strain was resistant to third-generation cephalosporins and trimethoprim-sulfamethoxazole. Ciprofloxacin or doxycycline plus one or two of the aforementioned antibiotics is the currently recommended regimen for the treatment of inhalational anthrax, but doxycycline is not recommended for the treatment of anthrax meningitis owing to poor CNS penetration and recent in vitro resistance. ... 

Fortunately, anthrax meningitis can be treated with a multi-drug antibacterial regime. However, although there is an anthrax vaccine, it requires multiple doses over a protracted period and annual boosters and is also in relatively short supply. Vaccination is therefore not really an option for mass protection at present. 

Natural penicillin Infections like streptococcal pneumonia, enterococcal and nonenterococcal group D endocarditis, diphtheria, anthrax, meningitis, tetanus, botulism, actinomycosis, syphilis, and relapsing fever, Lyme disease prophylaxis against pneumococcal infections, rheumatic fever, bacterial endocarditis... 

There is limited clinical experience for treating patients with anthrax meningitis (Sejvar et al., 2005). However,... 

Whilst not recommended for routine administration, vaeoines additional to those represented in the juvenile programme are available for individuals in special risk categories. These categories relate to oeeupational risks or risks associated with travel abroad. Such immunization protocols include those directed against cholera, typhoid, meningitis (types A, C), anthrax, hepatitis A and B, influenza, Japanese encephahtis, rabies, tick-borne encephalitis, and yellow fever. 

Suggested Alternatives for Differential Diagnosis Anthrax, brucellosis, dengue, ehrlichiosis, infectious mononucleosis, Kawasaki disease, leptospirosis, malaria, meningitis, men-ingococcemia, relapsing fever, Rocky Mountain spotted fever, syphilis, toxic shock syndrome, toxoplasmosis, tularemia, typhoid fever, rubella, measles. 

Suggested Alternatives for Differential Diagnosis Anthrax, tetanus, rabies, meningitis, encephalitis, cerebral trypanosomiasis, piroplasmosis, theileriosis, listeriosis, parasitism poisoning by strychnine, lead, organophosphates, arsenic, and various plants that affect the central nervous system. 

Depending on the route of exposure to this biological agent, the exposed person may experience inhalation anthrax, cutaneous anthrax, or gastrointestinal anthrax. Any one of these forms can be complicated by meningitis occurring in about 5% of cases when anthrax bacilli enter the central nervous system via the bloodstream and eventually reach the blood-brain barrier. 

Anthrax A (Bacillus anfhracis) Animals— herbivores 1-5 days No Standa d (invasive procedures should be avoided) Inhalation— fever, dry cough,resp distress, meningitis cutaneous-skin ulcer Dea h may occur about 24-36 h post exposure Ciprofloxacin, doxycycline A vaccine is available... 

The toxin produced by B. anthracis is a major cause of the morbidity associated with the disease. One study suggested corticosteroids as adjunct therapy for inhalational anthrax associated with extensive edema, respiratory failure and meningitis (11,12). 

Many of these agents (such as anthrax) may present with headache, meningitis, or mental status changes in addition to... 

Perhaps surprising for those outside the medical profession is the fact that all three forms of anthrax infection - inhalation, cutaneous and gastrointestinal - may be complicated by meningitis. An anthrax biological weapons attack would most likely be an attempt to spread the spores on the air to cause inhalation anthrax. Once inside the... 

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