Anthrax cutaneous

Vaccine is available for cutaneous, possibly inhalation, anthrax. Cutaneous anthrax responds to antibiotics (penicillin, terramydn, Chloromycetin), sulfadiazine, and immune serum. Pulmonary (inhaled) anthrax responds to immune serum in initial stages but is of little use after disease is well established. Intestinal, same as for pulmonary. 

Anthrax. A nonspecific prodrome (i.e., fever, dyspnea, cough, and chest discomfort) follows inhalation of infectious spores. Approximately 2-4 days after initial symptoms, sometimes after a brief period of improvement, respiratory failure and hemodynamic collapse ensue. Inhalational anthrax also might include thoracic edema and a widened mediastinum on chest radiograph. Gram-positive bacilli can grow on blood culture, usually 2-3 days after onset of illness. Cutaneous anthrax follows deposition of the organism onto the skin, occurring particularly on exposed areas of the hands, arms, or face. An area of local... 

In the fall of 2001, letters containing a sophisticated and lethal form of powdered anthrax were sent to news media outlets and two democratic senators (the letters to the two senators were more highly refined and therefore more deadly). Of the eleven victims of inhalational anthrax, six survived. Eleven people also came down with cutaneous anthrax. Thousands of potentially exposed individuals were prescribed the antibiotic Cipro. The perpetrator is still unknown. This attack demonstrated that an individual could create highly refined anthrax spores, which, if disseminated properly, could infect hundreds, thousands or more. What is less clear is whether the perpetrator or any other terrorist could produce larger amounts (kgs) of anthrax and efficiently disseminate the spores over a wide area. According to the nuclear threat initiative, Producing... 

Anthrax Bacterial agent that may cause inhalation anthrax, cutaneous anthrax, or gastrointestinal anthrax disease. 

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. 

Untreated cutaneous anthrax can have a fatality rate of up to 20%. Fatalities are rare when patients are treated with appropriate antibiotics. While anthrax is not transmissible from person to person, direct exposure to vesicle secretions of cutaneous anthrax lesions can produce secondary cutaneous lesions. Secretions from vesicles may be prolific, so caution is advised.3... 

Time magazine had recently reported some cases of cutaneous anthrax appearing on the European continent. Sandals, made in India and cut from leather cured in cow dung, were the source. Consulting my textbooks, 1 found a description of anthrax skin lesions that seemed very much like the one between my distal digits. (Of course, 1 had never seen a case of anthrax, and my... 

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. 

In 2001, 11 people in the United States were diagnosed with confirmed or probable cases of cutaneous anthrax (Inglesby et al., 2002). One of these victims was a 7-month-old infant, who probably contracted the spores at his mother s workplace (Freedman et al., 2002). The previously healthy infant experienced severe systemic illness, despite early antibiotic therapy and hospitalization that included microangiopathic hemolytic anemia with renal involvement, coagulopathy, and hyponatremia (Freedman et al., 2002). The patient was hospitalized for 17 days, and his symptoms resolved 30 days after admission (Freedman et al., 2002). Fortunately, the infant survived. 

Freedman, A., Afonja, 0., Chang, M., Mostashari, F, Blaser, M., Perez-Perez, G. et al. (2002). Cutaneous anthrax associated with microangiopathic hemolytic anemia and coagulopathy in a 7-month-old infant. Journal of the American Medical Association, 287(7), 869-874. 

Anthrax occurs in three distinct forms, cutaneous, inhalational, and gastrointestinal. Although the cutaneous form represents the majority of anthrax cases, the inhalational form is responsible for virtually all anthrax-related mortality. Cutaneous anthrax is typically contracted by contact with abraded skin by products... 

Cutaneous Anthrax. Cutaneous anthrax occurs when anthrax spores enter the skin through cuts or abrasions. The affected area develops a small macule or papule that then ulcerates. A black painless eschar then follows, associated with extensive local edema and painful regional lymphadenopathy (see Figure 21.3). Systemic symptoms can follow. 

Cutaneous anthrax Raised bump on face, hands or arms, typically with black painless ulceration Ulcer with black eschar, moderate to severe localized edema and lymphadenopathy. Time course is 1-7 days until appearance of typical ulcer. 

The diagnosis of cutaneous anthrax, likewise, is initially difficult. A history of skin contact with anthrax spores or potentially anthrax-contaminated animal products is helpful. In early stages, the skin lesion is very nonspecific, hut the later presence of a painless black eschar accompanied hy severe localized edema is essentially pathognomonic for the diagnosis. Other causes of painful lymphadenopathy such as staph, strep, plague, and tularemia may mimic cutaneous anthrax. Cutaneous anthrax lesions can also resemble the necrotic ulcerated lesions due to brown recluse spider bite. 

Health care workers who come in contact with patients in whom anthrax is suspected should use universal precautions at all times, including the use of rubber gloves, disposal of sharps, and frequent hand washing. No human-to-human transmission of anthrax has been reported and respiratory isolation precautions are not needed. Patients with inhalational or cutaneous anthrax should be placed on contact isolation, due to the potential for contact with open wounds or wound drainage. 

Postexposure prophylaxis is not recommended for contacts of patients infected with B. anthracis, or for health care workers who may treat anthrax patients. It is also not recommended for the prophylaxis of cutaneous anthrax. It is currently only indicated for persons who may have been exposed to airspace contaminated with aerosolized B. anthracis (Bell, Kozarsky, Stephens, 2002). The duration of therapy is generally determined to be 60 days of either ciprofloxacin or doxy-cycline, with amoxicillin as an option for children and pregnant or lactating women. The U.S. Department of Health and Human Services has recently announced additional options for prophylaxis of inhalational anthrax, especially for those in whom inhalational exposure may have been significant. These options include 60 or 100 days of prophylaxis, as well as 100 days of prophylaxis plus anthrax vaccine as an investigational agent (GDG, 2001a Nass, 2002). 

Centers for Disease Control and Prevention. (2002). Update Cutaneous anthrax in a laboratory worker—Texas, 2002. Morbidity and Mortality Weekly Report, 51, 482. 

Localized Cutaneous Lesion Specific diagnosis consistent with cutaneous anthrax or tularemia Acute localized edema or lesion that may be consistent with cutaneous anthrax or tularemia Anthrax (cutaneous) Tularemia... 

Construct a case-based scenario that would suggest a naturally occurring cutaneous anthrax infection. 

In 2001, the first case of intentional anthrax release in the USA occurred. In October and November of that year, 11 confirmed cases of inhalation anthrax and 11 confirmed or suspected cases of cutaneous anthrax were reported in postal workers and others who handled mail that had been deliberately contaminated with anthrax spores (Abalakin et al., 1990). These contaminated letters were mailed anonymously to several news media and Federal government offices. The letters contained handwritten threats as well as cryptic references to the terrorist attacks on September 11 of that year. The anthrax spores were analyzed and determined to be of the Ames variety, the strain which originated in the USA and had been acquired by Army research institutes for vaeeine development. 

Worldwide, the annual incidence of human anthrax infection is estimated between 20,000 and 100,000 (Oncu et al, 2003 Pile et al, 1998). The vast majority are cutaneous anthrax. In the USA, less than one case is diagnosed per year, as compared to 127 cases/year diagnosed in the early 20th century (Oncu et al, 2003 Pile et al, 1998 Shafazand et al, 1999). Occasionally, outbreaks of anthrax will occur as a result of breakdown in public health standards and practices or lack of public health services. 

FIGURE 31.3. Spore uptake in cutaneous anthrax disease. The steps involving spore uptake at the primary site of local infection on the skin, germination inside the macrophage, and migration back into lymphatic ducts are illustrated. Illustrations are copyright protected and printed with permission by Alexandre M. Katos. 

Symptoms of cutaneous anthrax infection begin with a painless papule at the site of infection 3-5 days after exposure. After 24-36 h, the papule progresses to a vesicle 1-2 cm in diameter. Once the lesion mptures, it slowly... 

Punch biopsies can confirm cutaneous anthrax if Gram stain and culture results are negative, due to antibiotic treatment (Godyn et al., 2005), and a suspicion of cutaneous anthrax remains (Celia, 2002). The center of the eschar, the erythematous region, and the skin margin should all be included in the biopsy when an eschar is present (Godyn et al., 2005). 

Alternative option Amoxicillin in cutaneous anthrax" 500 mg PO TID 80 mg/kg/day divided every 8 h ... 

Cutaneous anthrax with signs of systemic involvement, extensive edema, or lesions of the head or neck require intravenous therapy, and a multidrug therapeutic approach ln children, ciprofloxacin dosage should not exceed 1 g/day... 

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