Anthrax gastrointestinal

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. 

This form of anthrax is caused by ingestion of raw or undercooked contaminated meat. The incubation period for this form is 2 to 7 days. The two types of gastrointestinal anthrax (intestinal and oropharyngeal) have different sets of symptoms. 

The symptoms of oropharyngeal anthrax include swelling of the neck, and lesions in the oral cavity (similar to cutaneous lesions), sometimes on the tonsils. Other symptoms include fever, swollen lymph nodes, and inability to swallow. Shock and toxemia can characterize both forms of the disease. The fatality rate for gastrointestinal anthrax ranges from 25 to 60%.3... 

Swelling of lymph nodes Death is rare Gastrointestinal anthrax ... 

Gastrointestinal Anthrax. Gastrointestinal (GI) anthrax is contracted by germination of ingested spores in the upper or lower GI tract. The GI forms of the disease are generally an upper GI form and a lower GI form. In the upper GI form, oral or esophageal ulcers develop with associated edema, lymphadenopathy, and sepsis. In the lower GI form, partial necrosis of the GI tract can occur with symptoms including bloody diarrhea, acute abdomen, ascites, or sepsis. 

Gastrointestinal anthrax Vomiting, diarrhea, and abdominal pain Diarrhea may be bloody. Acute abdomen may be present with or without ascites. Fluid volume loss may be severe. 

FIGURE 31.4. Spore uptake in gastrointestinal anthrax disease. The steps involving spore colonization of the gastrointestinal mucosa, uptake by phagocytes, germination, and lymphatic spread are illustrated. Illustrations are copyright protected and printed with permission by Alexandre M. Katos. 

In cutaneous and gastrointestinal anthrax, spore germination takes place at or near the inoculation site following uptake by the macrophage or dendritic cell. It is the vegetative form, not the spore, which produces the deadly factors. After transformation to the vegetative bacilli, these bacteria are free to mediate toxicity at the inoculation site in skin and gastrointestinal tract (Beatty et al., 2003). In inhalational... 

At the time of writing, the recommended initial therapy for inhalational, oral, and gastrointestinal anthrax in adults is 400 mg of ciprofloxacin every 12 h or 100 mg of doxycycline every 12 h, administered intravenously (Inglesby et al, 2002). In addition to these treatments, one or two... 

Anthrax can present as one of three types of infection in humans inhalational, cutaneous and gastrointestinal. Cutaneons anthrax is the most common naturally occurring form, with about 224 cases reported between 1944 and 1994 in the United Sates. Inhalational anthrax, the most likely form of anthrax to follow a biologic attack, is incredibly rare. Until the 2001 terrorist attacks, the last reported inhalational anthrax case in the United States occurred over 20 years earlier in 1978. Naturally occurring gastrointestinal anthrax is uncommon, with outbreaks occasionally reported in Africa and Asia (4). It is unlikely that gastrointestinal illness would result from a terrorist attack. Experiments on primates have revealed... 

Given the rapid transit of food through the gastrointestinal system, it is unlikely that exposure to spores could cause gastrointestinal anthrax. Instead, gastrointestinal... 

Anthrax is initiated by exposure to heat-resistant endospores of B. anthracis (a dormant form of the organism) that can exist in soil or animal products for decades. The spores enter the body through skin abrasions (cutaneous anthrax), the lungs (inhalation anthrax), or the ingestion of contaminated food (gastrointestinal anthrax). After inhalation of the endospores (the most deadly form of the disease) they are absorbed by macrophages, immune sys-... 

Gastrointestinal anthrax is exceedingly difficult to diagnose because of the rarity of the disease and... 

Inhalational, oropharyngeal, and gastrointestinal anthrax should be treated with large doses of intravenous penicillin (2 million units administered every 2 h) with appropriate vasopressors, oxygen, and other supportive therapy. 

Gastrointestinal anthrax is more serious than skin anthrax. The initial symptoms are nausea, loss of appetite, and fever, followed by severe abdominal pain. This is the least common form of anthrax. 

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