Inhalation anthrax

Holty, Jon-Erik C., Dena M. Bravata, Hau Liu, Richard A. Olshen, Kathryn M. McDonald, and Douglas K. Owens. "Systematic Review A Century of Inhalational Anthrax Cases from 1900 to 2005." Annals of Internal Medicine 144 (February 21,2006) 270-80. 

Differential Diagnosis An epidemic of inhalation anthrax in its early stage with nonspecific symptoms could be confused with a number of viral, bacteria, and fungal infections. Progression over two to three days with sudden development of severe respiratory distress followed by shock and death within twenty-four to thirty-six hours in essentially all untreated cases eliminates diagnosis other than inhalation anthrax. Other diagnosis to consider would include aerosol exposure to staphylococcal enterotoxin B (SEB), plague, or tularemia pneumonia. 

Routes of Entry to the Body Inhalation, skin, and mouth. A biological warfare attack or a terrorist incident utilizing anthrax spores disseminated by aerosol would cause inhalation anthrax, a very rare form of this naturally occurring disease. Normal infection could occur through scratches or sores, wounds, eating insufficiently cooked infected meat, or by flies. All human populations are susceptible. The good news is that if you survive anthrax disease the first time, you would be immune to anthrax disease in the future. 

Decontamination Soap and water, or diluted sodium hypochlorite solution (0.5 percent). Drainage and secretion precautions are necessary. After invasive procedures or autopsy, decontaminate instruments and surfaces with 0.5 percent sodium hypochlorite or with a sporici Anthrax, after symptoms have became apparent, can be very deadly. Although the death rate for dermal anthrax is roughly about five to 20 percent, the fatality rate for inhalation anthrax after symptoms progress is almost always fatal, regardless of treatment. 

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. 

According to one spokesperson, Senator Leahy s letter, in potency and appearance, was a twin to Senator Daschle s letter. It contained twenty-three thousand anthrax spores, a number of spores roughly equal to two lethal doses of inhalation anthrax (i.e., the infec-... 

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... 

Decontamination/cleanup workers working in environments known to be contaminated with Bacillus anthracis spores may be at risk for inhalational anthrax. These workers should wear appropriate personal protective equipment (PPE) and follow appropriate procedures, as outlined in other CDC Guidance documents. 

Treatment (See Inhalational Anthrax Treatment Protocol at http //www.cdc.gov/ mmwr/preview/mmwrhtinl/m in5042al.htm for specific therapy)... 

Inhalation) Anthrax Spores in aerosols No Moderate 1-6 days 3-5 days High Spores are highly stable Yes Little effect Experi- mental... 

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. 

Symptoms of the acute phase are acute respiratory distress, breathing difficulty, profuse sweating, turning bluish in color, high temperature, and increased pulse and respiratory rate with chest sounds. If an x-ray is performed, mediastinal widening (swelling of lymph nodes under the breastbone) is very characteristic. Shock and death usually follow within 24 to 36 hours after the onset of respiratory distress. The fatality rate from inhalation anthrax ranges from 65 to 90% even with antibiotic therapy.3... 

Bacillusanthracis Inhalation, ingestion, direct contact via Inhaled anthrax ... 

Cipro—A Bayer antibiotic that combats inhalation anthrax. 

Generally, ciprofloxacin should be continued for 2 days after the signs and symptoms of infection have disappeared, except for inhalational anthrax (postexposure). 

Begin drug administration as soon as possible after suspected or confirmed exposure to B. anthracis spores. This indication is based on a surrogate endpoint, ciprofloxacin serum concentrations achieved in humans, reasonably likely to predict clinical benefit. Total duration c ciprofloxacin administration (IV, IR, or oral) for inhalational anthrax (postexposure) is 60 days. 

Inhalational anthrax (postexposure), adult-,- 500 mg Every 24 h 60 days-... 

Severe acne (tetracycline, doxycycline, minocycline only) As adjunctive therapy. Anthrax, including inhalational anthrax (doxycycline only) To reduce the incidence or progression of disease following exposure to aerosolized Bacillus anthracis. 

In a contained casualty setting, children with inhalation anthrax can receive intravenous antibiotics in a mass casualty setting and as postexposure prophylaxis, children can receive oral antibiotics (Inglesby et al., 2002). Doxycycline is dispensed in a tablet that children may not be able to swallow however, it can be ground and mixed with food or drink to make it palatable. Palatable foods and drinks for mixing doxycycline include chocolate pudding, chocolate milk, low-fat chocolate milk, simple syrup with sour apple flavor. 

U.S. Food and Drug Administration. (2001b). Commentary on non-labeled dosing of oral amoxicillin in adults and pediatrics for post-exposure inhalational anthrax. U.S. Food and Drug Administration Center for Drug Evaluation and Research. Retrieved March 13, 2007 from http //www.fda.gov/cder/ drugprepare/amox-anthrax.htm... 

However, Bacillus anthracis, the causative agent in inhalation anthrax, still remains the premier bioterrorist threat today. The Bacillus anthracis spore is nearly ubiquitous in nature and is not terribly difficult to isolate and grow. Being a spore former, the anthrax bacterium can withstand environmental stress while maintaining its virulence, as well as being hardy enough to withstand chemicals, UV light, and processes used in its weaponization. Finally, especially nowadays, the word anthrax alone strikes a fearsome chord in most people. 

Another example occurred at a flea market in Palm Beach, Florida, approximately a month after the first inhalation anthrax case was confirmed in neighboring... 

Jernigan, J. A., Stephens, D. S., Ashford, D. A., Omenaca, C., et al. (2001). Bioterrorism-related inhalational anthrax The first 10 cases reported in the United States. Emerging Infectious Diseases, 7, 933-944. 

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