ANTHRAX

Etiology:
Bacillus anthracis
(Zoonosis)
 Clinical findings

Symptoms and signs

1. Cutaneous anthrax

2. Inhalational anthrax bioterrorism

3. Gastrointestinal anthrax
CUTANEUS ANTRAKS
 1. Cutaneous anthrax
Incubation period 2 weeks

The initial lesion is an erythematous papule, often on an

exposed area of skin that vesiculated and then ulcerated and
undergoes necrosis, ultemately progressing to a purple to black
schar:
Painless pain indicates secondary infection

The surrounding area is edematous and vesicular but not purulent

Clinical findings: Cutaneous anthrax (cont.)

Regional adenopathy,

Fever

Malaise

Headache

Nausea and vomiting

 2. Inhalational anthrax
Two stages
Begins on average 10 days after exposure. Although a longer incubation
period of up to 6 weeks
Nonspecific viral-like symptoms:

Fever

Malaise

Headache

Dyspnea

Cough

Congestion of the nose, throat and larynx

 2. Inhalational anthrax (cont.)

Two stages

Anterior chest pain is an early symptom of mediastinitis.

Whithin hours to a few days, progression to the fulminant stage
of infection occurs in which signs and symptoms of sepsis
predominate:

Delirium, obtudation, or meningeal irritation suggest an

accopanying hemorrhagic meningitis
3. Gastrointestinal anthrax
INHALATION ANTRAKS
3. Gastrointestinal anthrax
Symptoms begin 2-5 days after ingestion of meat contaminated with
anthrax spores:
Fever

Diffuse abdominal pain

Rebound abdominal tenderness

Vomiting

Constipation or diarrhea

Emesis is blood-tinged or coffee-ground

The stool may be blood tinged or melenic

Bowel perforation
GASTROINTESTINAL ANTRAKS
A. Suatu edema berat pada
lengkungan duodenum pada
intestinal anthrax dengan
suatu pembesaran limfonodus
( di antara jari dokter bedah di
atas ).
B. Segmen usus yang sama
setelah dibuka. Terdapat
edema, nekrosis, dan mukosa
hemoragik. Sebuah eschar
sentral ( pada tanda panah )
dan tersisa nodul kecil yang
mengelilingi pada lesi
cutaneus anthrax
Clinical findings 4. The oropharyngeal form of the
disease is characterized by:

Local lymphadenopathy

Cervical edema

Dysphagia

Upper respiratory tract obstruction

 Differential diagnosis
Types of anthrax DD
-Cutaneous anthrax -Ecthyma gangrenosum, rat bite fever,
ulceroglandular tularemia, plague,
glanders, rickettsialpox, orf, cutaneous
mycobacterial infection

-Inhalational anthrax -mediastinitis

-Gastrointestinal anthrax -Bowel obtruction, perforates

viscus,peritonitis, gastroenteritis, peptic
ulcer disease
 Treatment
Antimicrobial Recommended dosee
agents
First-line agents - Ciprofloxacin, 2 x 500 mg daily orally or 2 x 400
mg/ 12 hours intravenously (IV) DOC
- Docycycline, 100 mg every 12 hours orally or IV

Second-line agents - Amoxicillin 3 x 500 mg daily orally

- Penicillin G, 2 mU every 4 hours intravenously

Alternative agents - Rifampin, 10 mg/kg/d orally or intravenously

with in vitro activity - Clindamycin, 450-600 mg every 8 hours orally/iv
- Clarithromycin, 500 mg twice daily
- Erythromycin, 500 mg mg every 6 hours iv
- Vancomycin, 1 g every 12 hours
- Imipenem, 500 mg every 6 hours iv