kuliah uniba Anthrax5

8/17/2019 kuliah uniba Anthrax5

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AnthraxMalignant Pustule, MalignantEdema, Woolsorters’ Disease,

Ragpickers’ Disease, MaladiCharbon, Splenic Fever


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Center for Food Security and Public Health, Iowa State University, 2008

Overview

• Organism

• History

• Epidemiology• Transmission

• Disease in Humans

• Disease in Animals• Prevention and Control


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The Organism


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The Organism

• acillus anthracis

• Large, ram positive,

non!motile rod• "egetative #orm

and spores

• $early worldwidedistri%ution

• Over &,'(( strains


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The )pore

• )porulation re*uires

+Poor nutrient onditions

+Presene o# oxygen

• )pores

+"ery resistant to extremes

+)urvive #or deades

+Ta-en up %y host and germinate

• Lethal dose ',.(( to ..,((( spores


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History


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'((& Anthrax Letters


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Transmission


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Human Transmission

• /ndustry

+Tanneries

+Textile mills

+0ool sorters

+1one proessors

+)laughterhouses


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Human Transmission

• Cutaneous+Contat with in#eted

tissues, wool, hide, soil

+1iting #lies• /nhalational

+Tanning hides,

proessing wool or %one• astrointestinal

+2nderoo-ed meat


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Animal Transmission

• 3ost ommonly in#eted %yingestion #rom ontaminated soil orontaminated #eed or %one meal


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Epidemiology


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'(,(((!&((,((( ases estimated glo%ally4yearhttp544www6vetmed6lsu6edu4who4mp7world6htm


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Anthrax in 26)6

• Cutaneous anthrax

+Early &8((s5 '(( ases annually

+Late &8((s5 9 ases annually

• /nhalational anthrax

+'(th entury5 &: ases4&9 #atal


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Anthrax in the 26)6

• Out%rea-s ! soil o# endemi areas

• Al-aline soil

• ;Anthrax weather


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Disease in Humans


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Anthrax Disease Proess


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Cutaneous Anthrax

• 8.= o# all ases glo%ally

• /nu%ation5 '!> days ?up to &' days@

• )pores enter s-in through openwound or a%rasion

• Papule progresses to %la- eshar

• )evere edema• ever and malaise


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Day 2

Day

Day !


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Cutaneous Anthrax

• Case #atality rate .!'(=

• 2ntreated B septiemia and death

• Edema an lead to death #romasphyxiation

Day "0


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1iologi Agent Case• Another #amily %rings

in their adolesentdaughter #or evaluation

o# a ;%ad in#etion


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Cutaneous Anthrax


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/nhalational Anthrax Clinialeatures

• /nitially starts with a non!

spei#i #lu!li-e illnessand then progresses to5

+espiratory Distress

+)ho- 3ay see a widened

mediastinum on x!ray


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A h H h i


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Anthrax B Hemorrhagi3eningitis


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NEJM 1999; 341 !1"# !$%

Anthrax: Cutaneous


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Anthrax: Cutaneous


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Anthrax: Cutaneous

6otice the ede%a

and ty&ical lesions


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Anthrax: Cutaneous

Day 4Day 6

Day 10

7scharfor%ation

-esicledevelo&%entDay 2


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ediastinal !idenin" and #leuralEffusion on Chest $%&ay in 'nhalational

Anthrax


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astrointestinal Anthrax

• )evere gastroenteritis

+ /nu%ation5 '!. days a#ter onsumptiono# underoo-ed, ontaminated meat

• Case #atality rate5 '.!.=

• / anthrax never doumented in 26)6

+)uspeted ases in '(((


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/nhalational Anthrax

• /nu%ation5 &! days ?highly varia%le@

• /nitial phase

+$onspei#i ! 3ild #ever, malaise

• )eond phase

+)evere respiratory distress

+Dyspnea, stridor, yanosis, mediastinalwidening, death in '!>9 hours

• Case #atality5 .!8(= ?untreated@


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'solate on ()A

Colony mor*holo"y+emolysis

otility

(*ores ,ram stain

alachite "reen

B. anthracis:#resum*ti-e 'dentification

Clinical s*ecimen ./lood C(F etc2

,ram stain

Ca*sule *roduction


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B. anthracis:

Confirmatory 'dentification

'solate

#ha"e

lysis

Ca*sule

)icar/onate

media

+orse

/lood.3Fadyean

(tain)

.3Fadyean stain

'ndia ink stain2

DFA

Ca*sule anti"enCell all


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B. anthracis

ra%4&ositive, s&ore4for%in+, non4%otile bacillus


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Diagnosis in Humans

• Anthrax *ui- EL/)A test

+$ew test approved %y DA on Fune th,'((6

+Detets anti%odies produed duringin#etion with acillus anthracis

+Gui-er and easier to interpret than

previous anti%ody testing methods esults in less than O$E hour


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Treatment

• Peniillin

+Has %een the drug o# hoie

+)ome strains resistant to peniillin and

doxyyline

• Cipro#loxain

+Chosen as treatment o# hoie in '((&

+$o strains -nown to %e resistant

• Doxyyline may %e pre#era%le


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Treatment

Cutaneous Anthrax • "ithout systemi signs, extensive edema

or lesions loated on head and ne-6

• /nitial reommended treatment5+ Doxyyline or Cipro#loxain PO #or 9( days


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Treatment

Cutaneous Anthrax

• "ith systemi signs,extensive edema or lesionson the head and ne-6

• /nitial reommended treatment5

+ Doxyyline or Cipro#loxain /"+ 3ay swith to PO when linially appropriate


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Prevention and Control

• Humans proteted %y preventingdisease in animals

+ "eterinary supervision

+ Trade restritions

• /mproved industry standards

• )a#ety praties in la%oratories

• Post!exposure anti%ioti prophylaxis


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"aination

• Cell!#ree #iltrate

• Liensed in &8(

•

At ris-+0ool mill wor-ers+"eterinarians

+La% wor-ers

+Livesto- handlers

+3ilitary personnel


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"aine )ide E##ets

• /netion site reations+3ild5 >(= men, 9(= women

+3oderate5&!.=

+Large loal5&=• .!>.= experiene systemi e##ets

+3usle or oint ahes, headahe, rash,

hills, #ever, nausea, loss o# appetite,malaise

• $o long!term side e##ets noted


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"aine )hedule

• > inetions at two!wee- intervals

• > inetions 9 months apart

•

Annual %ooster

P t ti A i t


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Protetion Against/nhalational Anthrax

$o human

postexposuretrials have

%eendoumented

• '& mon-eys vainated at ( and 'wee-s6

o Challenged %y anthrax spores at :

wee- and >: wee- later5 All

survived

o Challenged at &(( wee-s5 ::=survived

• The two doses o# vaine ?( and '

wee-s@ provided protetion #or mostanimals #or almost two years


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"aination


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Animals and

Anthrax


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uminants

• Peraute in#etion

+apid onset

+)udden death

+1loody disharge#rom %ody ori#ies

+ /nomplete rigor mortis

+apidly %loat


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uminants

• Aute in#etion5 &!> days

+ever, anorexia

+Dereased rumination

+3usle tremors

+Dyspnea

+A%ortions

+Disorientation

+1leeding #rom ori#ies

+Hemorrhages on internal organs


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uminants

• Chroni in#etion

+Pharyngeal and lingual edema

+"entral edema

+Death #rom asphyxiation

• Treatment suess#ul i# started early


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Di##erential Diagnosis

• 1la-leg

• 1otulism

• Poisoning

+Plants, heavy metal, sna-e %ite

• Lightening stri-e

• Peraute %a%esiosis


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E*uine

• /ngestion

+Enteritis, severe oli,high #ever, wea-ness,

death within :!89 hours• /nset %ite4vetor

+Hot, pain#ul swelling

+)preads to throat, sternum,a%domen, external genitalia

+Death

Co&yri+ht .H9


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)wine

• )udden death without symptoms

• LoaliIed swelling o# throat

• Death %y asphyxiation

• /ngestion o# spores

+Anorexia, vomiting,enteritis


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Dogs J Cats

• elatively resistant

+ /ngestion o# ontaminated raw meat

• Clinial signs+ever, anorexia, wea-ness

+$erosis and edema o# upper / trat

+Lymphadenopathy and edemao# head and ne-

+Death Due to asphyxiation, toxemia, septiemia


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Diagnosis and Treatment

• $eropsy not advisedK

• Do not open arassK

• )amples o# peripheral %lood needed

+Cover olletion site with disin#etantsoa-ed %andage to prevent lea-age

• Treatment

+Peniillin, tetraylines

• eporta%le disease


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Animal Anthrax "aine

• eommended #or livesto-in endemi areas

• )terne strain

+ Live enapsulated spore vaine• /mmunity in !&( days

• Other ountries use in pets and exotis+ $o sa#ety or e##iay data

+ Aduvant may ause reations

• 0or-ing dogs may %e at ris-


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Animal Disease )ummary

• Anthrax should always %e high ondi##erential list when

+High mortality rate in group o#

her%ivores+)udden death with unlotted %lood

#rom ori#ies

+LoaliIed edema Espeially ne- o# pigs or dogs


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Prevention and

Control


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• 1urn or %ury arasses,%edding, other materials

• Deontaminate soil

• emove organimaterial anddisin#et strutures


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• )i- animals should %e isolated

• )avengers should %e disouraged

• /nset ontrol or repellants toprevent #ly dispersal

• Prophylati anti%iotis

•"aination+ /n endemi areas

+Endangered animals


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Disin#etion

• E##etive disin#etion an %e di##iult

• Prevention o# sporulation %est

• High pressure leaners disouraged

• )oil+.= lye or *ui-lime

+Hydrogen peroxide, peraeti aid, or

gluteraldehyde• 1leah &5&( dilution

+3ay %e orrosive


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Disin#etion

• Preliminary disin#etion+ &(= #ormaldehyde

+ = glutaraldehyde ?pH :6(!:6.@

•

Cleaning+ Hot water, sru%%ing, protetive lothing

• inal disin#etion5 one o# the #ollowing+ &(= #ormaldehyde

+ = glutaraldehyde ?pH :6(!:6.@+ >= hydrogen peroxide,

+ &= peraeti aid

1iologial Terrorism5


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1iologial Terrorism5Estimated E##ets

• .( -g o# spores

+2r%an area o# . million

+'.(,((( ases o# anthrax

&((,((( deaths

• &(( -g o# spores

+2pwind o# 0ash D6C6

+&>(,((( to > million deaths


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kuliah uniba Anthrax5