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BW Agents: Anthrax

BW Agents: Anthrax. J.A. Sliman, MD, MPH LCDR MC(FS) USN Preventive Medicine Resident Johns Hopkins Bloomberg School of Public Health. Anthrax. Bacillus anthracis Rod-shaped, gram-positive, sporulating Zoonotic disease of cattle, sheep, and horses

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BW Agents: Anthrax

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  1. BW Agents: Anthrax J.A. Sliman, MD, MPH LCDR MC(FS) USN Preventive Medicine Resident Johns Hopkins Bloomberg School of Public Health

  2. Anthrax • Bacillus anthracis • Rod-shaped, gram-positive, sporulating • Zoonotic disease of cattle, sheep, and horses • Spores are stable and viable for years in soil and water

  3. BW History • Easily stabilized = easily deliverable • First weaponized by U.S. in early 1950s • Weaponized by FSU and disseminated • Iraq (admitted in 1995) • Who else???

  4. BW Significance • Easy to cultivate (induced sporulation) • Spores are highly resistant to: • Heat, sunlight, most disinfectants • Can be produced in wet or dry form • Can be disseminated in aerosol cloud or point source spray devices

  5. Human Disease • Normally contracted by handling contaminated animal products or excreta • Infection via cutaneous abrasions, inhalation, & ingestion

  6. Cutaneous anthrax • Hands and forearms of livestock handlers • Initial papule converts to fluid-filled vesicle • Vesicle dries and forms a black scab • “anthrax” = Greek for “coal” • Can disseminate and become fatal (CFR = 25%)

  7. Intestinal anthrax • From ingesting undercooked meat from an infected animal • Features are similar to other food poisonings • Nearly 100% CFR

  8. Inhalational anthrax • Likely form of BW attack • Endemic form is known as “Woolsorters’ disease” • Presents like atypical pneumonia • 100% CFR if untreated

  9. Inhalational anthrax • Incubation period = 1-6 days • Depends upon the strain and inhaled dose • Gradual, nonspecific onset of fever, malaise, headache, fatigue, dry cough, pleuritic chest pain • Often followed by 2-3 days of improvement

  10. Inhalational anthrax • CXR may show widened mediastinum (55%) but no obvious infiltrates • Gram stain usually (-) at this point • Toxin & bacilli detectable in the bloodstream by day 3 post-exposure (along with elevated WBC count)

  11. Inhalational anthrax • Improvement period followed by abrupt onset of severe acute respiratory distress • Dyspnea, diaphoresis, stridor, cyanosis • Death occurs within 36 hours of onset of respiratory distress

  12. Medical Management • Nearly 100% fatal after onset of severe respiratory distress regardless of treatment • PCN, tetracycline, erythromycin, Cipro • Cipro 400mg bid f4wks • Supportive therapy for shock & airway management

  13. Medical Management • Standard vaccine is available • 3-shot regimen (0, 6, 12 months) • Prophylactic therapy for likely exposures • Cipro 400mg bid f4wks • Vaccinate the previously unvaccinated • Give booster shot to those previously vaccinated

  14. Anthrax • Fluor atypical pneumonia-like symptoms • Widened mediastinum on CXR without infiltrates • Cipro 400mg bid f4wks & vaccinate

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