Anthrax: Etiology, Transmission, Forms, Diagnosis, and Treatment, Slides of Pediatrics

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ANTHRAX

Anthrax

• Etiology- Bacillus anthracis toxin producing gram positive encapsulated spore forming non motile rod

Anthrax

• zoonotic disease-spores found on skin/hides carcasses of goats, cattle, horses, buffalo, sheep. Spread thru contaminated meat, feed, soil
• agricultural disease-spores found in soil and remain viable for up to 40 years
• incubation period is 1-7 (2-5) days

Anthrax-

• Inhalation-18 cases/US 1900-
• Cutaneous-2000 cases/yr

244 cases/US 1944-

• Gastrointestinal-occasional outbreaks

Anthrax

• Cinical- Three forms:

Cutaneous Gastrointestinal-

oropharyngeal/abdominal Inhalational

Anthrax-Cutaneous

• 95% of all American cases
• Requires a break in the skin
• Initial manifestation is itching--> papule- -> vesicle--> depressed painless black eschar

Anthrax-Cutaneous

Anthrax-Gastrointestinal

• Due to ingestion of infected undercooked meat
• Presents with nausea, fever, bloody diarrhea,
• Often proceeds to toxemia, shock and death (fatality rate -50%)

Anthrax-Inhalation

• Inhalation of 8000-50,000 spores
• Initial sx are of mild URI, malaise, fatigue
• Initial sx followed by short period of improvement (hrs-2 days)

Anthrax-Inhalation

• Day 3-5 beginning of increasing resp distress of fever, tachypnea, rales, cyanosis
• CXR-mediastinal widening +/- effussions are seen in late stage in 55% cases
• Pneumonia generally does not occur

Anthrax-Inhalation

• Associated with hemmorhagic menningitis in 50% cases
• Case fatality rate is 100% untreated. Treatment begun “late” is ineffective

Anthrax-Diagnosis

• Gram stain of nasal swab/ discharge/lesion
• Culture
• ELISA for toxin
• Fluorescent Ab
• PCR

Inhalation Anthrax-Therapy

Pediatric Guidelines

• Initial therapy-Cipro 10-15 mg/kg/dose q12 then switch pending sensitivity
• Prophylaxis-same

Inhalation Anthrax-

Alternative Therapies

• Doxycycline 2.5 mg/kg (max=100) q 12 when Cipro is unavailable/advisable
• Amoxicillin 12-15 mg/kg q8 <20 kg

500 mg q8 >20 kg after sensitivities are known