Clinical aspects, diagnosis and treatment of anthrax

Abstract

There are three clinical presentations of anthrax in humans: cutaneous (>95% of cases), orogastric and inhalational. The infectious form, the spore, enters the body and is thought to germinate within macrophages either at the site of inoculation (cutaneous or orogastric) or in the regional lymph node (inhalational). The bacillus then synthesizes its antiphagocytic capsule and the lethal and oedema toxins which interfere with the non-specific host defences leading to the characteristic locally destructive lesion and spread by lymphatics to the systemic circulation and other organs. The cutaneous form begins as a papule which progresses over several days to a vesicle and then ulcerates. There is often oedema, sometimes massive, probably due to the oedema toxin that surrounds the lesions which then develop a characteristic black eschar. The patient may be febrile with mild to severe systemic symptoms of malaise, headache and toxicity. Oropharyngeal anthrax presents with severe sore throat or an ulcer in the oropharyngeal cavity associated with neck swelling, fever, toxicity and dysphagia. Gastrointestinal anthrax begins with anorexia, nausea, vomiting and abdominal pain which may be similar to an acute abdomen. There may be diarrhoea and ascites, both of which may be haemorrhagic. Inhalational anthrax begins with non-specific symptoms of malaise, fever, myalgia and non-productive cough. After a period of 2-3 days, this is followed by a sudden onset of severe respiratory distress associated with diaphoresis, cyanosis and increased chest pain. There may be a widened mediastinum and pleural effusions on chest X-ray. Death follows in 24-36 h from respiratory failure, sepsis and shock. The diagnosis of anthrax is easy if it is considered. The organism is readily observed by Gram or Wright stain in local lesions or blood smear and can be easily cultured from the blood and other body fluids. However, because of its rarity, it is not often included in the differential diagnosis and in inhalational disease the diagnosis is rarely made until the patient is moribund. More rapid diagnostic tests are under development. Penicillin, combined with supportive care, remains the mainstay of treatment, although the organism is susceptible in vitro to many antibiotics. In recent years, there have been significant advances in our knowledge of the organism and its toxins and it is anticipated that similar progress will be made in the future in developing more rapid diagnostic tests and new modalities of treatment.

Early Bacillus anthracis-macrophage interactions: intracellular survival and escape

“…Once phagocytosed, endospores are transported to the regional lymph nodes, germinating inside Mf en route (Ross, 1957;Dutz and Kohout, 1971;Dutz and Kohout-Dutz, 1981;Guidi-Rontani et al, 1999). During later stages of the disease, growth of vegetative bacilli occurs extracellularly with titres approaching 10 8 organisms per ml of blood (Ross, 1957;Dixon et al, 1999;Friedlander, 1999). B. anthracis vegetative cells must survive the hostile intracellular environment of the Mf phagosome and ultimately be released from the phagocyte for infection to spread.…”

<i>Vibrio cholerae</i> - As Biological Weapons

“…Do najczęściej wymienianych należą: Bacillus anthracis, Yersinia pestis, Francisella tularensis, Brucella sp., Coxiella burnetii, Burkholderia mallei, Burkholderia pseudomallei, Variola virus, Arenaviridae, Bunyaviridae, Filoviridae, Flaviviridae [1][2][3][4][5][6][7][10][11][12][13][14][15][19][20][21][22][23][24][25][26][27].…”

“…Wśród 6 rodzajów patogenów zaliczonych w klasyfikacji CDC, dotyczącej broni biologicznej, do kategorii A (patogeny rzadko spotykane w USA charakteryzujące się wysoką zakaźnością i powodujące wysoką śmiertelność, ogromne zagrożenie dla zdrowia publicznego, wymagające specjalnych działań realizowanych przez rząd federalny) aż 4 to patogeny zwierzęce (Bacillus anthracis, Yersinia pestis, Francisella tularensis, wirusy wywołujące gorączki krwotoczne) [1][2][3][4][5][6][7][8][9][14][15][16][17][18][19][20][21][22][23][24][25][29][30][31][32].…”

“…Cholera jest to ostra zakaźna i zaraźliwa choroba jelit, wywołana przez bakterieprzecinkowce cholery (Vibrio cholerae) [1][2][3][4][5][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Historia:…”

Pestis (<i>Yersinia pestis</i>) - As Biological Weapons

“…W historii Europy pojawiła się pierwsza fala terroryzmu. Odtąd zamachy na polityków i wywoływanie zamieszek stały się dla wielu grup politycznych próbą doprowadzenia do sytuacji społecznego wrzenia i dokonania rewolucyjnego przewrotu [1][2][3][4][5][6][7][8][9][10][11][12][17][18][19][20][21][22][23][24][25][30][31][32][33][34][35][36][37][38][39][40][41][42]. Druga fala terrorystycznych metod sięgania po władzę polityczną miała miejsce w dwudziestoleciu międzywojennym XX wieku, kiedy to na arenie dziejowej pojawiły się ruchy totalitarne [1][2][3][4][5][6][7][8][9][10][11][12][15][16]…”