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Introduction

Anthrax is a bacterium of the strain Bacillus Anthraces. A deadly killer, it has a spore form which is extremely resistant and infectious. Lethal in small doses, it can penetrate either by you coming into contact with infected animals and their products or by inhaling contaminated air, wool or similar substances. In fact, the people most likely to get Anthrax are those working closely with animal products, particularly those residing in rural areas.

Anthrax is an efficient killer, its victims being made to suffer the agony of having a sudden onset of difficulty in breathing, profuse sweating, cyanosis, shock and death within 36 hours. In most cases, the symptoms improve after a few hours but the patient begins to deteriorate rapidly soon after. It takes around three excruciating days for the bacteria to destroy the membranes of your lungs and intestines. A minor scratch or abrasion, usually on an exposed area of the face or neck or arms, is infected by spores from the soil or a contaminated animal or carcass. The spores germinate, vegetative cells multiply, and a characteristic gelatinous edema develops at the site. This develops into papule within 12-36 hours after infection. The papule changes rapidly to a vesicle, then a pustule, and finally into a necrotic ulcer from which infection may disseminate, giving rise to septicemia. Lymphatic swelling also occurs within seven days. In severe cases, where the blood stream is eventually invaded, the disease is frequently fatal.

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Anthrax
Anthrax is a serious disease caused by Bacillus anthracis, a bacterium that forms spores. A bacterium is a very small organism made up of one cell. Many bacteria can cause disease. A spore is a cell that is dormant (asleep) but may come to life with the right conditions. Like many other members of the genus Bacillus, Bacillus anthracis can form

dormant endospores that are able to survive in harsh conditions for decades or even centuries. Such spores can be found on all continents, even Antarctica. When spores are inhaled, ingested, or come into contact with a skin lesion on a host they may reactivate and multiply rapidly.

Fig. Anthrax affected child

Anthrax commonly infects wild and domesticated herbivorous mammals that ingest or inhale the spores while grazing. Ingestion is thought to be the most common route by which herbivores contract anthrax. Carnivores living in the same environment may become infected by consuming infected animals. Diseased animals can spread anthrax to humans, either by direct contact (e.g.,
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inoculation of infected blood to broken skin) or by consumption of a diseased animal's flesh.

History of Anthrax
Anthrax, a potentially fatal infection, is a virulent and highly contagious disease. Descriptions of this disease begin in antiquity, with the best ancient account being by the Roman poet Virgil. During the 19th century, anthrax was the infection involved in several important medical developments. It served as the prototype for Koch's postulates regarding the causation of infectious disease. The first vaccine containing attenuated live organisms was Louis Pasteur's veterinary anthrax vaccine. In the 1900s, human inhalation anthrax occurred sporadically in the United States among textile and tanning workers, but the incidence of the illness had declined dramatically. An outbreak of inhalation anthrax occurred in Sverdlovsk near a Soviet military microbiology facility in 1979. This epidemic represented the largest documented outbreak of human inhalation anthrax in history. In October and November 2001, 22 cases of confirmed or suspected inhalation and cutaneous anthrax were reported associated with the intentional release of the organism in the United States. An additional case of cutaneous disease occurred in March of 2002.

Discovery:
Robert Koch, a German physician and scientist, first identified the bacterium that caused the anthrax disease in 1875. His pioneering work in the late nineteenth century was one of the first demonstrations that diseases could be caused by microbes. In a groundbreaking series of experiments, he uncovered the life cycle and means of transmission of anthrax. His experiments not only helped create an understanding of anthrax, but also helped elucidate the role of microbes in causing illness at a time when debates were still held over spontaneous generation versus cell theory. Koch went on to study the mechanisms of other diseases and was awarded the 1905 Nobel Prize in Physiology or Medicine for his discovery of the bacterium causing tuberculosis. Koch is today recognized as one of history's most important biologists and a founder of modern bacteriology.

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Types of Anthrax:

There are three forms of disease caused by anthrax: coetaneous (skin) anthrax, inhalation anthrax, and gastrointestinal (bowel) anthrax.

Coetaneous Anthrax:
The coetaneous (skin) form of anthrax starts as a red-brown raised spot that enlarges with considerable redness around it, blistering, and hardening. The center of the spot then shows an ulcer crater with blood-tinged drainage and the formation of a black crust called an eschar. There are swollen glands (lymph nodes) in the area. Symptoms include muscle aches and pain, headache, fever, nausea, and vomiting . The illness usually resolves in about six weeks, but deaths may occur if patients do not receive appropriate antibiotics.

Inhalation Anthrax :
The first symptoms are subtle, gradual and flu-like (influenza) . In a few days, however, the illness worsens and there may be severe respiratory distress. Shock, coma, and death follow. Inhalation anthrax does not cause a true pneumonia. In fact, the spores get picked in the lungs up by scavenger cells called macrophages. Most of the spores are killed. Unfortunately, some survive and are transported to glands in the chest called lymph nodes. In the lymph nodes, the spores that survive multiply, produce deadly toxins, and spread throughout the body. Severe hemorrhage and tissue death (necrosis) occurs in these lymph nodes in the chest. From there, the disease spreads to the adjacent lungs and the rest of the body. Inhalation anthrax is a very serious disease, and unfortunately, most affected individuals will die even if they get appropriate antibiotics. Why is this so? The antibiotics are effective in killing the bacteria, but they do not destroy the deadly toxins that have already been released by the anthrax bacteria.
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Gastrointestinal Anthrax :

Now rare, anthrax of the bowels (gastrointestinal anthrax) is the result of eating undercooked, contaminated meat. The symptoms of this form of anthrax include nausea, loss of appetite, bloody diarrhea and fever followed by abdominal pain. The bacteria invade through the bowel wall. Then the infection spreads throughout the body through the bloodstream (septicemia) with deadly toxicity.

Anthrax in human body :


How Anthrax enters the body through Lung

Effects on human body : 1. Anthrax spores are dormant forms of the bacteria and like seeds , germinate in suitable
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conditions .

2 . Larger spores lodge in the throat and windpipe . 3 . The immune system destroy some spores . 4 . Other germinate in 1 to 60 days producing more bacteria . 5 . The bacteria produce more toxins that enter the blood and can cause Hemorrhaging and tissue decay. 6 . Smaller spores between 1 and 5 microns penetrate the alveoli tiny sacks in the lung .

Anthrax in animal body and Measures To Control.

Most animals are simply found dead. Once an outbreak begins in the herd animals may be observed with signs of weakness, fever, excitement followed by depression, difficulty breathing, uncoordinated movements and convulsions. Bloody discharges the animal's body rapidly decomposes. from the natural body openings as well as edema in different parts of the body are sometimes observed. After death,

Because anthrax is often fatal in domestic animals, a preventive strategy should be adopted involving annual vaccination of susceptible animals (usually cattle, sheep and goats) in areas prone to the disease. This is usually done two to four weeks before the onset of known period of outbreaks. In situations where animals show clinical signs of the disease, antibiotic treatment is recommended. Some animals may be saved if treated very early with penicillin or tetracyclines. Vaccination is very effective in preventing further disease from occurring inanimals on a property experiencing an outbreak, however full immunity takes 10 to 14 days to develop. Antibiotics must not be used at the same time as vaccines are given, since they interfere with the development of immunity. Other measures to be adopted in addition to immunization and treatment are enforcement of quarantine regulations, prompt disposal of dead animals, bedding and have come in contact with diseased or dead animals.
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contaminated materials, control of scavengers, and observation of general hygiene by people who

How is anthrax contracted?

Anthrax can infect humans in three ways. The most common is infection through the skin, which causes an ugly sore that usually goes away without treatment. Humans and animals can ingest anthrax from carcasses of dead animals that have been contaminated with anthrax. Ingestion of anthrax can cause serious, sometimes fatal disease. The most deadly form is inhalation anthrax. If the spores of anthrax are inhaled, they migrate to lymph glands in the chest where they proliferate, spread, and produce toxins that often cause death.
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How long is the incubation period with anthrax

The incubation period of anthrax is three to seven days, with a range of one to 14 days. A common feature of anthrax is that animals in apparently good condition die suddenly without showing overt signs of ill health. Acute cases in cattle, sheep and wild herbivores are characterized by fever, depression, difficulty in breathing and convulsions. Animals may die within two or three days if not treated. It is common to see bloody discharges from natural openings. In few instances, anthrax can manifest itself as a mild disease characterized by general malaise. In pigs, the disease is characterised by swelling of the throat, which may cause difficulties in breathing. In dogs, cats and wild carnivores, the disease resembles that seen in pigs.

Exposure

Occupational exposure to infected animals or their products (such as skin, wool, and meat) is the usual pathway of exposure for humans. Workers who are exposed to dead animals and animal products are at the highest risk, especially in countries where anthrax is more common. Anthrax in livestock grazing on open range where they mix with wild animals still occasionally occurs in . the United States and elsewhere. Many workers who deal with wool and animal hides are routinely exposed to low levels of anthrax spores but most exposures are not sufficient to develop anthrax infections. It is presumed that the body's natural defenses can destroy low levels of exposure. These people usually contract cutaneous anthrax if they catch anything. Throughout history, the most dangerous form of inhalational anthrax was called Woolsorters' disease because it was an occupational hazard for people who sorted wool. Today this form of infection is extremely rare, as almost no infected animals remain. The last fatal case of natural inhalational anthrax in the United States occurred in California in 1976, when a home weaver died after working with infected wool imported from Pakistan. The autopsy was done at UCLA hospital. To minimize the chance of spreading the disease, the deceased was transported to UCLA in a sealed plastic body bag within a sealed metal container.
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In November 2008, a drum maker in the United Kingdom who worked with untreated animal skins died from anthrax. Gastrointestinal anthrax is exceedingly rare in the United States, with only one case on record, reported in 1942, according to the Centers for Disease Control and Prevention. In December 2009 an outbreak of anthrax occurred amongst heroin addicts in Glasgow, Scotland, resulting in ten deaths. The source of the anthrax is believed to be dilution of the heroin with bone meal in Afghanistan.

Diagnosis
Other than Gram Stain of specimens, there are no specific direct identification techniques for identification of Bacillus species in clinical material. These organisms are Gram-positive but with age can be Gram-variable to Gram-negative. A specific feature of Bacillus species that makes it unique from other aerobic microorganisms is its ability to produce spores. Although spores are not always evident on a Gram stain of this organism, the presence of spores confirms that the organism is of the genus Bacillus.

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All Bacillus species grow well on 5% Sheep blood agar and other routine culture media. PLET (polymyxin-lysozyme-EDTA-thallous capsule formation, acetate) can be used to isolate B.anthracis from contaminated specimens, and bicarbonate agar is used as an identification method to induce

Prevention

Vaccines An anthrax vaccine licensed by the U.S. Food and Drug Administration (FDA) and produced from one non-virulent strain of the anthrax bacterium, is manufactured by Beauport Corporation, subsidiary of Emergent BioSolutions. The trade name is BioThrax, although it is commonly called Anthrax Vaccine Adsorbed (AVA). It was formerly administered in a six-dose primary series at 0, 2, 4 weeks and 6, 12, 18 months, with annual boosters to maintain immunity. On December 11, 2008, the FDA approved omitting the week 2 dose, resulting in the currently recommended fivedose series Unlike NATO countries, the Soviets developed and used a live spore anthrax vaccine, known as the STI vaccine, produced in Tbilisi, Georgia. Its serious side-effects restrict use to healthy adults.

Treatment

Anthrax cannot be spread directly from person to person, but a patient's clothing and body may be contaminated with anthrax spores. Effective decontamination of people can be accomplished by a thorough wash-down with antimicrobial effective soap and water. Waste water should be treated with bleach or other anti-microbial agent. Effective decontamination of articles can be accomplished by boiling contaminated articles in water for 30 minutes or longer. Chlorine bleach effective. Burning clothing is very effective in destroying spores. After decontamination, there is
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is ineffective in destroying spores and vegetative cells on surfaces, though formaldehyde is

no need to immunize, treat or isolate contacts of persons ill with anthrax unless they were also exposed to the same source of infection.

Antibiotics
Early antibiotic treatment of anthrax is essentialdelay significantly lessens chances for survival. Treatment for anthrax infection and other bacterial infections includes large doses of intravenous and oral antibiotics, such as fluoroquinolones, like ciprofloxacin (cipro), doxycycline, erythromycin, vancomycin or penicillin. FDA-approved agents include ciprofloxacin, doxycycline and penicillin. In possible cases of inhalation anthrax, early antibiotic prophylaxis treatment is crucial to prevent possible death. In May 2009, Human Genome Sciences submitted a Biologic License Application (BLA, permission to market) for its new drug, raxibacumab (brand name ABthrax) intended for emergency treatment of inhaled anthrax. If death occurs from anthrax the body should be isolated to prevent possible spread of anthrax germs. Burial does not kill anthrax spores. In recent years there have been many attempts to develop new drugs against anthrax, but existing drugs are effective if treatment is started soon enough.

Current condition in Bangladesh


An anthrax outbreak in Bangladesh has infected more than 500 individuals since August 18th. The infections were acquired from eating or handling contaminated cattle. In one instance, a man purchased a cow which became ill a few days later. He brought the cow to a veterinarian where it was vaccinated against anthrax. This would have been protective against future infections if the cow survived, but it did not treat the current infection. The man slaughtered the cow when its condition deteriorated, and unknowingly fed the contaminated meat to over 40 families. Contaminated meat is also being sold in the market, which has caused cattle and livestock sales to
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be around 1/10 of the expected levels. Considering that around three quarters of the population

rely at least partially on livestock for their livelihood, this outbreak is sure to take a heavy toll on the health of both the population and the economy. More than a 250,000 animals have been vaccinated in the region, with a plan underway to vaccinate 500,000 more to help control the outbreak. It is also reported that the government has launched a massive public awareness campaign to warn people against consuming infected beef and prevent cattle traders from inadvertently spreading the disease when disposing of infected animals. The proper disposal of infected animals is extremely important since Bacillus anthracis spores can survive for decades in the soil, and a single dose of the anthrax vaccine is unlikely to be effective the following year. Farmers are being told to bury their infected cattle carcasses deep underground, though this is also a burdensome task that some will be unlikely to perform. The chief technical officer of the Food and Agriculture Organization (FAO) said that some farmers are disposing of animals in rivers and lakes, which is very risky. It is likely that we will see future anthrax outbreaks in Bangladesh, though hopefully their impact will be smaller due to increased awareness of this devastating disease.

Society and culture:


Anthrax spores can survive for long periods of time in the environment after release. Methods for cleaning anthrax-contaminated sites commonly use oxidizing agents such as -peroxides, ethylene oxide, Sandia Foam, chlorine dioxide (used in Hart Senate office building), and liquid bleach products containing sodium hypochlorite. These agents slowly destroy bacterial spores. A bleach solution for treating hard surfaces has been approved by the EPA. Bleach and vinegar must not be combined together directly, as doing so could produce chlorine gas. Rather some water must first be added to the bleach (e.g., two cups water to one cup of bleach), then vinegar (e.g., one cup), and then the rest of the water (e.g., six cups). The pH of the solution should be tested with a paper test strip; and treated surfaces must remain in contact with the bleach solution for 60 minutes (repeated applications will be necessary to keep the surfaces wet). Chlorine dioxide has emerged as the preferred biocide against anthrax-contaminated sites, having been employed in the treatment of numerous government buildings over the past decade. Its chief drawback is the need for in situ processes to have the reactant on demand.
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To speed the process, trace amounts of a non-toxic catalyst composed of iron and tetro-amido macro cyclic legends are combined with sodium carbonate and bicarbonate and converted into a spray. The spray formula is applied to an infested area and is followed by another spray containing tert-Butyl hydro peroxide. Using the catalyst method, a complete destruction of all anthrax spores can be achieved in under 30 minutes. A standard catalyst-free spray destroys fewer than half the spores in the same amount of time. They can be heated, exposed to the harshest chemicals, and they do not easily die.

Conclusion
Vaccines ( for prevention ) are available for humans and animals . Antibiotic therapy usually results in dramatic recovery of the individual or animal infected with Anthrax if given before onset or immediately after onset of illness . Bangladesh has ordered half a million ampoules of the vaccine for the cattle , which are in the process government are very concerned about it . of being distributed right now . We and

References: 1. Daily star, October 31, 2011


2. http://emergency.cdc.gov/agent/anthrax/

3. Slides 4. www.Medicine.net.com

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