ANTHRAX

Presented by
Dr.Anjana B
I MD
Organon of medicine
 Other Names
Malignant Pustule,
Malignant Edema,
Woolsorters’ Disease,
Ragpickers’ Disease,
Maladi Charbon,
Splenic Fever
 What is anthrax ?
• Anthrax is a serious zoonotic disease that can affect most
mammals and several species of birds, but is particularly
important in herbivores.
• The word anthrax is derived from a Greek word meaning
charcoal.
• Anthrax, the disease, likely originated 6,000 to 7,000
years ago in Mesopotamia and Egypt, where agricultural
civilization was first recorded.
• Scientific literature first contained a reference to anthrax
in 1769, by Fournier.
 Bacillus anthracis
•Large, rod shaped
•Gram-positive,
•Non-motile
•Bamboo stick appearance in Gram staining
•Two forms
•Vegetative, spore
•Over 1,200 strains
•Nearly worldwide distribution
Bamboo stick appearance in gram staining
Center for Food Security and Public Health, Iowa State
University, 2012
The Spore
•Sporulation requires:
•Poor nutrient conditions
•Presence of oxygen
•Spores
•Very resistant
•Survive for decades
•Taken up by host and germinate
 Agent of Biowar

Anthrax spores were used for this porpose

U.S., 2001

Center for Food Security and Public Health, Iowa State

University, 2011
Transmission
Zoonotic Disease
 Human Transmission
•Cutaneous
• Contact with infected
tissues, wool, hide, soil
• Biting flies
•Inhalational
• Tanning hides,
processing wool or bone
•Gastrointestinal
• Undercooked meat
 Risk group
•Workers in
Tanneries
Textile mills
Slaughter houses
•Wool sorters
•Bone processors
•Laboratory workers
Animal Transmission
•Ingestion
•Most common
From Contaminated soil
•Out breaks are associated with
Heavy rainfall, drought, flooding
•Inhalation
•Mechanical (insects)
• In infected animals, large numbers of bacteria are
present in hemorrhagic exudates from the mouth,
nose, and anus.
• When they are exposed to oxygen, these bacteria
form spores and contaminate the soil.
• Sporulation also occurs if a carcass is opened and
oxygen exposure occurs – sporulation does not occur
inside a closed carcass.
• Anthrax spores can remain viable for decades in the
soil or animal products, such as dried or processed
hides and wool.
• Vegetative organisms are thought to be destroyed
within a few days during the decomposition of
unopened carcasses.
 Pathophysiology
After entering the body, spores germinate inside
macrophages, which migrate to regional lymph nodes
where the bacteria multiply.
Virulence factors
•Antiphagocytic capsule
( polypeptide capsule)
• Toxins (factors)
1.Protective antigen(PA),
2.Edema factor(EF)
3.Lethal factor (LF)
•Cell-binding protein, called protective
antigen (PA), binds to target cells and
facilitates cellular entry of edema toxin
and lethal toxin.
•Edema toxin causes massive local
edema.
•Lethal toxin triggers a massive release of
cytokines from macrophages, which is
responsible for the sudden death
common in anthrax infections.
Epidemiology
 Cutaneous Anthrax
• Incubation: 1-10 days
• begins as a painless, pruritic, red-brown papule
• The papule enlarges with a surrounding zone of brawny
erythema and marked edema.
• Vesiculation and induration are present. 
• Central ulceration follows, with serosanguineous exudation
and formation of a black eschar (the malignant pustule).
• Local lymphadenopathy is common, occasionally with
malaise, myalgia, headache, fever, nausea, and vomiting.
• It may take several weeks for the wound to heal and the
edema to resolve. Untreated – septicemia and death
• 95% of all cases globally
• Case fatality rate 5 to 20%
Center for Food Security and Public Health, Iowa State
University, 2012
 Inhalational Anthrax
• Incubation: 1 to 7 days
• It is estimated that 2,500 to 55,000 spores represent the lethal inhalation dose for
humans.
• Initial phase
Nonspecific flu like illness
• Second phase
• chest pain and Severe respiratory distress
• Dyspnea, stridor, cyanosis, mediastinal widening, death in 24 to 36 hours
• Severe hemorrhagic necrotizing lymphadenitis develops and spreads to adjacent
mediastinal structures.
• Serosanguineous transudation, pulmonary edema, and bloody pleural effusion
occur.
• Case fatality: 75 to 90% (untreated)
 Gastrointestinal Anthrax
• Consumption of undercooked or contaminated meat
• Incubation: 2 to 5 days
• Fever, nausea, vomiting, abdominal pain, and bloody
diarrhea are common.
• Ascites may be present.
• Intestinal necrosis and septicemia with potentially
lethal toxicity ensue
• Case fatality rate: 25 to 75%
Diagnosis
•Identification of B. anthracis
•Blood, skin, secretions
•Culture
•PCR
•Serology
•ELISA
•Nasal swabs
•Screening tool
 Differential Diagnosis

Inhalational Cutaneous Gastrointestinal

Influenza Spider bite Gastroenteritis

Pneumonia Ecthyma Typhoid

gangrenosum
(Psudomonas
bacteria)

Mediastinitis Pyoderma Peritonitis

gangrenosum

Thoracic aortic Ulceroglandular Perforated ulcer

aneurysm tularemia
(Francinella
tulerensia)

Mycobacterial Bowel obstruction

ulcer(Myco.ulcerans)

Cellulitis
Treatment
•Penicillin
•Most natural strains susceptible
•Additional antibiotic options
•Ciprofloxacin
•Treatment of choice in 2001
•No strains known to be resistant
•Doxycycline
•Course of treatment: 60 days
Prevention and Control
•Humans protected by preventing disease
in animals
−Veterinary supervision
−Trade restrictions
•Improved industry standards
•Safety practices in laboratories
•Post-exposure antibiotic prophylaxis
Vaccination
• Cell free filtrate
• At risk groups
• Veterinarians
• Lab workers
• Livestock handlers
• Military personnel
• Immunization series
• Five IM injections (day 0, week 4, months 6,
12, and 18)
• Annual booster
• A separate veterinary vaccine is also available.
Post exposure prophylaxis

Postexposure measures include

•Antibiotics
•Vaccination
•Monoclonal antibodies
•Asymptomatic people (including pregnant
women and children) exposed to inhaled
anthrax require prophylaxis with oral
antibiotics, given for 60 days
 Miasm
•Acute miasm –Recurrent
 Rubrics
• In KENT
• EXTREMITIES,ANTHRAX Anthr.,ars.,sec
• SKIN,ERUPTIONS,pustules,malignant Anthr., Ars, Lach
• EXTREMITIES, ERUPTION, black:  Ars, Sec
• SKIN, ERUPTION, blackish:  Ars, Bell, Bry, Lach, Rhus-t, Sec, Sil, Still
• CHEST, PAIN, inflammation of lungs after: Lyc, Phos, Sulph,  Ars, Lach
• CHEST, PAIN, sternum behind: Sang,  Agar,  Arg-n, Cact, Chel, Cimex, Eup-
per, Phos , Rumex, Sang, Seneg, Sil, Syph

• In BOERICKE
• ANTHRAX-Carbuncle
Anthrac., Apis, Ars.,  Carb. ac., Cinch., Echin.,
Malignant pustule 
 Lach., Led., Pyr.,  Scolop., Sil.,  Tar. c.
Homoeopathic therapeutics
• Arsenic-alb • Apis
• Anthracinum • Belladonna
• Pyroginum • Secale cor
• Crot-h
• Sepia
• Lachesis
• Silicea
• Carbo veg
• Echinecia • Muriatic acid

• Rhus tox • Tarent-c

THANK YOU
 Anthracinum
• This nosode has proven a great remedy in epidemic spleen diseases of domestic animals, and in
septic inflammation, carbuncles and malignant ulcers.
• boils and boil-like eruptions, acne.
• Terrible burning.
• Haemorrhages, black, thick, tar-like, rapidly decomposing, from any orifice.
• Ulceration, sloughing and intolerable burning.
• Black and blue blisters.
• Apis mellifica
• Carbuncles, with burning, stinging pain
• Swelling or puffing up of various parts, oedema, red rosy hue. Stinging pains, soreness.
• Extreme sensitiveness to touch and general soreness is marked.
• Cannot concentrate mind when attempting to read or study.
• Vomiting of food.
• Craving for milk
• Secale cor
• Remarkable remedy for anthrax.
• Burning which is relieved by cold.
• Skin feels cold to touch, yet covering is intolerable.
• Great aversion to heat.
• Formication under skin.
• Arsenic album
• Very good remedy for the symptoms of anthrax, itching, burning,
swelling, edema, eruptions, popular, rough, dry and scaly.
• Epithelioma of the skin.
• Urticaria with burning and restlessness.
• Lachesis 
• Hot perspiration.
• Bluish purplish appearance.
• Boils, carbuncles, ulcers with bluish purple surroundings.
• Pyrogenium
• Pyrogen is the great remedy for septic states, with intense restlessness.
• All discharges are horribly offensive-menstrual, lochial, diarrhoea, vomit, sweat, breath, etc.
• Great pain and violent burning in abscesses.
• Great debility in the morning
• Bursting headache with restlessness.
• Tarantula cubensis
• A toxaemic medicine, septic conditions.
• Adapted to the most severe types of inflammation and pain, early and persistent prostration.
• Purplish hue and burning, stinging pains.
• Abscesses, where pain and inflammation predominate.