Infectious

Al-Hayat University

Diseases
Chapter 2
Bacterial Diseases 20/ 10/2022
1. Anthrax Diseases
&
2. Bacterial meningitis
Dr :Saadaq Mo’alim Adam
 Anthrax
 Anthrax is an acute zoonotic disease caused by the
spore-forming bacterium Bacillus anthracis, a
microbe that lives in the soil.
 Anthrax is a serious infectious disease caused
by gram-positive, rod-shaped bacteria known
as Bacillus anthracis.
 It occurs naturally in soil and commonly affects
domestic and wild animals around the world.
Dr :Saadaq Mo’alim Adam
 Anthrax- Cont…
 People can get sick with anthrax if they
come in contact with infected animals or
contaminated animal products
 Anthrax is caused by Bacillus anthracis,
toxin-producing, encapsulated, aerobic or
facultative anaerobic organisms.
 Anthrax, an often fatal disease of animals, is
transmitted to humans by contact with Dr :Saadaq Mo’alim Adam

infected animals or their products.

 Where did anthrax come from ?
 Anthrax is thought to have originated
in Egypt and Mesopotamia (Modern Iraq).
 Many scholars think that in Moses' time (14th–
13th century), during the 10 plagues of Egypt,
anthrax may have caused what was known
as the fifth plague, described as a
sickness affecting horses, cattle, sheep,
Dr :Saadaq Mo’alim Adam

camels and oxen.

 First Described

 The anthrax bacterium was first

described in 1823 and was the first
bacterium ever shown to be the cause of
a disease - in 1876, Robert Koch obtained
a pure culture.

Dr :Saadaq Mo’alim Adam

 Etiology
 Anthrax is an important domestic animal
disease, occurring in goats, cattle, sheep,
and horses.
 It is rare in humans and occurs mainly in
countries that do not prevent industrial or
agricultural exposure to infected animals or
their products. Dr :Saadaq Mo’alim Adam
 Pathophysiology
 Bacillus anthracis readily form spores(Bacteria) when they dry—
an environmental condition bad for growth.
 Spores resist damage and can remain viable in soil, wool, and
animal hair for decades.
 Spores germinate and begin multiplying rapidly when they
enter the body.
 Human infection can be acquired by
A. • Cutaneous contact (most common)
B. • Ingestion
Dr :Saadaq Mo’alim Adam
C. • Inhalation
Cutaneous contact (most common) ,Ingestion and Inhalation

Dr :Saadaq Mo’alim Adam

 Pathophysiology
 After entering the body, spores germinate inside
macrophages, which migrate to regional lymph nodes
where the bacteria multiply.
 In inhalation anthrax, spores are deposited in alveolar
spaces, where they are ingested by macrophages,
usually causing a haemorrhagic mediastinitis.
 Bacteraemia may occur in any form of anthrax as
meningeal involvement .
Dr :Saadaq Mo’alim Adam
 Pathophysiology
 The major toxins are edema toxin and lethal
toxin.
 Edema toxin causes massive local edema.
 Lethal toxin causes a massive release of
cytokines from macrophages, which is
responsible for the sudden death common in
anthrax infections. Dr :Saadaq Mo’alim Adam
Cycle anthrax Disease

Dr :Saadaq Mo’alim Adam

Cycle anthrax disease

Dr :Saadaq Mo’alim Adam

 Symptoms and Signs

 Most patients present within 1 to

6 days of exposure, but for
inhalation anthrax, the incubation
period can be > 6 wk.
Dr :Saadaq Mo’alim Adam
 Symptoms and Signs
 Cutaneous anthrax begins as a painless, pruritic,
red-brown papule 1 to 10 days after exposure to
infective spores.
 This enlarges with a surrounding zone of brawny
erythema (Redness of the skin) and edema.
 Vesiculation and induration are present.
 Central ulceration follows, with serosanguineous
exudation and formation of a black eschar (the
Malignant pustule).
Dr :Saadaq Mo’alim Adam
 Symptoms and Signs

Malignant pustule
Dr :Saadaq Mo’alim Adam
 Symptoms and Signs
 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.
Dr :Saadaq Mo’alim Adam
 Symptoms and Signs

 GI-anthrax ranges from asymptomatic to

fatal.
 Fever, nausea, vomiting, abdominal pain,
and bloody diarrhea are common.
 Ascites may be present.
 Intestinal necrosis and septicaemia (blood poisoning by

with potentially lethal toxicity result.

bacteria.)
Dr :Saadaq Mo’alim Adam
 Symptoms and Signs
 Inhalation anthrax begins insidiously as
a flu-like illness.
 Within a few days, fever worsens, and
chest pain and severe respiratory distress
develop, followed by cyanosis, shock, and
coma. Dr :Saadaq Mo’alim Adam
 Diagnosis
 Gram stain and culture.
 Occupational and exposure history is
important.
 Chest x-ray (or CT) if pulmonary symptoms
are present.
 Lumbar puncture if patients have meningeal
signs or a change in mental status.
Dr :Saadaq Mo’alim Adam
 Who is at risk of anthrax
 Workers who may be at risk for anthrax
include farmers, veterinarians, livestock
handlers, diagnostic laboratory workers,
and those who work with animal
products.
 Anthrax infections occur naturally in wild and
unvaccinated domestic animals in many
countries including the United States. Dr :Saadaq Mo’alim Adam
 Geographic distribution anthrax
 There are endemic areas with more frequent outbreaks,
other areas are subject to sporadic outbreaks in
response to unusual weather patterns which can cause
spores that were dormant in the soil to come to the
surface where they are ingested by ruminants,
germinate and cause illness.
 This disease is prevalent in many parts of the world,
including Asia, southern Europe, sub-Saharan
Africa, and parts of Australia. Dr :Saadaq Mo’alim Adam
 Prognosis
 Mortality in untreated anthrax varies depending
on infection type:
• Inhalation and meningeal anthrax: 100%
• Cutaneous anthrax: 10 to 20%
• GI anthrax: About 50%

Dr :Saadaq Mo’alim Adam

 Treatment
 Ciprofloxacin or doxycycline
 Cutaneous anthrax without significant edema or
systemic symptoms is treated with ciprofloxacin
500 mg (10 to 15 mg/kg for children) po q 12 h or
doxycycline 100 mg (2.5 mg/kg for children) po q
12 h for 7 to 10 days.
 Treatment is extended to 60 days if concomitant
inhalation exposure was possible. Dr :Saadaq Mo’alim Adam
 Treatment

 Inhalation and other forms of anthrax, including

cutaneous anthrax with significant edema or systemic
symptoms, require therapy with 2 or 3 drugs:
ciprofloxacin 400 mg (10 to 15 mg/kg for children) IV
q 12 h or doxycycline 100 mg (2.5 mg/kg for children)
IV q 12 h, plus penicillin, ampicillin,
imipenem/cilastatin,
meropenem, rifampin, vancomycin, clindamycin, or
clarithromycin. Dr :Saadaq Mo’alim Adam
 Prevention

 An anthrax vaccine is available for

people at high risk (Eg, military
personnel, veterinarians, laboratory
technicians, employees of textile mills
processing imported goat hair).
Dr :Saadaq Mo’alim Adam
Bacterial
meningitis
Dr :Saadaq Mo’alim Adam
 Meninges Anatomy
 Meninges are three layers of
membranes that cover and protect your
brain and spinal cord (your central
nervous system [CNS]).
 They're known as:
 Dura mater:
 This is the outer layer, closest to your
skull.
 Arachnoid mater: This is the middle
layer.
 Pia mater: This is the inner layer, closest Dr :Saadaq Mo’alim Adam
Meninges Anatomy

Dr :Saadaq Mo’alim Adam

 Define Meningitis
 Meningitis is an inflammation of the
fluid and membranes (meninges)
surrounding your brain and spinal
cord.
 Bacterial meningitis is an acute
meningeal inflammation of
bacterial origin, which may affect
the brain and carry a risk of
Dr :Saadaq Mo’alim Adam
 Etiology
The two main causes of meningitis are viruses and bacteria.
Bacterial meningitis:
• Streptococcus pneumoniae.
• Group B Streptococcus.
• Neisseria meningitidis.
• Haemophilus influenzae.
• Listeria monocytogenes.
• Escherichia coli.
Dr :Saadaq Mo’alim Adam
 Etiology
viruses
Most cases in the United States are
caused by a group of viruses known as
enteroviruses, which are most
common in late summer and early fall.
Viruses such as herpes simplex
virus, HIV, mumps virus, West Nile virus
and others also can cause viral
meningitis. Dr :Saadaq Mo’alim Adam
 Etiology
In a non-epidemic context the main bacteria responsible are:
 In patients over 3 years: meningococcus and pneumococcus
 In children between 2 months and 3 years: Hemophilus
influenzae, pneumococcus and meningococcus
 In infants under 2 months: Escherichia coli, Listeria
monocytogenes, Salmonella spp, group B streptococcus.

Dr :Saadaq Mo’alim Adam

 Etiology…
In an epidemic context: particularly in Sub-
Saharan Africa during the dry season
 In patients over 1 year: Meningococcus
 In infants under 1 year: the other
pathogens are also found
Dr :Saadaq Mo’alim Adam
 Clinical signs
Children over 1 year and adults
 Classic febrile meningeal syndrome with severe
headache, neck stiffness, Brudzinski’s sign ( neck
flexion in a supine patient results in in involuntary
flexion of the hips and knees) and Kernig’s sign
(attempts to extend the knee from the flexed thigh
position are met with strong passive resistance).
 Severe forms: coma, convulsions, focal signs, purpura
fulminans Dr :Saadaq Mo’alim Adam
 Clinical signs…
Children under 1 year
 The classic signs of meningitis are often absent.
 Consider if the following signs are present:
 Refusal to eat, fever, diarrhoea, vomiting, drowsiness,
high-pitched cry, unusual behavior
 Generalized or partial seizures, gaze turned upwards,
coma.
 Hypotonia(decreased muscle tone), limp neck, bulging fontanelle
Dr :Saadaq Mo’alim Adam

when not crying.

Sings

Dr :Saadaq Mo’alim Adam

S/S

Dr :Saadaq Mo’alim Adam

 Laboratory
 To confirm a clinical suspicion, carry
out a lumbar puncture and examine
the cerebrospinal fluid (CSF).
 Always ask for a gram stain and
direct microscopic examination if this
is possible. Dr :Saadaq Mo’alim Adam
 Laboratory…
Normal CSF Bacterial meningitis

Appearance clear turbid

“ rice water ”

White cell count <5/cubic mm polynuclear cells

>500/cubic mm

protein <0.40 g/l about 1 g/l

Dr :Saadaq Mo’alim Adam
 Laboratory…
 Rapid test for detection of bacterial
antigens In an epidemic context, once the
meningococcal etiology has been confirmed,
there is no need for routine lumbar puncture
for new cases.
 In an endemic area, it is essential to test for
cerebral malaria (thick and thin films). Dr :Saadaq Mo’alim Adam
 Treatment
 Start antibiotics without delay if the
lumbar puncture yields turbid CSF.
 In an epidemic context, treatment is
based on long-acting oily
chloramphenicol or ceftriaxone
injections. Dr :Saadaq Mo’alim Adam
 Treatment…
In a non-epidemic context
 The treatment of choice is Ceftriaxone IM
 Children: 75-100 mg/kg once daily for 5 to 7 days.
 Adults: 1 to 2 g once daily for 5 to 7 days (1 g in each
buttock).
If that fails: Ampicillin IV is given for 7 days
 Children: 200 mg/kg/day in 3 or 4 divided doses
 Adult: 12 g/day in 3 or 4 divided doses Dr :Saadaq Mo’alim Adam
 Supportive therapy
 Ensure that the patient is well fed and
well hydrated (by infusion or
nasogastric tube if necessary).
 Treat seizures
 Coma: nursing (prevention of bed
sores, care of the mouth and eyes).
Dr :Saadaq Mo’alim Adam
 Prevention
 There are four vaccines are available to prevent bacterial
meningitis.
 Meningococcal vaccine refers to any vaccine used to
prevent infection by Neisseria meningitidis.
 Different versions are effective against some or all of the
following types of meningococcus: A, B, C, W-135, and Y.
 The vaccines are between 85 and 100% effective for at
least two years.
 Good hygiene, such as regular hand washing
Dr :Saadaq Mo’alim Adam
Thanks

Dr :Saadaq Mo’alim Adam