Prevalence of Anthrax in Kurdistan Region

PREPEARED BY

Zhala Idris Razaq Fathwala Basoz Jawhar Karim

Sara Jamal Hisam Aldin

Supervisor

Assistant Proffesor Dr, Zuber Ismail Hassan

2023
Introduction

Anthrax is an acute febrile, contagious zoonotic disease characterized by septicemia, failure of blood to clot
and sudden death. Exudation of tarry blood from the body orifices of cadaver, absence of regor mortis and
presence of splenomegaly are most important necropsy findings.
Anthrax is most common in wild and domestic herbivores (eg, cattle, sheep, goats, camels, and antelopes) but can also be seen in
humans exposed to tissue from infected animals, to contaminated animal products, or under certain conditions, directly to B anthracis
spores. Depending on the route of infection, host factors, and potentially strain-specific factors, anthrax can have different clinical
manifestations. In herbivores, anthrax commonly causes acute septicemia with a high fatality rate, often accompanied by hemorrhagic
lymphadenitis. In dogs, humans, horses, and pigs, disease is usually less acute but still potentially fatal.
 Etiology
Bacillus anthracis, the causative agent of anthrax, is a large, gram-positive, aerobic, spore-forming bacillus.
After wound inoculation, ingestion, or inhalation, anthrax spores infect macrophages, germinate, and proliferate. In
cutaneous and GI infection, proliferation can occur at the site of infection and in the lymph nodes draining the site
of infection. Lethal toxin and edema toxin are produced by B anthracis and respectively cause local necrosis and
extensive edema, which are frequent characteristics of the disease. As the bacteria multiply in the lymph nodes,
toxemia progresses and bacteremia may ensue. With the increase in toxin production, the potential for
disseminated tissue destruction and organ failure increases.
. Morphology and staining
The anthrax bacillus is large gram- positive rod about 1 um in diameter and 3-6 um long. In cultures it forms long
chains, which when unstained appear as solid filaments because the square ends of individual cells fit very closely
together. Long filaments are never seen in tissues, and the ends of the cell are rounded. Here the elements occur either
individual or in short chains of 2-5 or 6 organisms.

Gram positive, rod, about 1 nm in diameter & 3-8 nm – long, it

belongs to family Bacillaceae . showing when staining the capsule

Epidemiology

Anthrax worldwide in distribution. The major enzootic zone of world are found in the tropic &
sub tropic – India, Pakistan, Africa & South America.
Epidemiology and transmission Anthrax in humans is traditionally classified in two ways: (i)
based on how the occupation of the individual led to exposure differentiates between
nonindustrial anthrax, occurring in farmers, butchers, knackers/renderers, veterinarians, etc., and
industrial anthrax, occurring in those employed in the processing of bones, hides, wool and other
animal products
 Table 1: Human with anthrax in Dohuk City

City/ District Year recorded Number

Dohuk / Shangal 2011 3

Dohuk/ Zakho 2012 5

Table 2: Anthrax cases in Human in Erbil City

City/ District Year recorded Number

Erbil/Sidakan 2011 4

Erbil/Soran 2012 2

Erbil/ Choman 2014 1

Erbil/Koya 2015 2
 Table 3: Anthrax cases in Human in Suliamany City

City/ District Year recorded Number

Suliamany/ Dukan 2011 3
Suliamany/ Penjwen 2012 1
Suliamany/ Mawat 2014 1
Suliamany/ Kaladiza 2015 2
Figure (4): Haemorrhagic meningitis and cutaneous anthrax with extensive edema on the face.
Figure (3): showing cutaneous form of anthrax
showing Routs of inhalation of bacteria through respiratory system.
Injection Anthrax

Injection Anthrax Recently, another type of anthrax infection has been identified in heroin-injecting drug users in
northern Europe. Symptoms may be similar to those of cutaneous anthrax, but there may be infection deep under
the skin or in the muscle where the drug was injected. Injection anthrax can spread throughout the body faster and
be harder to recognize and treat. Lots of other more common bacteria can cause skin and injection site infections,
so a skin or injection site infection in a drug user does not necessarily mean the person has anthrax.
 Fever and chills
 A group of small blisters or bumps that may itch, appearing where the drug was injected
 A painless skin sore with a black center that appears after the blisters or bumps
 Swelling around the sore
 Abscesses deep under the skin or in the muscle where the drug was injected
 Keep in mind
The presumptive diagnosis based up on:

1- History, by few premonitory symptoms, sudden death of several animals in the herd and characteristics gross
lesion found of necropsy (Jones et al., 1997).

2- Specific diagnostic tests including bacterial culture, Bacillus anthracis grows well on most laboratory media
exposed to atmospheric oxygen, with optimum growth at 37 C. on agar plates the anthrax organism, form
surface colonies with a ground-glass appearance. The margins of these colonies are irregular and under low
magnification resemble locks of wavy hair, it is of this reason they are some described as medusa-head colonies
(Timoney et al., 1988; Aillo and Mays, 1998). On culturing when grown on blood agar plates the organism
produces non hemolytic gray colonies. Carbohydrate fermentation is not useful. In semisolid medium anthrax
bacilli are always non-motile whereas nonpathogenic organisms (for example Bacillus cereus) exhibits motility
by “swarming”.

3- Smear are made from local lesion, or when local edema fluid is evident smears may be made from aspirated
edema or blood collected from Jugular vein, (Brooks et al., 1995; Radostits et al., 2000) or mammary vein or
ear vein (Rebhun, 1995). Smears are stained by Gram’s Method. The finding of large, typical gram-positive rods
indicates the likelihood pf infection. Spores appear clear with gram stain. It should be kept in mind that
clostridia are often found in the blood and tissues a few hours after death. The absence of square-ended capsules
4- Dried smears by immunofluorescence staining techniques, use on blood smear and tissue sections, but it is not
particularly specific (Timoney et al., 1988; Brook et al., 1995).

5- Capsular antigen in tissue or hide can be detected by an agar-gel precipitin technique but this test although very
useful is not absolutely specific (Timoney et al., 1988).

6- Monoclonal antibodies are also used to provide specific identifications of anthrax organism (Radostits et al.,
2000).

6- Polymerase chain reaction test (PCR) is used to determine the presence of viable and nonviable Bacillus
anthracis. Also a chromatographic assay is used to demonstrate protective antigen in the blood.
7- Western blot and Enzyme linked immunosorbent assay (ELISA) are available for antibody detection
Gastrointestinal anthrax
symptoms can include
 Fever and chills
 Swelling of neck or neck glands
 Sore throat
 Painful swallowing
 Hoarseness
 Nausea and vomiting, especially bloody vomiting
 Diarrhea or bloody diarrhea
 Headache
 Flushing (red face) and red eyes
 Stomach pain
 Fainting
 Swelling of abdomen (stomach)
Figure ( ): Showing Pharyngeal and gastrointestinal form of anthrax.
aboratory systems are set up in the United States to quickly confirm or rule out whether a patient
has anthrax or whether the environment is contaminated with Bacillus anthracis, the type of
bacteria that causes anthrax. These labs are vital to the early identification of anthrax, especially in
the case of a bioterrorism attack using anthrax.

Laboratory testing plays the largest role in diagnosing patients with anthrax. That’s why the Laboratory Response Network
(LRN) would be essential to help hospitals, doctors, and public health officials quickly confirm a diagnosis of anthrax.
Control and prevention

Antibiotics Antibiotics can prevent anthrax from developing in people who have been exposed but have not developed
symptoms. Ciprofloxacin and doxycycline are two of the antibiotics that could be used to prevent anthrax. Each of these
antibiotics offers the same protection against anthrax. Anthrax spores typically take 1 to 6 days to be activated, but some spores
can remain inside the body and take up to 60 days or more before they are activated. Activated spores release toxins—or poisons
—that attack the body, causing the person to become sick. That’s why people who have been exposed to anthrax must take
antibiotics for 60 days. This will protect them from any anthrax spores in their body when the spores are activated.

Vaccine:
While there is a vaccine licensed to prevent anthrax, it is not typically available for the general public. Anthrax Vaccine
Adsorbed (AVA) protects against cutaneous and inhalation anthrax, according to limited but well researched evidence. The
vaccine is approved by the Food and Drug Administration (FDA) for at-risk adults before exposure to anthrax. The vaccine does
not contain any anthrax bacteria and cannot give people anthrax. Currently, FDA has not approved the vaccine for use after
exposure for anyone. However, if there were ever an anthrax emergency, people who are exposed might be given anthrax vaccine
to help prevent disease. This would be allowed under a special protocol for use of the vaccine in emergencies.
 Conclusion

1. Anthrax is an important zoonotic disease.

2. Generally anthrax present in all Iraqi regions, but it is higher in north than other regions.

3. In human most of the cases are cutaneous form which is about 95%.

4. Meningitis can be a complication of cutaneous form.

5. Inhalation anthrax is the most hazardous route for transmission, mortality approach 100%.

6. There is no evidence of person to person transmission.

Thank you