1) Anthrax is caused by the bacterium Bacillus anthracis. It can cause serious illness in humans and animals.
2) There are three main types of anthrax disease in humans - cutaneous, inhalation, and gastrointestinal. Cutaneous anthrax is the most common, usually occurring after exposure to infected animals or contaminated products.
3) Anthrax bacteria produce toxins that are major virulence factors. The anthrax toxins are composed of three proteins that combine to cause tissue damage and edema.
4) Diagnosis involves lab tests of samples from lesions, blood, or sputum to identify B. anthracis. Treatment involves antibiotics such as
1. Anthrax and
Anthrax Vaccine
Under Supervision of :
Prof. Dr Ekram M. El-Shabrawy
Team Work :
Mostafa Emad Ahmed
Mohammed Bahaa El-Din
Mostafa Abd-Elsamee
Ahmed Mohamed Taha
4. Causative Organism
* Bacillus Species
The genus bacillus includes large
aerobic.
Gram-positive rods occurring in chains.
Most members of this genus are
saprophytic organisms prevalent in soil,
water, and air and on vegetation.
Spores may remain viable in soil for
years
5. Causative Organism
B cereus can grow in foods and
produce an enterotoxin or an
emetic toxin and cause food
poisoning.
may occasionally produce
disease in immunocompromised
humans .
B anthracis, which causes
anthrax, is the principal
pathogen of the genus.
6. Causative Organism
* Morphology
The typical cells,
measuring 1 x 3 - 4
micron.
have square ends
and are arranged in
long chains.
spores are located
in the center of the
nonmotile bacilli.
7. Causative Organism
Identification
On Culture:-
Colonies of B anthraces are
round and have a "cut glass"
appearance.
Haemolysis is uncommon with
B anthraces.
10. Causative Organism
Growth Characteristics:-
The saprophytic bacilli utilize simple
sources of nitrogen and carbon for
energy and growth.
The spores are resistant to
environmental changes, withstand dry
heat and certain chemical disinfectants
for moderate periods, and persist for
years in dry earth
11. Disease Exit
Type :-
Anthrax is primarily a Zoonotic disease ( eg. goats,
sheep, cattle, horses, etc;)
other animals (eg, rats) are relatively resistant to
the infection
12. Disease Exit
Infection To Human
Humans become infected incidentally by
contact with infected animals or their
products.
13. Disease Exit
Mode Of Transmision
cutaneous anthrax
by the entry of spores
through injured skin.
gastrointestinal
anthrax (rarely) by
the mucous
membranes.
inhalation anthrax
:- by inhalation of
spores into the lung .
14. Pathogenesis
growth of
the
vegetative
organisms
via lymphatics
To Man or Animal to the bloodstream
From
dead
body to
Env.
15. Pathogenesis
B anthracis that does not produce a
capsule is not virulent and does not
induce anthrax in test animals.
The poly-D-glutamic acid capsule is
antiphagocytic. The capsule gene is
on a plasmid.
16. Virulence Factors
Anthrax Toxin:-
Toxin Structure:-
Anthrax toxin is made up of three proteins:-
protective antigen (PA).
edema factor (EF).
lethal factor (LF).
17. Virulence Factors
Anthrax Toxin:-
EF is an adenylyl cyclase; with PA it forms a
toxin known as edema toxin.
LF plus PA form lethal toxin, which is a
major virulence factor and cause of death in
infected animals.
Toxins responsible for tissue damage and
edema
22. Clinical Findings
In humans, approximately 95% of cases are
cutaneous anthrax and 5% are inhalation.
100%
90%
80%
70%
60% Column1
50%
Series 2
40%
30% Series 1
20%
10%
0%
cutanous Pulmonary GIT
23. Clinical Findings
Gastrointestinal anthrax is very
rare; it has been reported from Africa,
Asia, and the United States following
occasions where people have eaten
meat from infected animals.
The bioterrorism events in the fall of
2001 resulted in 22 cases of anthrax:
11 inhalation and 11 cutaneous. Five of
the patients with inhalation anthrax
died. All the other patients survived.
24. Cutaneous Anthrax
Clinical Picture :-
The lesions typically are 1–3 cm in diameter and have a
characteristic central black eschar. Marked edema occurs.
Lymphangitis and lymphadenopathy and systemic signs
and symptoms of fever, malaise, and headache may
occur.
25. Cutaneous Anthrax
Cutaneous Anthrax Vesicle Development
Day 2 Day 4 Eschar Formation
Day 6 Day 10
Day 7
26. Cutaneous Anthrax
Sequelae :-
1) Healing
After 7–10 days the eschar is fully developed.
Eventually it dries, loosens, and separates.
healing is by granulation and leaves a scar.
It may take many weeks for the lesion to
heal and the edema to subside.
27. Cutaneous Anthrax
Sequelae :-
2) Death
In as many as 20%
of patients,
cutaneous anthrax
can lead to sepsis,
the consequences of
systemic infection
(including meningitis
) and death
29. Inhalation Anthrax
Preview:-
Incubation period: 1-7 days (range up to
43 days).
Infection occure by inhalation of B.Anthrasis
spores.
Case-fatality:
1) without antibiotic treatment – 85%- 97%
2) with antibiotic treatment – 75% (45% in
2001)
31. Inhalation Anthrax
Clinical Picture:-
Rapid deterioration with
fever, dyspnea, cyanosis
and shock.
Hemorrhagic pleural
effusions follow
involvement of the
pleura; cough is
secondary to the effects
on the trachea.
32. Inhalation Anthrax
Chest X-rays is
Chest X-Ray :- advised as an initial
method of inhalation
anthrax detection,
but it is sometimes
not useful for
patients without
symptoms.
Find a widened
mediastinum and
pleural effusion
33. Inhalation Anthrax
Chest X-Ray :-
Substernal pain
may be prominent,
and there is
pronounced
mediastinal
widening visible on
x-ray chest films
34. Gastrointestinal anthrax
Preview:-
Animals acquire anthrax through
ingestion of spores and spread of the
organisms from the intestinal tract
This is Rare in Humans,
Gastrointestinal anthrax is Extremely
Uncommon.
35. Gastrointestinal anthrax
Clinical Picture :-
Abdominal pain, vomiting, and bloody
diarrhea are clinical signs.
Sepsis occurs, and there may be
hematogenous spread to the
gastrointestinal tract, causing bowel
ulceration, or to the meninges,
causing hemorrhagic meningitis.
36. Laboratory Diagnostic Tests
Specimens:-
Specimens to be
examined are fluid
or pus from a local
lesion, blood, and
sputum.
Gram Stain :-
Gram stain shows
large gram-positive
rods.
37. Laboratory Diagnostic Tests
Direct Examination :
Stained smears from the local lesion or of
blood from dead animals often show chains of
large gram-positive rods.
Carbohydrate fermentation is not useful.
. Anthrax can be identified in dried smears by
immunofluorescence staining techniques.
immunofluorescence staining of sporation
38. Laboratory Diagnostic Tests
Culture :
Nutrient broth non
motile
on blood agar plates, the
organisms produce
nonhemolytic gray to
white colonies
On Mixed Flora a rough
texture and a ground-
glass appearance.
Comma-shaped
outgrowths (Medusa head)
may project from the
colony.
40. Laboratory Diagnostic Tests
Lab Characters
Virulent anthrax cultures kill mice upon
intraperitoneal injection.
Demonstration of capsule requires growth
on bicarbonate-containing medium in 5–7%
CO2.
Lysis by a specific anthrax -bacteriophage
may be helpful in identifying the organism.
41. Anthrax Vaccines
Development By Years
1881 Pasteur develops first live attenuated
veterinary vaccine for livestock
1939 Improved live veterinary vaccine
1954 First cell-free human vaccine
1970 Improved cell-free vaccine licensed
42. Anthrax Vaccines
Preparation:
Immunization to prevent
anthrax is based on the
classic experiments of
Louis Pasteur.
In 1881 he proved that
cultures grown in broth at
42–52 C for several
months lost much of their
virulence
be injected live into sheep
and cattle without causing Louis Pasteur
disease; subsequently,
such animals proved to be
immune.
43. Anthrax Vaccines
Preparation:
Four countries
produce vaccines for
anthrax.
Russia and China
use attenuated spore-
based vaccine
administered by
scarification.
The US and Great
Britain use a bacteria-
free filtrate of cultures
adsorbed to aluminum
hydroxide
44. Anthrax Vaccines
Pre-exposure Vaccination
The current US FDA approved
vaccine contains cell-free filtrates of
a toxigenic nonencapsulated
nonvirulent strain of B anthracis.
The vaccine is available only to the
US Department of Defense and to
persons at risk for repeated
exposure to B anthracis.
45. Anthrax Vaccines
Vaccination Schedule
Initial doses at 0, 2,
and 4 weeks.
Additional doses at 6,
12, and 18 months.
Annual booster doses
thereafter.
Alternative schedules
being investigated.
46. Anthrax Vaccines
Post-exposure Vaccination
No efficacy data for postexposure
vaccination of humans.
Postexposure vaccination alone not
effective in animals
Combination of vaccine and antibiotics
appears effective in animal model
47. Anthrax Vaccines
Precautions and Contraindications
Severe allergic reaction to a vaccine
component or following a prior dose.
Previous anthrax disease.
Moderate or severe acute illness.
• By: El Omda
48. Treatment
Many antibiotics are
effective against anthrax
in humans, but
treatment must be
started early.
Ciprofloxacin is
recommended for
treatment; penicillin G,
along with gentamicin or
streptomycin, has
previously been used to
treat anthrax.
• By: El Omda
49. Chemoprophylaxis
prophylaxis with
ciprofloxacin or
doxycycline should be
continued for 4 weeks
while three doses of
vaccine are being
given, or for 8 weeks if
no vaccine is
administered.
In the setting of
potential exposure to B
anthracis as an agent
of biologic warfare.
• By: El Omda
50. Epidemiology
Soil is contaminated
with anthrax spores
from the carcasses of
dead animals.
These spores remain
viable for decades.
Perhaps spores can
germinate in soil at
pH 6.5 at proper
temperature.
52. Prevention & Control
Control measures include :-
(1) disposal of animal carcasses by
burning or by deep burial in lime pits,
(2) decontamination of animal
products.
(3) protective clothing and gloves for
handling potentially infected materials.
(4) active immunization of domestic
animals with live attenuated vaccines.
Persons with high occupational risk
should be immunized. • By: El Omda