Anthrax

exp date isn't null, but text field is

Description

This is a highly infectious disease of animals caused by Bacillus anthracis, transmitted to man by contact with the animal or animal products (carcasses) or faeces. It is a notifiable disease. It is classified as cutaneous, pulmonary or inhalational or gastrointestinal. Farmers, animal product industry, laboratory personnel are at high risk of infection

Signs and Symptoms

The incubation period varies from 12 hours to 5 days

The cutaneous form:

  • Painless (but may be pruritic) red-brown papule that enlarges with considerable peripheral erythema, vesiculation, and induration. Central ulceration follows, with serosanguineous exudation and formation of a black eschar.
  • Local lymphadenopathy
  • Fever
  • Malaise
  • Nausea and vomiting
  • Myalgia
  • Headache

Pulmonary (Inhalation) Anthrax:

  • Progresses rapidly after non-productive cough and low-grade fever
  • Pulmonary oedema
  • Pleural effusion
  • Severe shortness of breath
  • Cyanosis
  • Chest pain
  • Septic shock

Investigations

  • Microscopy and culture of swabs from cutaneous lesions or sputum
  • Blood culture
  • Lumbar puncture if anthrax meningitis is suspected
  • Serological tests (ELISA)
  • PCR
  • Chest x-ray/CT scan of chest may show diffuse patchy infiltration; the mediastinum is widened because of enlarged haemorrhagic lymph nodes.

Treatment

Treatment of Anthrax

Non-pregnant adult

Pregnant/lactating woman

Children

Ciprofloxacin 500mg 12 hourly

Ciprofloxacin 500mg 12 hourly

Ciprofloxacin 30 mg/kg/day divided 12 hourly (max 500mg /dose)

Doxycycline 100mg every 12 hours

 

Amoxicillin 75mg/kg/day every 8 hours (max 1 g/dose)

Levofloxacin 750 mg every 12 hours

 

 

Moxifloxacin 400 mg every 24 hours

 

 

ALTERNATIVE

Clindamycin 600 mg every 8 hours

Levofloxacin 750 mg every 12 hours

Clindamycin 30mg/kg/day divided every 8 hrs (max 600mg/dose)

 

 

Levofloxacin<50kg:16 mg/kg/day divided 12 hrs (max dose, 250mg/dose)
  • Prevention
    • Vaccination for those at high risk (veterinarians, laboratory technicians, butchers and employees of textile mills processing goat hair)
    • Use of personal protective equipment, gloves, overalls, and boots
  • Post exposure prophylaxis
    • Given to those with risk of inhalation of anthrax spores during the burning of infected carcasses
    • The evaluation of these cases should be in consultant with the Public health specialist and infectious disease physicians

The Regimens for the prophylaxis should be:

 Anthrax Post-Exposure Prophylaxis

Drug name and dosage

Duration

Doxycycline 100 mg twice daily

4 weeks post exposure

Ciprofloxacin 500 mg twice daily

For cutaneous exposure, the prophylaxis can be administered for a period of 7 days

Referral Criteria

Disseminated or meningitis anthrax should be referred for specialist treatment