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Disease Name: Anthrax
Quick Links
Variety of topics and situations pertaining to Anthrax and Anthrax emergencies- http://www.cdc.gov/anthrax/
Overview / Case Definition
Bacillus anthracis is an aerobic, gram-positive, encapsulated, spore-forming, nonhemolytic, nonmotile rod. B anthracis has 3 major virulence factors: an antiphagocytic capsule and 2 exotoxins, called lethal and edema toxins. The toxins are responsible for the substantial morbidity and clinical manifestation of hemorrhage, edema, and necrosis.
Cutaneous Anthrax
An acute illness, or post-mortem examination revealing a painless skin lesion developing over 2 to 6 days from a papular through a vesicular stage into a depressed black eschar with surrounding edema. Fever, malaise and lymphadenopathy may accompany the lesion.
Inhalation Anthrax
An acute illness or post-mortem examination revealing a prodrome resembling a viral respiratory illness, followed by hypoxia, dyspnea or acute respiratory distress with resulting cyanosis and shock. Radiological evidence of mediastinal widening or pleural effusion is common.
Gastrointestinal Anthrax
An acute illness, or post-mortem examination revealing severe abdominal pain and tenderness, nausea, vomiting, hematemesis, bloody diarrhea, anorexia, fever, abdominal swelling, and septicemia.
Oropharyngeal Anthrax
An acute illness or post-mortem examination revealing a painless mucosal lesion in the oral cavity or oropharynx, with cervical adenopathy, edema, pharyngitis, fever, and possibly septicemia.
Meningeal Anthrax
An acute illness, or post-mortem examination revealing fever, convulsions, coma or meningeal signs. Signs of another form will likely be evident as this syndrome is usually secondary to the above syndromes.
Restrictions
None
Reporting
Immediately, at time of identification.
Reportable by Healthcare and Labs:
Reportable by Food Service Facility:
Suspect Reportable:
Reporting Timeframe: Immediately, at time of identification
Diagnosis / Testing
Identification of B. anthracis from clinical specimens by the Laboratory Response Network (LRN) is done through the following:
- Gram stain,
- Culture,
- Polymerase Chain Reaction (PCR) testing of blood,
- pleural fluid,
- cerebrospinal fluid (CSF),
- tissue biopsy specimens,
- and on swabs or stool.
Information on collection of specimens:
http://www.cdc.gov/anthrax/specificgroups/lab-professionals/recommended-specimen.html
Initial testing is provided through the Idaho State Bureau of Laboratories.
Specific labeling and shipping protocols must be followed:
http://healthandwelfare.idaho.gov/Health/Labs/SentinelLabs/tabid/2153/Default.aspx
Treatment
tel:+18006328000 CDC recommendation for prevention and treatment of Anthrax in Adults:
http://wwwnc.cdc.gov/eid/article/20/2/13-0687-techapp1.pdf
Prescribing information for Anthrax Immune Globulin, used in the treatment of inhalational anthrax in adult and pediatric patients:
http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM439812.pdf
Pediatric Anthrax clinical management:
http://pediatrics.aappublications.org/content/pediatrics/early/2014/04/22/peds.2014-0564.full.pdf
Treatment of Anthrax in pregnant and postpartum women:
http://wwwnc.cdc.gov/eid/article/20/2/13-0611-techapp1.pdf
Anthrax antitoxin
- Because both antitoxins were approved under the Animal Rule, human efficacy data are not available.
- FDA-mandated post-marketing studies by the manufacturers will be implemented to gather critical safety and clinical benefit data from actual patients.
- Safety and clinical benefit data may be gathered through a different mechanism when the products are used for an unapproved indication (e.g., off-label [non-inhalation anthrax]).
- CDC may offer the treating physician an antitoxin as an adjunct to antimicrobial treatment for patients with systemic anthrax.
- When CDC releases antitoxin to a hospital, CDC will inform the treating physician of the postmarketing study and – with the physician’s permission – CDC will provide the physician contact information to the drug manufacturer. The intent is to help the manufacturers to collect data for the postmarketing study. Study participation is voluntary.
- Other data collection methods and different regulatory mechanisms, may be used to gather data about patients who receive antitoxin for an unapproved indication or during a mass event.
If antitoxin is required, contact the Idaho state epidemiologist at (208) 334-5939 during normal business hours, or request they be paged from (800) 632-8000.
If contamination with B. anthracis spores is identified, the following article provides information on decontamination:
http://wwwnc.cdc.gov/eid/article/9/6/02-0377_article
Military recruits may receive anthrax vaccine. More information on this practice can be accessed at: http://www.vaccines.mil/Anthrax
Additional Information
Variety of topics and situations pertaining to Anthrax and Anthrax emergencies- http://www.cdc.gov/anthrax/
Click to Call South Central Public Health District
Click to Call the Idaho State Epidemiologist
Click to Call Idaho State Communications
