Anthrax (anthrax)

Content

Introduction

The carbuncle, also called anthrax, is a rare disease caused by the bacillus anthracis, a bacterium capable of forming spores (forms of resistance of the bacterium) commonly found in the environment (water, soil, fodder). When anthrax spores enter the organism of an animal or man, the presence of water and nutrients cause them to become activated (germinate) and bacteria begin to multiply, spread and produce toxins (proteins that damage cells and tissues) causing a disease that can be very serious.

Domestic and wild animals, such as cattle, sheep, goats, antelopes, and deer, usually become infected by eating spore-contaminated fodder.

Occasionally, the disease can be transmitted to humans (generally it is an occupational disease that mainly affects farmers, breeders, leather tanners) through the inhalation of the spores or contact between them and a wound on the skin.

Another source of infection is eating spore-contaminated meat and food.

There is no evidence that anthrax is transmitted from person to person, but it is possible that skin lesions caused by anthrax can be contagious through direct contact or through contact with a contaminated object.

Quickly initiated antibiotic treatment resolves most anthrax infections. Inhaled anthrax is more difficult to treat and can even be fatal.

Anthrax, in the developed world, is now a rare disease. However, it is a concern because it can be used as a bacteriological weapon in bioterrorism. The spores, in fact, can be deliberately disseminated into the air causing severe cases of inhaled anthrax.

Symptoms

There are four ways you can get anthrax, each with different signs and disorders (symptoms). In most cases, complaints develop within six days of exposure. However, if inhaled, they may take longer to manifest.

Cutaneous anthrax (skin infection)

In skin infections, the anthrax spore enters the body through the skin, usually through wounds, cuts, or sores. It is by far the most common route of transmission of the disease but it is also the least severe as with therapy started quickly it rarely becomes fatal.

Disorders (symptoms) include:

  • formation of an itchy bump similar to an insect bite at the site of infection, which rapidly evolves into a painless sore with a black center (red-brown pustule hence the name carbuncle, from the Greek "burning coal")
  • swollen and painful lymph nodes, in the area close to the site of infection
  • flu-like symptoms, sometimes with fever and headache

Gastrointestinal anthrax

Gastrointestinal anthrax infection results from the consumption of undercooked meat from an infected animal. It can affect the entire gastrointestinal tract, from the throat to the large intestine (colon).

Disorders (symptoms) include:

  • nausea
  • He retched
  • abdominal pain
  • headache
  • loss of appetite
  • fever
  • severe diarrhea with blood, in the later stages of the disease
  • sore throat and difficulty swallowing
  • swollen neck

Anthrax by inhalation

Inhalation anthrax develops when bacterial spores are inhaled. It is the most severe form of the disease, often fatal despite treatment.

Initial symptoms (symptoms) include:

  • flu-like disorders, such as sore throat, mild fever, fatigue, and muscle aches that last for hours or days
  • mild chest discomfort
  • shortness of breath
  • nausea
  • cough with blood
  • pain to swallow

Final ailments include:

  • high fever
  • breathing problems
  • shock with collapse of the cardiovascular system
  • meningitis

Injection anthrax

This route of infection has recently been identified and is only reported in Europe. It is contracted through the use of illegal drugs given by injection.

Disorders (symptoms) include:

  • redness in the injection area, without an "area that turns black
  • significant swelling
  • shock
  • damage to various internal organs (multiple organ failure)
  • meningitis

If you suspect that you have been infected with anthrax, you should seek medical attention as soon as possible for evaluation and assistance (for example, if you work in an environment, such as a livestock farm, where spores of anthrax are likely to be present. anthrax). If any complaints appear after being in contact with animals or animal products in places where anthrax / anthrax is common, immediate medical attention should be sought. Rapid ascertainment (diagnosis) of the infection and its treatment are essential.

Causes

Carbuncle or anthrax it is still common throughout the developing world: Central and South America, Sub-Saharan Africa, Central and Southwest Asia, Southern and Eastern Europe, and the Caribbean.

Most infections in humans occur due to contact with infected animals, their meat or their skins.In the United States, some people have developed anthrax while making traditional African drums using the skins of infected animals.

One of the few known cases of non-animal transmission was the bioterrorist attack in the United States in 2001, during which letters containing anthrax spores were distributed, causing the infection of twenty-two people and five deaths. More recently, in Europe, there have been cases of intravenous infection (injection) while taking illegal drugs.

The most common risk factor for contracting anthrax / anthrax is coming into contact with its spores, the risk is greater if you work in an environment where you handle animal skins, furs or wool from areas with a high presence of bacteria of anthrax. Veterinarians dealing with livestock and the personnel of military and civil laboratories dealing with bioterrorism are also at risk. Even when slaughtering large game, such as deer, one can become infected with anthrax. The use of injectable drugs (heroin) is another risk factor.

Diagnosis

The assessment (diagnosis) of anthrax infection is usually carried out through:

  • laboratory analysis, for the direct detection of anthrax bacteria on blood samples, respiratory secretions and skin lesions
  • stool analysis, to identify anthrax bacteria
  • chest X-ray or computed tomography (CT) scan, the doctor may request a chest X-ray or CT scan to confirm the presence of anthrax caused by inhalation
  • lumbar puncture, the doctor inserts a needle into the spinal cord and withdraws a small amount of fluid for analysis. It is recommended to perform a lumbar puncture whenever the doctor suspects the presence of systemic anthrax - a form other than the cutaneous one - due to the possibility of developing meningitis

These tests should be done before starting antibiotic therapy. In case of confirmed anthrax, the disease must be reported to the Ministry of Health.

Therapy

Standard therapy for anthrax involves the administration of antibiotics, such as ciprofloxacin or levofloxacin (belonging to the fluoroquinolone class) or doxycycline (belonging to the tetracycline class). Penicillin (belonging to the beta-lactam class) can also be an antibiotic. The combination of antibiotics and the duration of treatment depend on how infected you are with anthrax, your age and general health. However, it is important to start the treatment as soon as possible.

After the terrorist attacks of 2001, monoclonal antibody therapies (raxibacumab and obiltoxaximab) were developed in the United States. Only the latter has been approved by the European Medicines Agency (EMA, the English European Medicine Agency) but its use is indicated only in exceptional circumstances. Instead of fighting disease-causing bacteria, these drugs help neutralize the toxins produced. Some cases of injection anthrax have also been successfully treated with surgical removal of infected tissue.

Although cases of anthrax respond to antibiotics, late-stage inhaled anthrax may not. As the disease progresses, bacteria can produce more toxins than drugs can eliminate.

Together with antibiotics, people with anthrax may need intensive care in which ventilators, fluids and medicines that can increase blood pressure (vasopressors) are used.

Prevention

Antibiotic treatment is also effective in preventing disease but, as anthrax is not transmitted from person to person, preventive treatment is not suitable for those who have had contact with a sick person unless they have been exposed to the same source of infection.

Currently there is a vaccine to prevent anthrax but it is available only for certain categories of people (military personnel). In Italy, however, the use of a vaccine for animals at risk is mandatory: the vaccine is produced and distributed in Italy only from the Zooprophylactic Institute of Puglia and Basilicata.

To prevent anthrax infection, contact with infected animals must be avoided. If you live or travel in areas where anthrax is widespread and farm animals are not routinely vaccinated, you should avoid contact with livestock and animal skins as much as possible and / or avoid eating meat that it has not been properly cooked Even in developed countries it is important to treat any dead animals with care and to take precautions when processing imported skins, furs or wool.

Complications

The most serious complications of anthrax are damage to multiple organs resulting from the multiplication of bacteria and the production of toxins (sepsis) and inflammation of the membranes and fluid covering the brain and spinal cord, resulting in massive bleeding (meningitis) If not treated quickly, anthrax becomes a very serious disease, which can lead to death in infected people.

Bibliography

Centers for Disease Control and Prevention (CDC). What is Anthrax? (English)

Mayo Clinic. Anthrax (English)

EpiCentro (ISS). Anthrax - Anthrax

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