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Anthrax Fact Sheet for Physicians

What is Anthrax?

Anthrax is a bacterial disease caused by the bacterium Bacillus anthracis. Anthrax is most commonly found among animals such as cows, horses, sheep and goats. However in the Caribbean anthrax has not been found in any form for the last twenty (20) years. Anthrax does not occur naturally in powders. Powdered anthrax is man-made.

Anthrax infection in humans is of three types reflecting the route by which the disease was acquired:

Symptoms

Symptoms of disease vary depending on how the disease was contracted. However, symptoms usually occur within 7 days after exposure. Initial stages of cutaneous anthrax are a small pimple or papule, which then evolves into a skin lesion and then to a depressed black eschar invariably accompanied by edema. The intestinal form of anthrax may follow the consumption of contaminated food and is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, and fever are followed by abdominal pain, vomiting of blood, and severe diarrhea. Initial symptoms of inhalation anthrax infection may resemble the common cold. After several days, the symptoms may progress to severe breathing problems and shock. Inhalation anthrax is often fatal.

Spread

Person-to-person spread of anthrax is extremely unlikely, if it occurs at all. Therefore, there is no need to treat contacts of persons ill with anthrax, such as household contacts, friends, or coworkers, unless they were also exposed to the same source of infection.

Treatment

In persons exposed to anthrax, disease can be prevented with antibiotic treatment. Early antibiotic treatment of anthrax is essential to increase the chances for survival. Anthrax is usually susceptible to penicillin, doxycycline, and fluoroquinolones. Vaccination against anthrax is not recommended for the general public to prevent disease. The vaccine is not available for general uses.

The following are the suggested recommendations for antibiotic prophylaxis, if one is exposed to Airborne Anthrax:

Adults

OR

OR

Drug-drug interactions and individual patient allergies should be considered when selecting an antibiotic for prophylaxis.

If allergic to amoxicillin or penicillin, consultation with a physician is required as ciprofloxacin or doxycycline may be indicated.

OR

OR

Drug-drug interactions and individual patient allergies should be considered when selecting an antibiotic for prophylaxis. In older adults, the potential CNS side effects of ciprofloxacin should also be considered when selecting an antibiotic for prophylaxis.

Antibiotics for children are listed in order of preference:

Children 9 yrs & over

OR

OR

OR

OR

Drug-drug interactions and individual patient allergies should be considered when selecting an antibiotic for prophylaxis. Amoxicillin is preferred for children. If allergic to amoxicillin or penicillin, consultation with a physician is required, as ciprofloxacin or doxycycline may be indicated.

Reminder:

Recommended case definition

Clinical description

An illness with acute onset characterized by several clinical forms. These are:

(a) localized form: (more frequent)
cutaneous: skin lesion evolving over 2 to 6 days from a papular through a vesicular stage, to a depressed black eschar invariably accompanied by edema that may be mild to extensive.

(b) systemic forms: (sporadic)

gastro-intestinal: abdominal distress characterized by nausea, vomiting, anorexia and followed by fever.

pulmonary (inhalation): brief prodrome resembling acute viral respiratory illness, followed by rapid onset of hypoxia, dyspnoea and high temperature, with X-ray evidence of mediastinal widening.

meningeal: acute onset of high fever possibly with convulsions, loss of consciousness, meningeal signs and symptoms; commonly noted in all systemic infections.

Laboratory criteria for diagnosis

Laboratory confirmation is by isolation of Bacillus anthracis from a clinical specimen (e.g., blood culture, sputum, lesions, discharges) or an environmental specimen.

The samples to be taken for laboratory testing for Bacillus anthracis are as follows:

Case classification

 
Thanks to the Ministry of Health, Trinidad and Tobago, for participating in the development of these guidelines.

Caribbean Epidemiology Centre
16-18 Jamaica Boulevard, Federation Park
P.O. Box 164, Port of Spain
Republic of Trinidad and Tobago
Tel: (868) 622-4261, Fax: (868) 622-2792
E-mail: postmaster@carec.paho.org

Page last modified 22 October, 2001