Anthrax bacterial infection

Anthrax

• Anthrax is a bacterial infection caused by Bacillus anthracis.
• Bacillus anthracis is a gram-positive organism.
• The organism forms central spores.
• The spores can survive in soil for years.
• Anthrax is considered an endemic zoonotic disease in many countries.
• It is commonly acquired through contact with infected animals, mainly herbivores.
• Human infection happens when spores enter the body through skin wounds, inhalation, or ingestion.
• The bacterium produces toxins that cause the disease's clinical symptoms.
• Anthrax is endemic in Africa, Central and South America, Asia, and parts of Europe and the Middle East.
• Epidemic outbreaks are often associated with agricultural practices and improper disposal of infected animal carcasses.
• In humans, anthrax can present in cutaneous, inhalational, gastrointestinal, or injectional forms.
• In October 2024, two residents of Sto. Niño town in Cagayan province were suspected of contracting anthrax after butchering and consuming meat from a deceased carabao.
• The individuals developed symptoms such as fever, tremors, weakness, and dark-colored skin lesions and specimens were sent to RITM for confirmation.
• Between 2017 and 2023, the Department of Health (DOH) recorded 82 suspected cases nationwide.
• No cases were reported in 2019, 2020, and 2021.

Pathophysiology of Anthrax

• Anthrax begins when spores from Bacillus anthracis enter the body which leads to macrophage uptake.
• It continues from lymphatic travel and germination to toxin production.
• Local effects include edema and tissue necrosis.
• Systemic effects include shock, respiratory failure, and meningitis.
• Multi-organ failure can occur, affecting the heart, liver, and kidneys.

Transmission Modes

• Cutaneous transmission happens through direct contact.
• Inhalation transmission happens through aerosol.
• Gastrointestinal transmission happens through ingestion.
• Injection transmission happens through direct injection of contaminated drugs.

Clinical Manifestations

• Cutaneous anthrax, is the most common form of anthrax.
• Early symptoms include an itchy bump similar to an insect bite.
• Progression results in a painless sore with a black center (eschar) and swollen lymph nodes.
• Severe cases present with fever and fatigue.
• Inhalation anthrax, is the most severe form of anthrax.
• Early symptoms include flu-like symptoms.
• Progression includebreathing trouble, chest pain, shock, and organ failure.
• A key sign is a widened mediastinum on X-ray.
• Gastrointestinal anthrax, mouth/throat symptoms include sores, difficulty swallowing, and neck swelling.
• Gastrointestinal symptoms include nausea, bloody vomiting/diarrhea, and severe stomach pain.
• Injection anthrax, is a rare form of anthrax.
• Symptoms include swelling, redness, and tissue death at the injection site, it can quickly spread to cause fever and shock.

Medical Management

• For cutaneous anthrax, administer antibiotics, such as ciprofloxacin or doxycycline, as first-line treatments.
• For inhalation anthrax, initiate intravenous antibiotics promptly using a first-line agent such as ciprofloxacin or doxycycline.
• Consider the use of antitoxins in severe cases to neutralize anthrax toxins.
• Provide supportive care, including respiratory support or mechanical ventilation if necessary.
• Administer intravenous antibiotics, such as ciprofloxacin or doxycycline, as first-line treatments for gastrointestinal anthrax.
• Manage symptoms with antiemetics for nausea and intravenous fluids to maintain hydration.
• For injection anthrax, initiate intravenous antibiotics promptly with ciprofloxacin or doxycycline as first-line agents.
• Surgical debridement to remove necrotic tissue can be considered if necessary.

Nursing Management

• For cutaneous anthrax provide wound care, monitoring, and patient education.
• For inhalation anthrax, provide respiratory monitoring, infection control, and patient support.
• For gastrointestinal anthrax, provide gastrointestinal monitoring, nutritional support, and patient education.
• For injection anthrax, provide wound care, monitoring, and patient education.

Diagnostic Tests

• Gram staining (skin lesion, blood/ pleural fluid, CSF) can be used as a diagnostic test.
• Culture (GOLD STANDARD) can be used as a diagnostic test.
• Adjunct assays, PCR testing, serology, immunohistochemistry can be used as diagnostic tests.

Prevention

• Vaccination is a method of prevention.
• Proper handling of animal products aids in prevention.
• Use protective measures for high-risk workers.
• Safe disposal of infected animals is a method of prevention.
• Avoidance of contaminated areas aids in prevention.
• Education and awareness is a method of prevention.

Control

• Surveillance and early detection is a method of control.
• Isolation of infected animals is a method of control.
• Prompt treatment.
• Decontamination of affected areas.
• Public health measures.
• Legal regulations.

Outbreak Management

• Immediate reporting .
• Isolation and quarantine.
• Investigation and risk assessment.
• Treatment of infected individuals.
• Implement control in animals.
• Implement environmental decontamination.
• Implement public health interventions.
• Implement surveillance and monitoring.
• Implement communication and collaboration.
• Implement legal and policy enforcement is a method of outbreak management.

Complications

• Sepsis occurs when bacteria can spread from the skin into the bloodstream, leading to widespread infection and systemic inflammation.
• Edema is the severe swelling around the infection site, and may impede blood flow and tissue healing.
• Tissue Necrosis/Necrotizing Fasciitis consists of extensive tissue death around the lesion which may require surgical intervention or amputation.
• Secondary Infections from open wounds increase the risk of bacterial superinfection.
• Anthrax Meningitis occurs when Bacillus anthracis invades the central nervous system, causing inflammation of the brain and spinal cord.
• High mortality rate with Anthrax Meningitis even with treatment.
• Septic Shock from inhalation anthrax can rapidly progress and is characterized by dangerously low blood pressure and organ failure.
• Respiratory Failure is widespread infection that leads to difficult breathing due to pulmonary edema and inflammation.
• Hemorrhage is bleeding into the gastrointestinal tract or surrounding tissues.
• Multi-Organ Failure occurs when rapid systemic spread of toxins causes failure of critical organs such as the kidneys, liver, and lungs.
• Toxemia occurs when anthrax toxins disrupt immune responses and cause widespread tissue injury leading to edema, hypotension, and organ damage.

Meningococcemia

• Meningococcemia is a bacterial infection of the blood due to Neisseria Meningitides and is more contagious than staphylococci, streptococcus B and S, and pneumonia and causes a very serious disease.
• The most commonly affected age groups are 6 months and 5-24 years.
• Meningococcemia primarily affects infants, adolescents, and young adults.
• It is transmitted through respiratory droplets.
• Higher incidence is found in areas with crowded living conditions that can lead to outbreaks.
• Vaccination plays a significant role in reducing its spread, especially in high-risk groups.
• Meningococcal disease is endemic to the Philippines with about 100 cases reported yearly and no seasonal variation.
• It is among the priority notifiable diseases under the Philippine Integrated Disease Surveillance and Response (PIDSR) Protocol.
• United States statistics from 2023 indicate a total of 244 confirmed and probable cases reported.

Pathophysiology of Meningococcemia

• Endotoxin release from Neisseria meningitidis leads to Endotoxin Binding in plasma proteins and cellular receptors and Cytokine Release from activated macrophages which includes Proinflammatory cytokines.
• This leads to tissue damage and vascular damage which include bleeding in skin and organs.

Mode of Transmission

• Transmission occurs from Person-to-person from Respiratory droplets, such as coughing, sneezing, kissing, or sharing foods, drinks and utensils.

Clinical Manifestation

• Clinical manifestations include pinpoint rashes (Petechiae), Purpura, Fever, Severe headache, Stiff neck, Nausea/Vomiting, Photophobia, and Confusion
• Symptoms also include Cough, Sore throat, Hypotension, Tachypnea, and SOB.

Diagnostic Tests/Examination

• Gram stain,
• Culture (Blood/CSF)
• Antigen detection
• Chest x-ray
• CT scan
• Hematologic and metabolic abnormalities.

Medical Management

• Initial Management includes isolation, antibiotic therapy, (Ceftriaxone, Ciprofloxacin, Rifampin, Penicillin G, Chloramphenicol).
• It also includes adjunctive Corticosteroids (Dexamethasone) and supportive care. ABCs, Fluid Resuscitation, Hemodynamic Support.
• Ongoing management includes monitor and treat complications: Septic Shocks, Disseminated Intravascular Coagulation (DIC), Multi-Organ Dysfunction Syndrome (MODS).
• Ongoing management also includes electrolyte and glucose monitoring and seizure management
• Preventive management includes vaccination.

Nursing Management

• Pre-hospitalization: includes education and chemoprophylaxis
• Hospitalization: includes monitoring,supportive care, and Isolation
• Post-Hospitalization: includes follow-up and rehabilitation

Prevention and Control Measures

• Avoid close contact
• Practice hygiene.
• Vaccinate with MenACWY, MenB
• Live a healthy lifestyle.

Outbreak Management

• Surveillance and Case Identification
• Vaccination Strategies
• Chemoprophylaxis
• Public Health Measures
• Monitoring and Evaluation

Complications

• Septic shock
• Disseminated intravascular coagulation (DIC)
• Purpura fulminans
• Tissue death
• Myocarditis Organ damage or failure