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Anthrax - #PHARMFAX

Bacillis anthracis, a gram positive, spore-forming, bacterium, has been formulated into a biologic weapon of mass destruction.

 


Bacillis anthracis, a gram positive, spore-forming, bacterium, has been formulated into a biologic weapon of mass destruction. Commonly known as anthrax, patients contract the disease through spore inhalation, ingestion, or inoculation into the skin.


When considering weapons of mass destruction, aerosolized biologic agents would be the most effective and easily dispersible for maximal exposure. Anthrax is often linked to terrorist attacks, but non-related related exposures have been reported in Europe with cutaneous anthrax amongst intravenous drug users.


Inhalation, cutaneous, and gastrointestinal are the three classifications of anthrax with inhalation being the deadliest form. Symptoms are initially non-specific with fevers or a cough. Once symptoms develop,patients rapidly deteriorate into shock, hemorrhagic mediastinitis, and stridor within 48 hours. Cutaneous anthrax is associated with a large vesicle that ruptures after a week and forms a black eschar.


Treatment of anthrax consists of antibiotics and supportive care. Cutaneous anthrax without toxicity can be treated with ciprofloxacin, doxycycline, or amoxicillin for 7 to 10 days.


Patients with inhalational, cutaneous, or GI anthrax with toxicity receive IV ciprofloxacin, doxycycline, or penicillin. Inhalation anthrax will need combination therapy with a protein synthesis inhibitor, such as linezolid, to prevent toxin release. Patients with signs of meningitis require a three-agent regimen that includes meropenem.. CNS anthrax infections are treated for two to three weeks. Severe toxicities should receive antitoxin in addition to antibiotics. Once treatment has been completed, prophylaxis oral antibiotics used for non-toxic cases are continued for 60 days or until receiving 3 doses of anthrax vaccine to prevent relapse.


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References

  1. Oncu et la. Anthrax--an overview. Med Sci Monit. 2003 Nov;9(11):RA276-83.

  2. Hicks et al. An overview of anthrax infection including the recently identified form of disease in injection drug users. Intensive Care Med. 2012 Jul;38(7):1092-104. doi: 10.1007/s00134-012-2541-0.

  3. Doganay M, Demiraslan H. Human anthrax as a re-emerging disease. Recent Pat Antiinfect Drug Discov. 2015;10(1):10-29.



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