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Key microbiological characteristics of Bacillus anthracis follow ASM :. B anthracis strains from around the world have been subtyped using molecular techniques such as variable number tandem repeat VNTR analysis. On the basis of such testing, all known anthrax strains can be classified into three different clades A, B, and C Pilo Spores germinate and form vegetative cells in environments rich in nutrients eg, glucose, network admission control resume minnesota, amino acids, nucleosides.
Vegetative bacteria generally survive poorly outside of mammalian hosts. Conversely, network admission control resume minnesota, vegetative cells form spores when exposed to air and nutrients in the environment are exhausted. Spores are protected by a morphologically complex protein coat Giorno The exosporium may restrict dispersal and thereby increase the probability of a lethal dose for the grazing animal Hugh-Jones Spores have been shown to have heat-resistance characteristics similar to other Bacillus species, and can survive in the environment for more than 40 years MancheeMontville The primary virulence factorsproduced by B anthracis are plasmid coded and include:.
During early stages of infection prodromal stagenetwork admission control resume minnesota, LT and edema toxin ET may coordinate to incapacitate neutrophils and macrophages, which allows for a systemic infection to occur LiuCote During the fulminant stage of infection see Staging of Inhalational Anthrax for additional description the combined vascular impacts of LT and ET lead to shock GuichardHicks Virulence of B anthracis appears to be related to clonality and to the numbers of copies of the pXO1 and pXO2 plasmids within each bacterial cell Coker The complete genomic sequence of B anthracis Ames strain has been analyzed; several chromosomally encoded potential virulence factors were identified, including hemolysin, phospholipases, and iron acquisition proteins Read B anthracis toxin genes are located on plasmids, and translocation of the plasmids has been identified in a naturally occurring B cereus isolate obtained from a patient with an illness similar to inhalational anthrax Hoffmaster More recently, anthrax-like illnesses were identified in two metalworkers who had inhalation exposure to B cereus that contained B anthracis toxin genes Avashia In another situation, a Bacillus strain, with a higher similarity to B thuringiensis and B network admission control resume minnesota than to B anthraciswas isolated from a chimpanzee in Cote d'Ivoire that died with clinical signs of anthrax Klee Pathogenesis of inhalational anthrax involves the following steps AbramovaHanna :, network admission control resume minnesota.
The pathogenesis of gastrointestinal anthrax is not clear, since this condition is relatively rare. Historically, illness has been thought to result from ingestion of B anthracis spores; however, more recently experts have postulated that illness predominantly results from ingestion of large numbers of vegetative cells such as may be found in poorly cooked meat from infected animals Inglesby Reservoirs Anthrax in Animals Modes of Transmission Anthrax in Humans—United States Anthrax in Humans—Global Perspective Outbreaks of Naturally Occurring Disease.
B anthracis is found in soil in many areas network admission control resume minnesota the world. Ecologic factors such as abundant rainfall following a period of drought may enhance spore density in soil, although the exact influence of such factors remains poorly understood, network admission control resume minnesota.
The organism generally exists in the endospore form in nature; germination of spores outside an animal host may occur when the following conditions are met WHO :. Endospores are resistant to drying, heat, ultraviolet light, gamma radiation, and some disinfectants. Spores can persist in soil for decades, as illustrated by biological warfare experiments during World War II on the Scottish island of Gruinard Manchee During andan estimated 4 x 10 14 anthrax spores were dispersed on the island through explosive means, network admission control resume minnesota.
Spores were still detectable more than 40 years later. Disinfection of the island was finally completed inusing a combination of seawater and formaldehyde. Frequent outbreaks of anthrax caused the death of 1. Because anthrax spores can survive in permafrost for approximately years, researchers have expressed concern that thawing of the permafrost in Siberia will expose extensive animal burial grounds that contain the remains of animals that died from anthrax Revich These researchers have suggested that careful monitoring of permafrost conditions in areas where anthrax outbreaks occurred is warranted, network admission control resume minnesota, since it is network admission control resume minnesota if further warming will lead to release of viable spores.
Most mammals are susceptible to anthrax, but it is predominantly a disease of livestock. Network admission control resume minnesota or other herbivores eg, cattle, sheep, network admission control resume minnesota, network admission control resume minnesota, pigs, bison, network admission control resume minnesota, water buffalo acquire infection from consuming contaminated soil or feed. Anthrax in animals is hyperendemic or endemic in the following areas of the world WHOCC :.
In most of the rest of the world, anthrax in animals occurs only sporadically. In the United States, outbreaks in animals have occurred since in the Midwest Kansas, Minnesota, Missouri, Nebraska, network admission control resume minnesota, North Dakota, South Dakotain the West California, Nevadaand in Texas and Oklahoma MBAHWHOCC.
Outbreaks also occurred in in Saskatchewan and Manitoba, Canada, affecting more than animals APHIS Other notable points about anthrax in animals include the following. Illness in humans most commonly occurs following exposure to infected animals or contaminated animal products; such exposures include:.
Cases following laboratory exposure have been recognized BrachmanCDC : Suspected cutaneous anthrax in a laboratory worker. Person-to-person transmission of B anthracis has been reported rarely with cutaneous anthrax, but has not been recognized with gastrointestinal or inhalational disease WeberWeber Outbreaks have been reported in industrial settings where animal products are processed and in agricultural settings following consumption of or exposure to ill animals.
Notable examples of outbreaks include the following:. Aerosol Release of Anthrax Spores Contamination of Food or Water Historical Perspective Preparedness.
Aerosol release of weaponized spores is the most likely mechanism for use of anthrax as a biological weapon Inglesby Although there is no formal definition of weaponized anthrax, weaponization for aerosol release generally involves:. The impact of a large aerosol release of weaponized anthrax spores remains unknown; however, scenarios have been hypothesized, including:.
Experience with aerosol spraying of B thuringiensis in Canada to control the European gypsy moth demonstrated the following pertinent findings Levin :. The findings from this study suggest that it is technologically feasible to disseminate biological agents from aircraft; however, the applicability of this information to an intentional aerosol release of B anthracis is unknown.
These data also raise concerns about indoor air safety should an intentional outdoor release of a biological agent occur. Deliberate contamination of food or water with anthrax spores also is a possibility. During World War II, the Japanese reportedly impregnated chocolate with anthrax to kill Chinese children.
The apartheid government of South Africa also experimented with anthrax in chocolate Sirisanthana Even though contamination of a water supply is unlikely owing to the large volume of water involved and the chlorination process, contamination of smaller water sources is theoretically feasible since spore counts remain stable in water for at least several days following inoculation Beatty Since B anthracis spores are not destroyed by pasteurization, contamination of milk is another theoretical possibility Perdue Although anthrax has not been responsible for the massive number of deaths associated with cholera, plague, or smallpox, it has played a prominent role in the history of infectious diseases.
Anthrax was the first disease for which a microbial origin was definitively established. Network admission control resume minnesota Koch identified the bacterium that causes anthrax in Martin Bacillus anthracis [anthrax], Purcell Anthrax also was the first disease for which an effective live bacterial vaccine was developed; Louis Pasteur developed this vaccine in and tested it in domesticated animals. Additionally, inhalational anthrax among wool and animal hide processors introduced the concept of occupational infectious disease risk.
Intentional spread of anthrax dates back to World War I, when German operatives infected horses and cattle with B anthracis while they were awaiting shipment overseas. During World War II, both the Axis and the Allies had biowarfare programs that involved anthrax Martin Anthrax as an agent of bioterrorism.
The US military has been concerned about anthrax as a potential biological weapon for many years because of its infectiousness via the aerosol route and the associated high mortality rate for untreated inhalational anthrax Purcell B anthracis is readily accessible and easy to grow; in the spore form it is stable, easily stored, and portable. Spores may be dispersed or sprayed as a powder or liquid.
Thus, anthrax remains the agent of greatest concern for bioterrorism Martin Anthrax as an agent of bioterrorism, network admission control resume minnesota. Inmore than countries signed the Biological and Toxin Weapons Convention, which called for termination of all offensive biological weapons research and development and destruction of existing biological weapons stocks.
However, the former Soviet Union continued to expand its biological weapons program which included weaponization of anthrax throughout the s and early s. After the demise of the Soviet Union, many of the scientists who worked in the biological weapons program left the country.
The status of those scientists remains unknown; however, Iraq, Iran, network admission control resume minnesota, Syria, Libya, and North Korea actively have recruited such experts Henderson These countries and others have been suspected of ongoing development of offensive bioweapons programs. Reports from the past few years suggest that at least three countries have offensive biological weapons programs and at least an additional six network admission control resume minnesota research programs with possible production of offensive weapons MIIS.
Weaponization of anthrax spores has caused two outbreaks of disease key points from each are outlined in the sections below. In addition, in Julythe religious group Aum Shinrikyo aerosolized a liquid suspension of B anthracis from the roof of an eight-story building in the Kameido district of Tokyo, but the release did not cause any human cases. Factors contributing to failure of this bioterrorist act included use of an attenuated B anthracis strain, low spore concentration, ineffective dispersal, a clogged spray device, and inactivation of spores by sunlight Takahashi In Octoberthe bipartisan WMD weapons of mass destruction Terrorism Research Center published a bio-response report card on the level of preparedness in the United States for responding to various levels of biological attacks WMD Center According to that report, the United States is moderately well prepared for small-scale biological incidents but is seriously unprepared for a large-scale incident.
Clinical Features Differential Diagnosis Staging of Inhalational Anthrax Distinguishing Inhalational Anthrax from ILI and CAP Pediatric Considerations Anthrax During Pregnancy Images. The three primary forms of anthrax correspond to the route of exposure: cutaneous, inhalational, and gastrointestinal HPA A fourth form, anthrax meningitis, may occur as a complication of network admission control resume minnesota, inhalational, network admission control resume minnesota, or gastrointestinal anthrax, network admission control resume minnesota, or it may be the presenting form.
These four clinical forms are described in the tables below. Anthrax also has been recognized in injecting drug users following the use of contaminated heroin mostly from injection, but snorting and smoking also may play a role.
Such patients may have localized findings at injection sites including presentations similar to necrotizing fasciitisor they may present with relatively nonspecific findings, such as malaise and fever HPS b network admission control resume minnesota and malaise are common.
a —Lesions tend to occur on exposed areas of body eg, hands, arms, face, neck. e Not all cases in this report received antimicrobial therapy.
a —Histologic examination shows necrosis, edema, and lymphocytic infiltrate. a Gold b Amidi c Kunanusont d Smyth e Bravata f Dixon g Doganay Abbreviations: CFR, case-fatality rate; CT, computed tomography; SGOT, serum glutamic oxalacetic transaminase; SGPT, serum glutamic pyruvic transaminase; WBC, white blood cell.
a Meselson b Baggett c Jernigan
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