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Pulmonary Anthrax

Inhalation Anthrax Disease


Presentation

  • In 2001, all 6 survivors presented for medical care in the “intermediate-progressive” stage [1,3].[upmc-cbn.org]
  • Unfortunately, the nonspecific clinical presentation is often misinterpreted as a flulike illness and confirmatory microbiologic tests may take up to 24 hours.[journals.lww.com]
  • Therefore clinicians should be aware of the possibility of cases of inhalation anthrax, and any previously healthy patient with the following clinical presentations should be immediately reported to the Consultant in Communicable Disease Control at the[gpnotebook.co.uk]
Fever
  • Clinical Mediastinal widening, pleural effusions, fever, nonproductive cough, myalgia, malaise, haemorrhage, cyanosis, SOB, stridor, shock, death; often accompanied by mesenteric lymphadenitis, diffuse abdominal pain and fever.[medical-dictionary.thefreedictionary.com]
  • The “late stage developed abruptly, with sudden fever, dyspnea, diaphoresis, and shock... A chest radiograph most often showed a widened mediastinum consistent with lymphadenopathy. Up to half of patients developed hemorrhagic meningitis.[upmc-cbn.org]
  • ( A78 ) rheumatic fever ( I00 ) schistosomiasis ( B65.0- B65.9 ) Type 1 Excludes candidial pneumonia ( B37.1 ) chlamydial pneumonia ( J16.0 ) gonorrheal pneumonia ( A54.84 ) histoplasmosis pneumonia ( B39.0- B39.2 ) measles pneumonia ( B05.2 ) nocardiosis[icd10data.com]
  • Features of inhalation anthrax: rapid onset of severe, un-explained febrile illness (fever, chills, fatigue, non-productive cough) rapid onset of severe sepsis not due to a predisposing illness abrupt onset respiratory failure and the presence of widened[gpnotebook.co.uk]
Fatigue
  • Features of inhalation anthrax: rapid onset of severe, un-explained febrile illness (fever, chills, fatigue, non-productive cough) rapid onset of severe sepsis not due to a predisposing illness abrupt onset respiratory failure and the presence of widened[gpnotebook.co.uk]
  • Clinical Meningeal symptoms, nuchal rigidity, fever, fatigue, myalgia, headache, nausea, vomiting, agitation, seizures, delirium, followed by neurologic degeneration and death. pulmonary anthrax Inhalation anthrax, see there. pul·mo·nar·y an·thrax ( pulmŏ-nar-ē[medical-dictionary.thefreedictionary.com]
  • Common early symptoms of inhalation anthrax are often similar to those seen with the flu and may include: Fever Nausea Vomiting Aches Fatigue. Inhalation anthrax symptoms can progress to: Labored breathing Shock Death.[anthrax.emedtv.com]
  • You could have: Flulike symptoms including fever, fatigue, body aches, and sore throat. These can last a few hours or days.[webmd.com]
Malaise
  • […] symptoms: substantial impairment in shortterm memory or concentration; sore throat; tender lymph nodes; muscle pain; multi-joint pain without swelling or redness; headaches of a new type, pattern, or severity; unrefreshing sleep; and post-exertional malaise[books.google.com]
  • Clinical Mediastinal widening, pleural effusions, fever, nonproductive cough, myalgia, malaise, haemorrhage, cyanosis, SOB, stridor, shock, death; often accompanied by mesenteric lymphadenitis, diffuse abdominal pain and fever.[medical-dictionary.thefreedictionary.com]
  • Pulmonary – entry is through inhalation of spores and illness begins insidiously with mild symptoms of slight fever and malaise lasting a few days.[hps.scot.nhs.uk]
  • Symptoms of inhalation anthrax: Begins with fever, malaise, headache, cough, shortness of breath, and chest pain Fever and shock may occur later Symptoms of gastrointestinal anthrax usually occur within 1 week and may include: Abdominal pain Bloody diarrhea[medlineplus.gov]
Veterinarian
  • Veterinarians and people whose jobs involve handling livestock typically are vaccinated against the disease if they work in high-risk areas of the world.[humanillnesses.com]
  • There is a vaccine available for people at high risk (such as veterinarians, laboratory technicians, employees of textile mills processing imported goat hair, and members of the armed forces). The Department of Defense and the U.S.[medicinenet.com]
  • People most at risk for cutaneous anthrax include farm workers, veterinarians, tanners, and wool workers. Inhalation anthrax develops when anthrax spores enter the lungs through the airways.[medlineplus.gov]
  • Humans have an increased risk of getting anthrax if they: work with anthrax in a laboratory work with livestock as a veterinarian (less likely in the United States) handle animal skins from areas with a high risk of anthrax (not common in the United States[healthline.com]
  • Each monkey was examined by a veterinarian prior to inclusion in the study and again prior to aerosol exposure and found to be free of malformations or clinical signs of disease.[nature.com]
High Fever
  • fever, dyspnea, confusion, syncope, increasing nausea and vomiting.[upmc-cbn.org]
  • Shortness of breath, high fever, fast heart rate, and heavy sweating then develop. Meningitis (swelling of the brain) and pain in the abdomen follow. Few survive more than a few days beyond the development of these types of symptoms.[medbroadcast.com]
  • High fever, difficulty breathing, cyanosis, and shock characterize this next phase. Death is universal in untreated cases and may occur in as many as 100% of treated cases if therapy is started more than 48 hours after symptoms begin.[rnceus.com]
  • Symptoms include high fever, extreme shortness of breath, shock, and rapid death within 48 hours in fatal cases.[en.wikipedia.org]
Cough
  • Clinical Mediastinal widening, pleural effusions, fever, nonproductive cough, myalgia, malaise, haemorrhage, cyanosis, SOB, stridor, shock, death; often accompanied by mesenteric lymphadenitis, diffuse abdominal pain and fever.[medical-dictionary.thefreedictionary.com]
  • […] is not a valid MySQL result resource in /home/kidsnetau/dictionary_content.txt on line 15 Dictionary Definition of pulmonary anthrax a form of anthrax infection acquired by inhalation of dust containing Bacillus anthracis; initial symptoms (chill and cough[dictionary.kids.net.au]
  • You may also get swabs of your skin or samples of your spinal fluid, stool, or mucus that you cough up. Tell your doctor what happened.[webmd.com]
  • […] and Human Services Office on Women's Health Alveolar abnormalities (Medical Encyclopedia) Blood gases (Medical Encyclopedia) Breath sounds (Medical Encyclopedia) Chemical pneumonitis (Medical Encyclopedia) Chest tube insertion (Medical Encyclopedia) Coughing[icdlist.com]
  • Features of inhalation anthrax: rapid onset of severe, un-explained febrile illness (fever, chills, fatigue, non-productive cough) rapid onset of severe sepsis not due to a predisposing illness abrupt onset respiratory failure and the presence of widened[gpnotebook.co.uk]
Pleural Effusion
  • effusions on chest x-ray nausea sweats (often drenching) confusion or altered mental status vomiting pallor or cyanosis raised red cell count dyspnoea tachycardia abdominal pain pleuritic chest pain sore throat (2,3) Gram-positive bacilli seen in blood[gpnotebook.co.uk]
  • effusions, dyspnea, cyanosis, stridor, and shock.[medical-dictionary.thefreedictionary.com]
  • The lymphatic stasis manifests as an early onset pleural effusion and peripheral infiltrates, representing thickened bronchovascular bundles, detectable on chest X-ray.[wikidoc.org]
Dyspnea
  • The “late stage developed abruptly, with sudden fever, dyspnea, diaphoresis, and shock... A chest radiograph most often showed a widened mediastinum consistent with lymphadenopathy. Up to half of patients developed hemorrhagic meningitis.[upmc-cbn.org]
  • […] fatal form of anthrax due to inhalation of dust containing anthrax spores, which are transported to the regional lymph nodes where they germinate, multiply, and produce toxin, and characterized by hemorrhagic edematous mediastinitis, pleural effusions, dyspnea[medical-dictionary.thefreedictionary.com]
  • […] valid MySQL result resource in /home/kidsnetau/dictionary_content.txt on line 15 Dictionary Definition of pulmonary anthrax a form of anthrax infection acquired by inhalation of dust containing Bacillus anthracis; initial symptoms (chill and cough and dyspnea[dictionary.kids.net.au]
  • […] exam cutaneous anthrax initial lesion is a painless and pruritic papule with central vesicle or bulla this progresses to painless and necrotic black eschar surrounded by edema eschar sloughs off at day 14 pulmonary anthrax mediastinitis shock hypoxia dyspnea[medbullets.com]
  • . • Emergency Department Management of Dyspnea in the Dying Patient Jul 2018 Dyspnea is a distressing symptom in the dying process, but it can be managed in the ED to keep patients comfortable, alleviate patient and family anxieties, and honor the patient's[ebmedicine.net]
Productive Cough
  • Features of inhalation anthrax: rapid onset of severe, un-explained febrile illness (fever, chills, fatigue, non-productive cough) rapid onset of severe sepsis not due to a predisposing illness abrupt onset respiratory failure and the presence of widened[gpnotebook.co.uk]
  • Fever, chills, drenching sweats, profound fatigue, minimally productive cough, nausea and vomiting, and chest discomfort were symptoms reported by most patients.[rnceus.com]
  • cough nausea and vomiting hemoptysis chest pain gastrointestinal anthrax nausea and vomiting dysentery abdominal pain Physical exam cutaneous anthrax initial lesion is a painless and pruritic papule with central vesicle or bulla this progresses to painless[medbullets.com]
  • During the first several days, symptoms are non-specific with myalgia, fatigue that may be profound, fever and chills, sweats, minimal non-productive cough, nausea or vomiting and some chest discomfort.[antimicrobe.org]
Common Cold
  • Pulmonary anthrax usually seems like a common cold or the flu at first, but it rapidly turns into severe pneumonia and requires hospitalization. It usually takes fewer than 7 days for a person to show signs of anthrax after being infected.[kidshealth.org]
  • The first symptoms of inhalation anthrax often resemble those of a common cold or influenza and include cough, difficulty in swallowing, headache, swollen lymph nodes * in the neck, and tiredness.[humanillnesses.com]
Vomiting
  • Following an asymptomatic incubation period, patients in the first, or early stage, “developed a spectrum of nonspecific symptoms, which could include fever, dyspnea, cough, headache, vomiting, chills, weakness, abdominal pain, and chest pain.[upmc-cbn.org]
  • Clinical Fever, diffuse abdominal pain with rebound tenderness, melanic stools, coffee grounds vomit, fluid and electrolyte imbalances, shock; death is due to intestinal perforation or anthrax toxemia.[medical-dictionary.thefreedictionary.com]
  • […] non-productive cough) rapid onset of severe sepsis not due to a predisposing illness abrupt onset respiratory failure and the presence of widened mediastinum or pleural effusions on chest x-ray nausea sweats (often drenching) confusion or altered mental status vomiting[gpnotebook.co.uk]
  • […] hemoptysis chest pain gastrointestinal anthrax nausea and vomiting dysentery abdominal pain Physical exam cutaneous anthrax initial lesion is a painless and pruritic papule with central vesicle or bulla this progresses to painless and necrotic black[medbullets.com]
Nausea
  • , un-explained febrile illness (fever, chills, fatigue, non-productive cough) rapid onset of severe sepsis not due to a predisposing illness abrupt onset respiratory failure and the presence of widened mediastinum or pleural effusions on chest x-ray nausea[gpnotebook.co.uk]
  • […] is defined as inclusion criteria for this stage: Positive blood cultures, or Mediastinal adenopathy, or Pleural effusion(s) Non-specific and non-defining symptoms and signs in this stage may include high fever, dyspnea, confusion, syncope, increasing nausea[upmc-cbn.org]
  • Clinical Meningeal symptoms, nuchal rigidity, fever, fatigue, myalgia, headache, nausea, vomiting, agitation, seizures, delirium, followed by neurologic degeneration and death. pulmonary anthrax Inhalation anthrax, see there. pul·mo·nar·y an·thrax ( pulmŏ-nar-ē[medical-dictionary.thefreedictionary.com]
  • […] and vomiting hemoptysis chest pain gastrointestinal anthrax nausea and vomiting dysentery abdominal pain Physical exam cutaneous anthrax initial lesion is a painless and pruritic papule with central vesicle or bulla this progresses to painless and necrotic[medbullets.com]
Abdominal Pain
  • Clinical Fever, diffuse abdominal pain with rebound tenderness, melanic stools, coffee grounds vomit, fluid and electrolyte imbalances, shock; death is due to intestinal perforation or anthrax toxemia.[medical-dictionary.thefreedictionary.com]
  • pain pleuritic chest pain sore throat (2,3) Gram-positive bacilli seen in blood cultures (if taken before antibiotic treatment), usually after 2-3 days of onset of illness.[gpnotebook.co.uk]
  • Following an asymptomatic incubation period, patients in the first, or early stage, “developed a spectrum of nonspecific symptoms, which could include fever, dyspnea, cough, headache, vomiting, chills, weakness, abdominal pain, and chest pain.[upmc-cbn.org]
  • pain Physical exam cutaneous anthrax initial lesion is a painless and pruritic papule with central vesicle or bulla this progresses to painless and necrotic black eschar surrounded by edema eschar sloughs off at day 14 pulmonary anthrax mediastinitis[medbullets.com]
Chest Pain
  • pain sore throat (2,3) Gram-positive bacilli seen in blood cultures (if taken before antibiotic treatment), usually after 2-3 days of onset of illness.[gpnotebook.co.uk]
  • Following an asymptomatic incubation period, patients in the first, or early stage, “developed a spectrum of nonspecific symptoms, which could include fever, dyspnea, cough, headache, vomiting, chills, weakness, abdominal pain, and chest pain.[upmc-cbn.org]
  • pain gastrointestinal anthrax nausea and vomiting dysentery abdominal pain Physical exam cutaneous anthrax initial lesion is a painless and pruritic papule with central vesicle or bulla this progresses to painless and necrotic black eschar surrounded[medbullets.com]
Tachycardia
  • […] predisposing illness abrupt onset respiratory failure and the presence of widened mediastinum or pleural effusions on chest x-ray nausea sweats (often drenching) confusion or altered mental status vomiting pallor or cyanosis raised red cell count dyspnoea tachycardia[gpnotebook.co.uk]
Headache
  • الصفحة 202 - The concurrent occurrence of four or more of the following symptoms: substantial impairment in shortterm memory or concentration; sore throat; tender lymph nodes; muscle pain; multi-joint pain without swelling or redness; headaches of a new[books.google.com]
  • Following an asymptomatic incubation period, patients in the first, or early stage, “developed a spectrum of nonspecific symptoms, which could include fever, dyspnea, cough, headache, vomiting, chills, weakness, abdominal pain, and chest pain.[upmc-cbn.org]
  • Clinical Meningeal symptoms, nuchal rigidity, fever, fatigue, myalgia, headache, nausea, vomiting, agitation, seizures, delirium, followed by neurologic degeneration and death. pulmonary anthrax Inhalation anthrax, see there. pul·mo·nar·y an·thrax ( pulmŏ-nar-ē[medical-dictionary.thefreedictionary.com]
  • Inhalation anthrax The first symptoms are subtle, gradual and flu -like ( influenza ) with a sore throat and headaches.[medicinenet.com]

Workup

Pulmonary Infiltrate
  • Infiltrate FBC: to look for raised haemocrit, raised WCC, especially neutrophilia LFT: to look for high transaminases CT Chest if high suspicion and normal Chest X-ray blood culture treatment may be successful in the prodromal stage, but by the time[gpnotebook.co.uk]
  • Because of the patient's progressive respiratory distress and multiorgan dysfunction (as evidenced by progression of pulmonary infiltrates and elevated liver function tests and serum creatinine), the Centers for Disease Control and Prevention recommended[academic.oup.com]
Pleural Effusion on Chest X-Ray
  • effusions on chest x-ray nausea sweats (often drenching) confusion or altered mental status vomiting pallor or cyanosis raised red cell count dyspnoea tachycardia abdominal pain pleuritic chest pain sore throat (2,3) Gram-positive bacilli seen in blood[gpnotebook.co.uk]
X-Ray Abnormal
  • Chest X-ray abnormalities associated with inhalation anthrax include mediastinal widening, paratracheal fullness, pleural effusions, parenchymal infiltrates, and mediastinal lymphadenopathy.[wikidoc.org]
Chest X-Ray Abnormal
  • Chest X-ray abnormalities associated with inhalation anthrax include mediastinal widening, paratracheal fullness, pleural effusions, parenchymal infiltrates, and mediastinal lymphadenopathy.[wikidoc.org]
Gram-Positive Rods
  • […] duty doctor at HPA Colindale (020 8200 6868). rapid onset of severe, unexplained febrile illness or febrile death. rapid onset of severe sepsis not due to a predisposing illness, or respiratory failure with a widened mediastinum. severe sepsis with Gram-positive[gpnotebook.co.uk]
  • Gram stain shows large solid and beaded gram-positive rods, particularly beneath the epithelium. The bacilli are not really visible on the hematoxylin and eosin stain. 2. Inhalation: Pulmonary (Pneumonic) type: Wool Sorter's Disease.[histopathology-india.net]
  • Anthrax and Endospores Anthrax is a disease caused by a Gram-positive, rod-shaped bacterium called Bacillus anthracis. Just in case you didn't know, Gram-positive bacteria have a really thick cell wall in comparison to Gram-negative bacteria.[study.com]
Gram-Positive Bacteria
  • Just in case you didn't know, Gram-positive bacteria have a really thick cell wall in comparison to Gram-negative bacteria.[study.com]
Brucella Abortus
  • abortus A23.2 Brucellosis due to Brucella suis A23.3 Brucellosis due to Brucella canis A23.8 Other brucellosis Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.[icd10data.com]
Pleural Effusion
  • effusions on chest x-ray nausea sweats (often drenching) confusion or altered mental status vomiting pallor or cyanosis raised red cell count dyspnoea tachycardia abdominal pain pleuritic chest pain sore throat (2,3) Gram-positive bacilli seen in blood[gpnotebook.co.uk]
  • effusions, dyspnea, cyanosis, stridor, and shock.[medical-dictionary.thefreedictionary.com]
  • The lymphatic stasis manifests as an early onset pleural effusion and peripheral infiltrates, representing thickened bronchovascular bundles, detectable on chest X-ray.[wikidoc.org]

Treatment

  • […] may be successful in the prodromal stage, but by the time respiratory or bacteraemic symptoms develop, treatment may not arrest the disease before a fatal outcome (2) begin antibiotic treatment to cover B. anthracis - Ciprofloxacin intravenously in combination[gpnotebook.co.uk]
  • *Early antibiotic treatment of anthrax is essential; delay significantly lessens chances for survival.[stepwards.com]
  • If your case is serious, you’ll get the treatment in a hospital. Anthrax Vaccine There is an anthrax vaccine, but it’s only for people who are at risk because they might become exposed to anthrax.[webmd.com]
  • CFU determination was performed 6 h post-treatment in the presence or absence of heat treatment. Data represent mean SEM; dotted line indicates initial inoculum.[journals.plos.org]

Prognosis

  • Transmission inhalation of spores Incubation Period one to six days Symptoms 1. initial flu-like symptoms except for the runny nose 2. hemorrhagic pneumonia and respiratory failure 3. shock and death 4. potential for long-term memory damage in survivors Prognosis[quizlet.com]
  • Based on clinical, radiologic, and microbiologic findings from these 11 patients, a new 3 level clinical staging system has been proposed [1]: STAGE NEW CLINICAL STAGING SYSTEM FOR INHALATIONAL ANTHRAX PROGNOSIS Early-prodromal stage Unchanged from original[upmc-cbn.org]
  • What is the prognosis for anthrax infections? The prognosis for anthrax infections depends on the type of infection and how rapidly antibiotic treatment is initiated.[medicinenet.com]
  • Associated conditions cutaneous anthrax most common pulmonary anthrax “woolsorter’s disease” gastrointestinal anthrax Prevention post-exposure prophylaxis 3 doses of anthrax vaccine 60 days of a single antibiotic ciprofloxacin or doxycycline are first line Prognosis[medbullets.com]
  • […] factors Working with animals, travelers, postal workers, military personnel [3] Diagnostic method Based on antibodies or toxin in the blood, microbial culture [4] Prevention Anthrax vaccination, antibiotics [3] [5] Treatment Antibiotics, antitoxin [6] Prognosis[en.wikipedia.org]

Etiology

  • Definition / general "Coal" in Greek; refers to black coloration of skin eschar Epidemiology 2,000 cases per year worldwide - 95% are skin infections Etiology An uncommon, cutaneous infection due to endospores of Bacillus anthracis, a common soil organism[pathologyoutlines.com]
  • Anthrax by Sarah Schoenfelder Disease Etiology, Characteristics, and Identification: Anthrax is a disease of microbial origin caused by the bacterium Bacillus anthracis, a Gram‐positive, endospore‐forming rod.[austincc.edu]
  • The etiology of anthrax, based on the ontogenesis of Bacillus anthracis ], Cohns Hongbin Liu; Nicholas H. Bergman; Brendan Thomasan; Shamira Shallom; Alyson Hazen; Joseph Crossno; David A. Rasko; Jacques Ravel; Timothy D. Read; Scott N.[en.wikipedia.org]

Epidemiology

  • Investigation of bioterrorism-related anthrax, United States, 2001: epidemiologic findings. Emerg Infect Dis 2002;8(10):1019-28. Brachman PS. Inhalation anthrax. Ann N Y Acad Sci 1980;353:83-93. Dr.[upmc-cbn.org]
  • Epidemiology Anthrax is usually a disease of herbivorous mammals and is caused by the bacterium Bacillus anthracis . The ability of this organism to form spores and survive for many years in a dormant state is a key feature of its epidemiology.[hps.scot.nhs.uk]
  • During the ensuing epidemiologic investigation, a previously proved case of fatal inhalation anthrax in a fifty-year-old housewife was uncovered.[nejm.org]
  • Definition / general "Coal" in Greek; refers to black coloration of skin eschar Epidemiology 2,000 cases per year worldwide - 95% are skin infections Etiology An uncommon, cutaneous infection due to endospores of Bacillus anthracis, a common soil organism[pathologyoutlines.com]
  • […] anthracis spore-forming and exotoxin-forming gram rod capsule protects against phagocytosis the only bacterial with polypeptide capsule (poly-D-glutamate) transmission inhalation of spores direct contact of spores to a skin break ingestion of spores Epidemiology[medbullets.com]
Sex distribution
Age distribution

Pathophysiology

  • . • Cannabinoids: Emerging Topics in Use and Abuse Aug 2018 2,450 views This issue reviews the pathophysiology and clinical findings associated with cannabinoid use, including acute intoxication, the recent emergence of cannabinoid hyperemesis syndrome[ebmedicine.net]

Prevention

  • A vaccine to prevent anthrax is available for people in the military and others at high risk.[icdlist.com]
  • WAS THERE A WAY TO PREVENT IT? Preventing exposure to B anthracis spores is the key to avoiding this infection. WHAT ELSE ARE WE WORRIED ABOUT? Spread of the infection![stepwards.com]
  • Antimicrobial prophylaxis is used to prevent the condition. The Centers for Disease Control and Prevention has published interim guidelines for investigation and response to Bacillus anthracis infection.[medical-dictionary.thefreedictionary.com]
  • Abstract Author Information Authors Article Metrics Metrics Inhalational anthrax is a lethal infection acquired from the inhalation of Bacillus anthracis, a pathogen classified as a Category A bioterrorist agent by the Centers for Disease Control and Prevention[journals.lww.com]
  • How can anthrax be prevented? If a person has been exposed to anthrax but is not yet sick, healthcare providers will prescribe antibiotics to prevent infection.[vdh.virginia.gov]

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