NCM 112: MEDICAL-SURGICAL NURSING
LECTURE 4: ANTHRAX | 1ST SEMESTER A.Y. 2023-2024
ANTHRAX From I to 7 days, although incubation periods up
to 60 days are possible. (In the Sverdlovsk
Is an infection caused by bacillus anthrasis that outbreak, incubation periods extended up to 43
occurs primarily in herbivores. Aeresolized spores days.)
of B. antracis have the potential for use in
biological warfare or bioterrorism. MODE OF TRANSMISSION
Anthrax can enter the human body through
The word anthrax is derived from the Greek word the intestines (ingestion), lungs
anthrakis, or "coal", in reference to the black skin (inhalation), or skin (cutaneous). Anthrax
lesions victims develop in a cutaneous skin is non-contagious and is unlikely to spread
infection. from person to person.
MORTALITY/MORBIDITY Pulmonary (pneumonic, respiratory, or
inhalation) anthrax
Most cases are cutaneous anthrax, are mild, and
resolve with/without treatment. However, other SIGNS AND SYMPTOMS
forms of anthrax are potentially fatal.
Fever
SEPTICEMIC ANTHRAX AND Dyspnea
INHALATION ANTHRAX Cough
have the highest mortality. Inhalational anthrax is Headache
a rapid fulminating disease that nearly always is Vomiting
fatal with or without antibiotic therapy (mortality
Chills weakness
rate >90%).
Abdominal pain
CUTANEOUS ANTHRAX Chest pain
is readily curable if treated early with appropriate CUTANEOUS ANTHRAX
antibiotics (mortality rate <1%).
In the most common cutaneous form of anthrax,
spores inoculate a host through skin lacerations,
INTESTINAL ANTHRAX
abrasions, or biting flies. Incubation is 2-5 days.
is difficult to diagnose and is associated with
higher morbidity (mortality rate 20-60%). Differential diagnoses of the skin lesion include
tularemia, plague, cutaneous diphtheria,
CAUSATIVE AGENT Staphylococcus infections, Rickettsia infections,
and orf (a viral disease of livestock).
Bacillus anthracis is a rod-shaped Gram-positive
bacterium of size about 1 by 6 micrometres. It was Cutaneous anthrax usually remains localized, but
the first bacterium ever to be shown to cause without treatment, it disseminates systemically in
disease, by Robert Koch in 1877. The bacteria up to one fifth of cases. Antibiotic therapy
normally rests in spore form in the soil, and can prevents dissemination but does not affect the
survive for decades in this state. Once ingested by natural history of the lesion. With treatment, the
an herbivore, the bacteria begins multiplying mortality rate is approximately 1%.
inside the animal and eventually kills it, then
continues to reproduce in the carcass. Once the
bacteria consume the host nutrients, they revert to INHALATION ANTHRAX
a dormant spore state Inhalational anthrax usually occurs in textile and
tanning industries among workers handling
INCUBATION PERIOD contaminated animal wool, hair, and hides.
NCM 112: MEDICAL-SURGICAL NURSING
LECTURE 4: ANTHRAX | 1ST SEMESTER A.Y. 2023-2024
then carried to hilar and mediastinal lymph nodes. DIAGNOSTIC EXAMS
Incubation is 1-6 days.
Blood culture and Gram stain are high yield
GASTROINTESTINAL ANTHRAX tests in infected persons who have not taken
antibiotics. A Gram stain is the easiest means
GI anthrax is a rare form of infection. It occurs
of initially identifying suggested cases.
from eating infected, undercooked meat. Only 11
Anthrax appears as a large gram-positive rod.
cases have been reported, all in underdeveloped
In October 2001, blood cultures were positive
countries.
for anthrax in all 8 patients who did not
Anthrax toxin further causes intrinsic renal failure receive antibiotics.
independent of prerenal azotemia.
NURSING DIAGNOSIS
Death is rapid without antibiotic therapy and
Anxiety
aggressive volume resuscitation. Mortality is 50%.
Altered nutrition
OROPHARYNGEAL ANTHRAX Altered body temperature
– Oropharyngeal anthrax is a more common Impaired physical mobility
form of GI anthrax and has occurred in Alteration in body elimination
epidemic settings. Altered nutrition: less than body
requirement
– Typically, 2 days after ingestion of infected
meat, fever and neck swelling occur in the MEDICAL MANAGEMENT
presence of an oral cavity lesion. The lesion
starts as an edematous area that becomes DRUG OF CHOICE
necrotic and forms a pseudomembrane within Penicillin has been the drug of choice for
2 weeks. Sore throat, dysphagia, respiratory years and remains effective, even for the
distress, and oral bleeding also occur. Soft infections we have all read about recently.
tissue edema and dramatic cervical lymph Other drugs from the penicillin family such as
node enlargement follow. amoxicillin should be equally effective.
MENINGEAL ANTHRAX Doxycycline, one of the tetracycline family of
antibiotics – and most recently listed as the
– Meningeal anthrax is usually the
CDC’s drug of choice in treating anthrax, is
result of bacteremia from the
also effective.
cutaneous, GI, or inhalational form
of the disease. It also has occurred Ciprofloxacin – more commonly known as
without a primary focus. Cipro – is one of the quinolone antibiotics and
is also effective.
COMPLICATION
Patients with cutaneous anthrax have a NURSING INTERVENTION
persistent circular scar at the point of With cutaneous anthrax, 80% of patients
eschar formation. who are not treated recover. However, a
fatal outcome is the rule in inhalational,
Patients with inhalational, oropharyngeal,
meningeal, or septicemic anthrax.
or cutaneous (neck) anthrax may develop
an airway obstruction. Antimicrobial therapy renders lesions
culture-negative within hours, but the
Patients with septicemic anthrax may
lethal effects of anthrax are related to the
develop overwhelming toxicity or shock.
effects of the organism's toxin.
Patients with inhalational anthrax also
Perform a tracheostomy on patients with
often develop hemorrhagic
anthrax involving the head or neck who
leptomeningitis.
NCM 112: MEDICAL-SURGICAL NURSING
LECTURE 4: ANTHRAX | 1ST SEMESTER A.Y. 2023-2024
have respiratory compromise. This
procedure ensures the patient has an
adequate airway.
Treat patients with hemorrhagic
mediastinitis and pulmonary edema
resulting from inhalational anthrax who
are on a ventilator with cardiopulmonary
supportive measures and appropriate
antimicrobial therapy.
DETERRENCE/PREVENTION
ANTHAX VACCINE
– A vaccine exists but is not readily available.
– Administer human anthrax vaccine in a dose
of 0.5 mL subcutaneously, and repeat at 2
weeks and at 1, 6, 12, and 18 months
following the initial immunization.
– Administer a booster of 0.5 mL of human
anthrax vaccine annually. Administer to
individuals who have exposure to anthrax-
containing animals or animal products.
– Assess the efficacy of the vaccine using the
anthracin skin test.
CHEMOPROPHYLAXIS
- To prevent infection from aerosolized spores
of B anthracis, use amoxicillin or doxycycline
chemoprophylaxis 60 days postexposure.
- Alternatively, any quinolone may be used for
postexposure chemoprophylaxis.
