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CUTANEOUS ANTHRAX Awajo.pptx

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Cutaneous anthrax is caused by Bacillus anthracis spores entering through cuts or abrasions in the skin. It presents as a painless skin lesion that progresses from a papule to a fluid-filled vesicle and then forms a depressed ulcer with surrounding edema. The ulcer forms a black eschar as it heals over 10 days. Treatment involves antibiotics such as ciprofloxacin or doxycycline for 7-10 days to prevent progression to systemic anthrax. Vaccination and antibiotic prophylaxis are recommended for those at high risk of exposure to anthrax spores.

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CUTANEOUS ANTHRAX A. Awajo
Introduction Bacterial zoonosis caused by endospores of Bacillus anthracis entering the body through cutaneous abrasions Also called malignant pustule 95% of clinical forms of anthrax Other forms- inhalation (5%), gastrointestinal (<1%) Transmission - exposure to spores while handling sick animals or contaminated wool
Etiology and epidemiology B. anthracis, a gram +ve aerobic rod Worldwide distribution and a local problem in Pakistan, India, Iran and SA Both sexes affected predominant in adult males, esp agricultural workers, veterinarians and butchers
Pathogenesis Cutaneous invasion through breaks in skin. Endospores phagocytosed by macrophages and carried to regional lymph nodes Multiply within macrophages; released and enter bloodstream Cause massive septicemia with production of edema and lethal exotoxins
Virulence factors: Bacterial capsule- poly-D-glutamic acid Toxins Lethal factor Edema factor Protective antigen
Clinical features History occupational exposure to animals or animal products PE: Skin lesions Painless pruritic papule 3-5 days after exposure Evolve to fluid filled vesicles within 24-35h Vesicles rupture to form depressed ulcers with local edema Ultimately dry black eschars 10 days Distribution- head, neck, extremities Oropharyngeal anthrax- cervical edema and local LN with dysphagia and respiratory distress
Anthrax: Cutaneous Day 4 Day 6 Day 10 Eschar formation Vesicle development Day 2
Left, Forearm lesion on day 7vesiculation and ulceration of initial macular or papular anthrax skin lesion. Right, Eschar of the neck on day 15 of illness, typical of the last stage of the lesion. From Binford CH, Connor DH, eds. Pathology of Tropical and Extraordinary Diseases. Vol 1. Washington, DC: AFIP; 1976:119. AFIP negative 71-12902. Anthrax: Cutaneous
DDX Spider bite Ecthyma gangrenosum Ulceroglandular tularemia Staphylococcal or streptococcal cellulitis Herpes simplex virus
Work Up Dx suggested by characteristic skin lesion Gram stain and culture of vesicular fluid Blood culture for immunohistochemistry Punch biopsy
Course and prognosis 20% of untreated cases result in death 80% are self limiting and resolve without scarring 10% progress to systemic anthrax Pain indicates strep or staph secondary infection
Treatment Can be self limited Antibiotic treatment is recommended DOC- ciprofloxacin PO is first-line treatment for all patients including pregnant women and children: Children: 15 mg/kg 2 times daily (max. 1 g daily) Adults: 500 mg 2 times daily doxycycline PO (except in children under 8 years and pregnant or lactating women)
Treatment Children 8 to 12 years: 50 mg 2 times daily Children over 12 years and adults: 100 mg 2 times daily clindamycin PO (e.g. in pregnant or lactating women and children less than 8 years) Children: 10 mg/kg 3 times daily (max. 1800 mg daily) Adults: 600 mg 3 times daily amoxicillin PO Children: 30 mg/kg 3 times daily Adults: 1 g 3 times daily Surgery for eschar excision is C/I
Eschar- daily dry dressings, surgery contraindicated Prevention Vaccine (BioThrax)- indicated for persons at risk of exposure to spores PEP doxy 100mg bid or cipro 500mg bid for 8 weeks; amoxicillin for children and lactating mothers

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CUTANEOUS ANTHRAX Awajo.pptx

  • 2. Introduction Bacterial zoonosis caused by endospores of Bacillus anthracis entering the body through cutaneous abrasions Also called malignant pustule 95% of clinical forms of anthrax Other forms- inhalation (5%), gastrointestinal (<1%) Transmission - exposure to spores while handling sick animals or contaminated wool
  • 3. Etiology and epidemiology B. anthracis, a gram +ve aerobic rod Worldwide distribution and a local problem in Pakistan, India, Iran and SA Both sexes affected predominant in adult males, esp agricultural workers, veterinarians and butchers
  • 4. Pathogenesis Cutaneous invasion through breaks in skin. Endospores phagocytosed by macrophages and carried to regional lymph nodes Multiply within macrophages; released and enter bloodstream Cause massive septicemia with production of edema and lethal exotoxins
  • 5. Virulence factors: Bacterial capsule- poly-D-glutamic acid Toxins Lethal factor Edema factor Protective antigen
  • 6. Clinical features History occupational exposure to animals or animal products PE: Skin lesions Painless pruritic papule 3-5 days after exposure Evolve to fluid filled vesicles within 24-35h Vesicles rupture to form depressed ulcers with local edema Ultimately dry black eschars 10 days Distribution- head, neck, extremities Oropharyngeal anthrax- cervical edema and local LN with dysphagia and respiratory distress
  • 7. Anthrax: Cutaneous Day 4 Day 6 Day 10 Eschar formation Vesicle development Day 2
  • 8. Left, Forearm lesion on day 7vesiculation and ulceration of initial macular or papular anthrax skin lesion. Right, Eschar of the neck on day 15 of illness, typical of the last stage of the lesion. From Binford CH, Connor DH, eds. Pathology of Tropical and Extraordinary Diseases. Vol 1. Washington, DC: AFIP; 1976:119. AFIP negative 71-12902. Anthrax: Cutaneous
  • 9. DDX Spider bite Ecthyma gangrenosum Ulceroglandular tularemia Staphylococcal or streptococcal cellulitis Herpes simplex virus
  • 10. Work Up Dx suggested by characteristic skin lesion Gram stain and culture of vesicular fluid Blood culture for immunohistochemistry Punch biopsy
  • 11. Course and prognosis 20% of untreated cases result in death 80% are self limiting and resolve without scarring 10% progress to systemic anthrax Pain indicates strep or staph secondary infection
  • 12. Treatment Can be self limited Antibiotic treatment is recommended DOC- ciprofloxacin PO is first-line treatment for all patients including pregnant women and children: Children: 15 mg/kg 2 times daily (max. 1 g daily) Adults: 500 mg 2 times daily doxycycline PO (except in children under 8 years and pregnant or lactating women)
  • 13. Treatment Children 8 to 12 years: 50 mg 2 times daily Children over 12 years and adults: 100 mg 2 times daily clindamycin PO (e.g. in pregnant or lactating women and children less than 8 years) Children: 10 mg/kg 3 times daily (max. 1800 mg daily) Adults: 600 mg 3 times daily amoxicillin PO Children: 30 mg/kg 3 times daily Adults: 1 g 3 times daily Surgery for eschar excision is C/I
  • 14. Eschar- daily dry dressings, surgery contraindicated Prevention Vaccine (BioThrax)- indicated for persons at risk of exposure to spores PEP doxy 100mg bid or cipro 500mg bid for 8 weeks; amoxicillin for children and lactating mothers