clinical features epidemiology lab diagnosis prophylaxis treatment k.vanya
DESCRIPTION
CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya. Clinical features . Clinical features of B.anthracis:. Anthrax is a zoonotic disease. Anthrax “coal” ,comes from black colour of eschar - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/1.jpg)
CLINICAL FEATURESEPIDEMIOLOGYLAB DIAGNOSISPROPHYLAXISTREATMENT
k.vanya
![Page 2: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/2.jpg)
Clinical features
![Page 3: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/3.jpg)
Clinical features of B.anthracis:Anthrax is a zoonotic disease.Anthrax “coal” ,comes from black
colour of escharRoute of infection: ingestion / inhalation of
spores /it may enter directly through skin.Infective material: discharges from mouth ,
nose &rectum of infected animals.The large no. of bacilli present in those
discharges sporulate in soil and remain as source of infection.
Direct spread from animal to animal is rare.
![Page 4: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/4.jpg)
![Page 5: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/5.jpg)
it causes fatal septicemia, but some times it is localized/resemble cutaneous diseases in humans.
acquired from animals directly / indirectly.Based on clinical features, Anthrax is divided into 3 types
cutaneous pulmonary intestinal All these lead to fatal septicemia/meningitis
![Page 6: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/6.jpg)
Cutaneous anthraxAlso called “hide porter’s disease”, as it is
common in dock workers,Route of infection: infection enter through
abraded skin.◦Also by shaving brushes made of animal hair
Usual sites: face,neck,hands,arms&back Lesion starts as papule 1-3 days after
infection
becomes vesicular (fluid clear/blood stained)
![Page 7: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/7.jpg)
![Page 8: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/8.jpg)
![Page 9: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/9.jpg)
Malignant pustule:The whole area congested,
edematous & several satellite lesions filled with yellow fluid/serum arranged around central necrotic lesion which is covered by black eschar.
resolves spontaneously.Complications: 10-20% develop fatal
septicemia/meningitis
![Page 10: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/10.jpg)
Malignant pustuleCongested
Edematous
Satellite lesions
![Page 11: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/11.jpg)
Pulmonary anthraxAlso called “wool sorter’s disease”.Because it is common in wool
factories.Route of infection: due to inhalation
of dust from infected wool.More severe than others.Complications:
hemorrhagic pneumonia (common) hemorrhagic meningitis(rare)
![Page 12: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/12.jpg)
![Page 13: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/13.jpg)
Intestinal anthraxRareMainly in primitive communities
i.e. who eat dead bodies of animals died of anthrax.
Complication: violent enteritis with bloody
diarrhea with high fatality rate
![Page 14: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/14.jpg)
![Page 15: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/15.jpg)
industrial Based on occupation non-industrial
Industrial: such as meat packing/wool factories.
Non-industrial: associated with animals(butchers
&farmers)
![Page 16: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/16.jpg)
Rarely stomoxys calcitrans –biting insect transmit infection mechanically.
![Page 17: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/17.jpg)
Epidemiology:Rare in western countriesLarge epidemics
russia&zimbabwe(1978-80)
Recently visakha agency has outbreaks of cutaneous anthrax
Andhra –tamilnadu region
Cutaneous,meningoencephalitic infections
![Page 18: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/18.jpg)
Laboratory diagnosis
1)microscopy 2)culture
3)Animal inoculation 4)Serological
demonstration of anthrax Ag in
tissueType of test
based on availability
of specimens
![Page 19: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/19.jpg)
Specimens: swab, fluid/pus from pustule-cutaneous anthrax
Sputum-pulmonary anthrax.Blood-septicemia anthrax.
![Page 20: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/20.jpg)
Microscopy:Gram positive bacilli arranged in
large chains.
![Page 21: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/21.jpg)
Capsule --Clear halo around bacillus in Indian ink preparation
![Page 22: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/22.jpg)
Direct flourescent antibody test: capsule specific staining for poly saccharide Ag
Mc fadyean’s reaction :Amorphous purple material – characteristic of B.anthracis.
Employed for presumptive diagnosis in animals
![Page 23: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/23.jpg)
Mc fadyean’s reaction
![Page 24: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/24.jpg)
Culture : inoculated on nutrient agar incubate at 37 c for overnight.
-medusa head coloniesGelatin stab culture : inverted fir
tree
![Page 25: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/25.jpg)
Animal inoculation : white mouse / guinea pigs injected with exudate /culture
Animal dies in 48 hrs
![Page 26: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/26.jpg)
Serology ( Ascoli Thermo Precipitin Test ):
Tissues are ground up in saline and boiled for 5
mins and filtered. Then this extract layered over
anti anthrax serum in a narrow tube.
+ve case :ring of precipitate appears at junction of two liquids with in 5minutes.
mainly used for rapid diagnosis
when sample received is putrid and viable bacilli less likely found
![Page 27: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/27.jpg)
CDC(centers for disease control)guide lines:
Any large gram positive baciili with general morphology, cultural features of anthrax-non motile, on hemolytic on blood agar,catalase positive given presumptive report as anthrax.
Initial confirmation-lysis by gamma phage,DFA test.
Further confirmation:PCR test
![Page 28: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/28.jpg)
Other methods :Polymerase chain reaction : used
for conformation of anthrax bacilli.
ELISA assay for antigen detectionX-ray and CT scanLysis by gamma phage
![Page 29: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/29.jpg)
PROPHYLAXIS:General methods : improvement of factory hygiene proper sterilization of animal
products , carcasses of animals suspected to have anthrax are buried deep in lime.
![Page 30: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/30.jpg)
Active immunizationSpore is common infective formSterne vaccine contains spores of
non capsulated avirulent mutant strain
Animal is protected for a year with single injection of spore vaccine
Extensively used in animalsNot safe for human use
![Page 31: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/31.jpg)
Contd….Alum precipitated toxoid
prepared from protective antigens used in persons occupationally exposed to anthrax infection.
Safe and effective in humansGiven in 3 doses IM at intervals
of 6 weeks
![Page 32: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/32.jpg)
Treatment:Before 2001, 1st line of treatment
was penicillin G◦ Stopped for fear of genetically
engineered resistant strains60 day course of antibioticsCiprofloxacin
◦ fluoroquinolone◦ 500 mg tablet every 12h or 400 mg
IV every 12h ◦ Inhibits DNA synthesis
Doxycycline◦ 6-deoxy-tetracycline◦ 100 mg tablet every 12h or 100 mg
IV every 12h ◦ Inhibits protein synthesis
![Page 33: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/33.jpg)
For inhalational, need another antimicrobial agent◦ clindamycin ◦ rifampin ◦ chloramphenicol
Anthrax infection gives permanent immunity&2nd attacks are rare.
![Page 34: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/34.jpg)
![Page 35: CLINICAL FEATURES EPIDEMIOLOGY LAB DIAGNOSIS PROPHYLAXIS TREATMENT k.vanya](https://reader035.vdocuments.net/reader035/viewer/2022062813/56816625550346895dd98064/html5/thumbnails/35.jpg)
THANK YOU