1.2010-20112nd Term 2nd Semester

2. Aerobic Gram-positive spore forming bacilli: Bacillus anthracis and other Bacillus species Bacillus anthracis Aerobic , Gram positive, Spore forming bacilli Causes anthracis, a zoonotic disease transmitted from animals tohumans Definition of Cases in anthracis diagnosticsConfirmed Case:Clinically compatible confirmed by isolation of B. anthracis based on two laboratory testsSuspected Case:Clinically compatible with one supportive lab test 3. Three forms of anthracis disease Cutaneous anthracis Usually forms black necrotic ulcer (eschar) Inhalational anthracis Hypoxia and dyspnea, often with radiographic evidence of mediastinal widening. Most serious Gastrointestinal anthracis Abdominal distress, usually accompanied by bloody vomiting and diarrhea,followed by fever, septicemia (poorly cooked meat. 4. Cutaneous anthracisVesicle development Day 2Day 4Day2Day 6 Day 10 Mediastinal Widening and Pleural Eschar formationsEffusion on Chest X-Ray in Inhalational Anthrax 5. B. anthracis:Presumptive Identificationspecimen (blood, CSF, etc.)Gram Positive Isolate on SBACapsule production Madusa Head ColonyNonHemolytic NonMotile Spores Gram stainMalachite green 6. B. anthracis: Confirmatory IdentificationIsolate Capsule DFAPhage lysisCapsule antigen Horse Bicarbonate Cell wall bloodmedia (MFadyean (MFadyean stainStain) India ink stain) 7. Recommended Post-exposure Prophylaxis toPrevent Inhalational Anthrax Initial TherapyDurationAdultsCiprofloxacin60 days500 mg PO BIDOR Doxycycline100 mg PO BIDChildren Ciprofloxacin*60 days1015 mg/kg PO Q 12 hrsChange toOR amoxicillinDoxycycline: if susceptible>8 yrs and >45 kg: 100 mg PO BID>8 yrs and 45 kg: 100 mg BID>8 yrs and 45 kg: Ciprofloxacin100 mg Q 12 hrs 1015 mg/kg Q 12 hrs >8 yrs and 45 kg: 2.2 mg/kg Q 12 hrs100 mg BID AND>8 yrs and