anthrax

Anthrax: description

The anthrax is the bacterium Bacillus anthracis. Derived from this bacterial name is also the disease term “anthrax”. The term anthrax is based on the observation that the spleen deceased at the autopsy has a brownish-burned appearance. The bacillus is able to form resistant spores and thus survive in the soil for decades. Transmission is almost exclusively via animals or animal material. A human-to-human transmission has not previously been described.

The largest known anthrax eruption was in 1979 in Yekaterinburg today. But also in Germany infections have become known again and again. In the years 2009, 2010 and 2012, several drug users fell ill in Germany and Europe. The cause was probably contaminated heroin. Anthrax occurs only sporadically in Germany.

Anthrax pathogens are also abused again and again as a bioterrorist weapon. In 2001, several letters appeared in the United States that were contaminated with the virus. It fell 22 people, five died. Thousands of people, especially Post employees, were advised to take antibiotic precautions against anthrax.

Anthrax is considered by the health authorities worldwide as a major threat in the context of both normal routes of infection and bioterrorism.

Anthrax: occurrence

The anthrax pathogen can be found in many parts of the world, but prefers warm climatic regions. He is mainly found in Africa, Central and South Asia. Even in damp areas, the pathogen can spread very well. In the soil spores of the bacterium can survive for decades. Therefore, it comes again and again to diseases in livestock, especially in grazing animals. People in industrialized countries are very rarely infected with the bacterium. Persons who are in close contact with livestock are particularly affected.

The most common form of the disease, skin anthrax, occurs around 2000 times a year, according to the World Health Organization (WHO).

Anthrax: symptoms

At the onset of the disease, the signs are not very specific to anthrax. Symptoms first affect the area that first came in contact with the bacillus. The distinction to other serious diseases is important to improve the chances of recovery through the right therapy. Depending on the route of infection, primarily various organs of anthrax may be affected:

Of the Cutaneous anthrax is the most common form of anthrax disease. The pathogen penetrates into the tissue through external injuries of the skin and begins to multiply. After one to seven days, inflammatory skin changes develop at the site of infection, which do not always cause pain. Around this point usually also liquid-filled bubbles form. Later comes black scab. In addition, the lymphatic vessels become inflamed and the lymph nodes swell. Characteristic is also a fluid-related swelling (edema) around the inflamed area. The damage in the tissue is often very heavy and can also affect deep tissue layers. For this reason, a surgical operation must be considered.

At the Pulmonary anthrax The infection usually takes place via the inhalation of the spores of the MiIzbranderregers. The time between infection and disease outbreak (incubation period) is relatively short, it only takes a few hours to days. Lungs anthrax resembles a sudden onset of pneumonia with bronchitis. This makes it difficult to diagnose anthrax early. The symptoms include a number of severe general symptoms, such as chills, vomiting and hemoptysis. The bloody sputum can be infectious. Lung anthrax is the most dangerous form of anthrax as it can cause severe respiratory problems.

The rarest form of anthrax is the Intestinal anthrax, For this purpose, the pathogen must reach the gastrointestinal tract, for example, by consuming raw or insufficiently heated meat of an infected animal. Three to seven days later, the disease breaks out. The symptoms are also initially unspecific in intestinal anthrax: Patients get high fever, combined with diarrhea, nausea, vomiting and loss of appetite. Later, severe bleeding may occur in the intestine, resulting in bloody diarrhea. The disease can pass into peritonitis, which is very difficult to control even with massive therapy.

Of the injection anthrax is a special form of anthrax. It mainly affects drug users injecting drugs into the vein. Some cases have been associated with spore-contaminated heroin. Injected anthrax causes massive edema and abscesses with severe inflammation beginning around the injection site. Tissue areas can die off and require rapid surgical intervention. The symptoms start very variable between one and ten days after the injection.

In a particularly severe case, the anthrax virus can spread throughout the body and cause further damage to organs. For example, anthrax infection can lead to severe meningitis (meningitis).

Anthrax: causes and risk factors

The cause of anthrax is Bacillus anthracis. There are two forms of bacteria. Particularly dangerous in the active form are its protective capsule and the ability to produce toxins. These toxins can damage the blood vessels, leading to bleeding. In addition, the anthrax pathogen forms spores as a second form. These are inactive forms of the anthrax pathogen that can survive in the soil for decades.

Anthrax is considered a zoonosis. This refers to infections that are transmitted from animals to humans or vice versa. The bacillus is common in livestock. The animals pick up the spores from the soil and thus become infected with anthrax. In the body of the animals, the inactive spore form changes back to the active form of the bacillus.

Human beings become infected mainly through direct contact with the anthrax pathogen, more rarely via their spores. It is believed that the outbreak of cutaneous burning requires previous damage, such as a wound or injury. Due to the intact skin, the bacillus can not penetrate. For this reason, insect bites play a crucial role. 95 percent of infections with anthrax affect the skin.

Anthrax: examination and diagnosis

It is important that the diagnosis is made early in anthrax. Because the disease is basically life-threatening. However, severe treatment can often be averted by early treatment. Therefore, the medical history should be accurately determined by the doctor. In addition to the question of the first symptoms, this also includes whether the person concerned, for example, has close contact with livestock or their flesh. For drug users, the doctor will always think of the possibility of an injection anthrax if symptoms are present.

The pathogen detection can be done in different ways. From wounds will be taken a smear. In addition, patients should also be sampled for blood samples to create so-called blood cultures. Through various laboratory methods, the bacillus can be detected directly and indirectly. The investigations should be carried out, if possible, in so-called reference centers for anthrax, where a special knowledge of the pathogen exists. Under the microscope, the appearance of the anthrax pathogen is typical. In further investigations also different strains can be identified. In the further course also antibodies can be detected.

Anthrax: treatment

An early start of treatment is crucial for the chance of recovery. The basis for the treatment of anthrax is a high-dose antibiotic combination. In severe cases, these agents should be given intravenously to carry them even faster and more efficiently into tissues and potentially affected organs. For severe skin-soft tissue infections, the affected tissue must be surgically removed.

If other therapies fail, or if the disease is particularly severe, experimental antibodies (anthrax immunoglobulin) may also be administered to the bacillus toxins. However, not all data are yet available on the efficacy of such therapy. Heavily ill anthrax patients are usually treated in intensive care units and specially monitored.

Anthrax prevention

For the prevention of anthrax, direct skin contact with animals and (raw) animal raw materials should be avoided. Condition for infection via the skin is at least a minor skin injury. Intestinal anthrax, on the other hand, results from the intake of raw meat from infected animals. This is very rare in industrialized countries.

A direct transmission of the pathogen from person to person has not been described. However, it can not be ruled out. Therefore, patients suffering from anthrax should be isolated and increased protective measures taken in contact with infected persons. Already the suspicion of an anthrax infection must be reported under name to the health department and from there to the responsible in Germany for infectious diseases Robert Koch Institute.

If people are at particularly high risk of infection, preventive treatment with antibiotics can take place without any indication of infection for about ten days. In some countries, a vaccine is offered for high-risk individuals with anthrax infection. However, this is not available in Germany. Animals, however, are vaccinated more often preventively.

A comparatively higher risk of infection exists above all in Africa as well as in Central and South Asia. This includes areas where the annual average temperature is high. There is special care in dealing with animals and their meat is required.

A vaccine against the anthrax pathogen is not available in Germany.

Anthrax: Disease course and prognosis

Anthrax is a serious condition that can be severe despite targeted antibiotic therapy. Due to the often unspecific symptoms at the beginning of the disease, it is particularly important to consider a possible anthrax infection early.

The prognosis of anthrax depends on the route of infection and the affected body region. In the most common form, the skin anthrax, with sufficient therapy, less than one percent of the patients die. Without antibiotic treatment, on the other hand, up to 25 percent die off.

Particularly dangerous is the lung anthrax, to which almost all sufferers fall victim without therapy after three to six days. Even if a therapy is initiated in time, around half of all patients die in intestinal and lung anthrax. The forecast is only slightly better for the injection milking. Here, even under therapy, around every third patient dies.

If the treatment starts, the regression of the symptoms, especially of the skin, can take days to weeks. For this reason, antibiotic therapy should not be prematurely stopped because of apparent ineffectiveness.

Also long-term consequences of anthrax are described. These include above all increased fatigue and rapid physical exhaustion.