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Anthrax
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Anthrax

From MayoClinic.com

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INFECTIOUS DISEASE

Bacterial

When to seek medical advice

How would you know if you've been exposed to anthrax?

For anthrax spores to be used as a biological weapon, they must be processed into a fine, white, powder-like form that disperses in the air. Powder that contains anthrax spores can be mailed in a letter and dispersed when the letter is opened. However, a lot of innocuous substances in our environment come in powder form, from sugar to plaster dust.

If you believe that you're at risk of anthrax exposure — for example, you work in an environment where anthrax has been detected — immediately notify authorities for testing and see a doctor for evaluation and care. If you develop signs and symptoms of the disorder after exposure to animals or animal products in parts of the world where anthrax exists, seek prompt medical attention.

Screening and diagnosis

The damage of a large-scale anthrax attack — if it were to happen — wouldn't be immediately and readily apparent. It would take one or many people seeking treatment for symptoms of anthrax to raise suspicion of an attack.

If authorities suspect exposure to anthrax, field tests can help determine whether a substance contains anthrax spores or whether an area — such as a mailroom, desk or ventilation system — may be contaminated.

In addition, various tests can help doctors determine if a person has the disease.

Field tests
If you find a suspicious powder that you think may contain anthrax, immediately contact local law enforcement authorities. They can decide to bring in hazardous-material teams trained to test for materials such as anthrax.

Wearing protective suits, the team collects samples of the substance and samples from surfaces that may have been contaminated. The samples are then checked for signs of Bacillus anthracis bacteria.

Testing for anthrax occurs in stages. Initial screening tests may be performed in community hospital laboratories. But these tests aren't definitive. A confirmation test must be performed in one of the more specialized state and large metropolitan public health laboratories in the LRN. This involves incubating a sample in a lab dish containing special nutrients that spur any bacteria growth. If anthrax is found, scientists then use a DNA fingerprinting technique to identify the specific strain of anthrax, which gives clues to the geographic origin of an anthrax attack. The entire process can take many days.

A variety of rapid field tests could speed up the confirmation process, including one developed by researchers at Mayo Clinic, Rochester, Minn., and Roche Diagnostics of Indianapolis. This rapid test uses polymerase chain reaction (PCR) technology to detect the DNA of anthrax bacteria in samples collected from people or potentially contaminated areas in less than an hour. However, these tests have yet to receive approval from the Centers for Disease Control and Prevention (CDC) or the Food and Drug Administration (FDA), so they must be used in conjunction with certified confirmatory tests.

If anthrax is found in the environment, then the contaminated areas — such as a mailroom, desk or ventilation system — are sterilized with special washes.

Should you have your home or office checked for anthrax? Probably not. Hand-held home test kits for anthrax can't provide definitive results. Some U.S. companies have hired private firms to test their buildings for anthrax. But, overall, scientists say that random checking of homes and offices is neither necessary nor practical.

Human tests
In addition to examining you and inquiring about your health status and where you work, your doctor can administer tests that may determine if you have the disease. However, there's no definitive test for exposure to anthrax, in the absence of overt infection.

Your doctor will want to rule out other, much more common conditions that may be causing your symptoms, such as flu (influenza) or pneumonia. He or she may use a rapid flu test to quickly diagnose a case of influenza.

Tests to detect and diagnose anthrax include:

  • Skin biopsy. A sample of a suspicious lesion on your skin can be sent to a lab to check for microscopic evidence of cutaneous anthrax.

  • Sputum testing. To diagnose inhalation anthrax, respiratory secretions can be cultured to check for the presence of anthrax bacteria.

  • Blood tests. If you have symptoms of any form of anthrax, your doctor can take a blood sample and send it to a lab, where it can be cultured to check for the presence of anthrax bacteria. The bacteria should grow in cultures within six to 24 hours, but a laboratory in the LRN must confirm any diagnosis. A new blood serology test is also available. This test detects antibodies produced by the body in response to anthrax infection in less than one hour and may be used at hospitals and laboratories outside the LRN. But this test won't be helpful until at least one or two weeks after infection, because it can take that long for antibodies to develop.

  • Chest X-ray or computerized tomography (CT) scan. Your doctor may request a chest X-ray or CT scan to help diagnose inhalation anthrax. Since this form of anthrax infects both the lungs and lymph nodes in your chest, there's often a very characteristic appearance on the chest X-ray.

  • Endoscopy and stool samples. To diagnose intestinal anthrax, your doctor may examine your throat or intestines with the aid of an endoscope — a thin, flexible tube with a video camera at its tip that can be inserted into your throat or intestines to check for anthrax lesions. Stool samples can be tested for the presence of anthrax bacteria.

  • Spinal tap. Sometimes your doctor may need a sample of spinal fluid to confirm a diagnosis of anthrax meningitis. This involves inserting a needle into your spinal canal and drawing out fluid for testing.

Because there's no definitive test for exposure to anthrax in the absence of signs and symptoms, doctors may prescribe antibiotics for anyone who may have been exposed to a contaminated area to prevent the disease.

If a case of anthrax is suspected or confirmed, doctors have been advised to contact local and state health officials immediately. This helps alert government and health leaders — and the public — of a possible outbreak.

To help local governments prepare for an anthrax attack, the U.S. Department of Health and Human Services has provided states, cities and territories with some funding. These funds are helping to assemble emergency response teams and to build better systems for detecting an anthrax attack.

Treatment

Treatment for all three forms of anthrax centers on oral or intravenous (IV) antibiotics. Treatment is most effective when started as early as possible.

Some strains of anthrax may be more responsive to one type of antibiotic than to another. Ciprofloxacin (Cipro), doxycycline and amoxicillin are FDA approved for treatment of anthrax. However, your doctor may prescribe other antibiotics or a combination of antibiotics, including:

  • Penicillin

  • Tetracycline

  • Chloramphenicol

Antibiotics work by killing the anthrax bacteria. However, antibiotics may fail in inhalation anthrax once symptoms become severe because, by that time, the bacteria already have released large amounts of toxin that aren't affected by antibiotics. Scientists are working to develop an anthrax antitoxin that — unlike antibiotics — could neutralize the toxin produced by anthrax bacteria.

If you've been exposed to anthrax, your doctor will likely prescribe a 60-day course of antibiotics. If you have inhalation anthrax, you'll likely be hospitalized and treated with high-dose antibiotics.

Anthrax isn't spread person to person. So a person with anthrax doesn't have to be quarantined or isolated. If you were in contact with someone with anthrax, you'll need to be treated only if you were exposed to a source of anthrax infection.

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