08-01-2008, 09:37 AM
Anthrax - a guide for doctors and patients
Introduction:
Anthrax is a bacterial disease. It is caused by a bacteria that belongs to the same family as E. coli. called Enterobacteraciae. It is not a virus. Unfortunately, it has become a recent threat as it can be used for biological warfare.
The bacteria:
It is a rod shaped bacteria with rounded edges. It cannot be seen by the naked eye. Labs need a microscope to see it.
When doctors check or screen for bacteria, they stain the specimens commonly with a simple technique called gram staining. There are very few bacteria that are rod shaped and test positive on this test. Fortunately - for diagnostic purposes, anthrax bacteria test positive. This immediately raises a flag.
Modes of spread:
It is spread by its spores that can survive harsh natural conditions for years.
It may be transmitted by infected or contaminated animals and animal products, insect bites, inhalation or ingestion.
Spread of anthrax usually does not take place from person to person except where the patient has skin lesions. It could however take place by handling contaminated articles.
In the Florida cases, it seemed to be transmitted by exposure from spores that were sitting on the computer keyboard (I am looking at my own keyboard as I type this).
I do not want people to panic because Florida is currently one of the most prepared states in the United States to tackle this problem. In my own office, we have at least a hundred doses of medicines that tackle anthrax. I am sure other doctors are prepared too.
Types of disease:
It is seen in three main forms.
Skin (cutaneous), intestinal (gastrointestinal), and its most dangerous form - lung infection or pneumonia (pulmonary).
Cutaneous anthrax is the most common manifestation of infection with B. anthracis. Inhalation (pulmonary) anthrax occurs in persons working in certain occupations where spores may be forced into the air from contaminated animal products, such as animal hair processing. Occupational risk groups include those coming into contact with livestock or products from livestock, e.g., veterinarians, animal handlers, abattoir workers, and laboratorians.
A patient with this form of anthrax may present with a blister with central denting and surrounding swelling that cannot be indented.
This is full of the antrax bacteria, making it highly infective as it sheds a lot of bacteria.
The intestinal form shows up as diarrhea and fever. Fortunately the commonest family of drugs used to treat this type of illness even in the non-anthrax condition treats anthrax as well.
The lung form of the disease begins abruptly with high fever and chest pain. It quickly turns into a bleeding type of illness and is frequently fatal. These cases are not highly infective.
If untreated, anthrax in all forms can lead to the bacteria entering the bloodstream and quickly - death. Early treatment of cutaneous (skin) anthrax is usually curative, and early treatment of all forms is important for recovery. 25% to 75%. of patients with gastrointestinal (intestinal) anthrax will die. Almost 90 - 100% of those with lung anthrax will die.
Preventing disease and its spread:
Anthrax in the veterinary world commonly affects herbivorous animals. Human immunity against anthrax is higher than the herbivores. This does not mean that vegetarians are any less immune to the bacteria than non-vegetarians.
We must identify what common things that come in contact with many hands in a day's time and be cautious about their safety. I am going to list a few here.
Currency notes and coins, Paper files and inter office mail envelopes, Card swiping areas, e.g. time card machines and credit card machines, Support bars into a bus, Door knobs, Water fountains, Gas station vending handles, Vending machines, Public telephones, Perfume testers in a mall, Coins and tokens for a slot machine, Buttons at traffic signals used by pedestrians to get access, Library computers, books and video tapes, Rented video tapes, etc, Objects in churches that many people touch, etc.
Please wash your hands before you touch your mouth or nose after you touch something that may be contaminated. Avoid opening letters if you have a wound on your hands.
Treatment:
Early treatment is vital. Therefore you do not need to hoard a full course of the antibiotics that are effective but just the first dose alone.
Many good antibiotics are available that are approximately equally useful but Once symptoms of the lung form appear, fatality is high inspite of treatment.
Levaquin, Cipro, Tequin, avelox are good medicines that could be used.
Penicillin too is useful as are many other antibiotics.
Most commonly, the skin form comes along and one can treat that very effectively.
What should your doctor do?
Having been a licensed practitioner for over 10 years, practice of reasonable and economical medicine has now become second nature to me. I am not trying to say that what is outlined here is perfect but these guidelines will certainly help those who have not put in a lot of thought into this. If other doctors also put in thought into this, they will come out with similar answers.
If a patient wants to keep antibiotics at home for him and his family, he should only be offered dosing for 24 hours.
This means 2 tablets of Ciprofloxacin (Cipro) or 1 tablet of Levaquin or Avelox or Tequin. He should be told that this should be given if suspicion is high and the patient should be examined by a doctor soon.
Giving out long courses are going to create a shortage and thus further panic in the community.
If the doctor has a suspicion of anthrax in the patient, he should immediately draw and keep blood from the patient and then administer the first dose of the antibiotic immediately.
If it is a skin lesion that the doctor sees, he should take a scraping from the skin lesion and send part of it for a Gram stain and another part for culture. Antibiotic of course should be given immediately.
Doctors also should try to avoid use of these antibiotics in conditions where other antibiotics are equally effective.
What does it mean that the cases are due to genetically un-altered bacterial strains?
Since the cases had the above type of strain, it is unlikely that these are from terrorists. It is more likely that someone who has animals got that strain and now has mailed the stuff to different people across the country. One should look through veterinary records and match up people who owned animals that died of anthrax in the Tampa-bay area. I could certainly be wrong but I rarely am.
How concerned should we be about the future:
Not very. I am not an astrologer nor a psychic but seeing that these cases have been from unaltered bacteria, I feel that these are not well prepared terrorists left around. Had this attack come from well prepared terrorists, we would have seen very communicable, genetically altered anthrax strains. They would have used their biowarfare material already within this one month. Regardless, almost all doctor's offices are well prepared with antibiotics.
Vaccine:
In the civilian world, the health departments are most likely going to be the first to recieve vaccine supplies. I think that many of us doctors should volunteer and offer to give out the vaccines if that is decided by the government. Our clinic has already registered with the health department for this purpose.