Bacillus anthracis Agent Specific Training

Bacillus anthracis Introduction Anthrax is caused by the large Gram-positive, rod-shaped, spore-forming bacterium, Bacillus anthracis. Anthrax can be found naturally in the soil. most common in agricultural regions of Central and South America, Africa, Asia, Europe and the Caribbean Domestic and wild animals are infected by breathing in spores or ingesting spores from contaminated soil, plants or water.

Bacillus anthracis Introduction Anthrax infection in the US is rare due to yearly livestock vaccination programs, but sporadic outbreaks do occur in grazing animals like cattle and deer. Drought → Rain → Spores come to surface ↓ Inhaled or Ingested Humans become infected by breathing in spores, eating food or drink contaminated with the spores, or by handling infected meat/carcasses where spores get into cuts or scrapes in the skin. CDC PHIL 275

Anthrax as an agent of bioterrorism Bacillus anthracis Anthrax as an agent of bioterrorism Anthrax spores can: be found in nature be produced in a lab last for a long time in the environment be released quietly, via powders, sprays, food and water. Anthrax spores are unable to be seen, smelled or tasted. Anthrax spores have been used before as a weapon.

Anthrax as an agent of bioterrorism Bacillus anthracis Anthrax as an agent of bioterrorism 2001 powdered anthrax spores deliberately put into letters mailed through US postal service CDC PHIL 22 people got anthrax and 5 died (12 mail handlers)

Bacillus anthracis Clinical Presentations Type of disease depends on how anthrax enters the body Cutaneous - spores enter through cuts in the skin. Those handling infected animals or animal products such as wool, hides, or hair are most at risk. Inhalation – spores enter through the lungs. Those who work in wool mills, slaughterhouses and tanneries are most at risk. Gastrointestinal – spores are ingested. Those who eat raw or undercooked meat from infected animals are most at risk. Injection – spores are injected. Recently identified route in heroin-injecting drug users in northern Europe. No cases reported in US.

Cutaneous Anthrax * most common but least dangerous Bacillus anthracis Cutaneous Anthrax * most common but least dangerous Signs and symptoms Develop 1-7 days post exposure Small group of blisters or bumps that itch followed by: papular lesion that turns vesicular subsequent development of black eschar within 7–10 days of initial lesion Most often located on face, neck, arms or hands. With treatment, almost all patients survive. CDC Home

Inhalation Anthrax * most deadly form Bacillus anthracis Inhalation Anthrax * most deadly form Signs and symptoms Initial symptoms 1-7 days post exposure but could take up to 2 months. Starts in lymph nodes of chest then spreads causing severe breathing problems and shock. Subsequent phase 1 to 5 days after onset of initial symptoms, may be preceded by 1–3 days of improvement abrupt onset of high fever and severe respiratory distress, and shock, death within 24–36 hours. Telltale sign is widening of mediastinum on chest x-ray. With aggressive treatment, about 55% of patients survive. CDC Home

Gastrointestinal Anthrax * Rare in US Bacillus anthracis Gastrointestinal Anthrax * Rare in US Signs and symptoms Initial symptoms 1-7 days post exposure. Once ingested, spores affect throat, esophagus, stomach and intestines. With proper treatment, 60% of patients survive. CDC Home

Bacillus anthracis Injection Anthrax * Northern Europe, no reports in US as of September 2015 Signs and symptoms Similar to cutaneous anthrax, but infection may be deep under skin or in the muscle. Can spread faster and be harder to recognize and treat than cutaneous anthrax. Multiple common types of bacteria that cause infection at an injection site. CDC Home

Bacillus anthracis Sample Types B. anthracis may be found in clinical specimens -Blood Culture -Serum -Pleural fluid -Vesicular Fluid -Tissue -Sputum

General Characteristics Bacillus anthracis General Characteristics Gram Stain Large gram positive rods Short chains from patient specimens Long chains from culture Decolorization increases with age of culture Spores increase with age of culture PHIL CDC

Bacillus anthracis General Characteristics Growth within 15 to 24 hrs on SBA & CHOC, but not MAC 2-5 mm frosted/ground glass appearance Flat or slightly raised colonies White to gray color colonies Tenacious (will stand when teased with a loop) Non-motile Non-hemolytic Catalase Positive – tube method recommended by ASM PHILCDC

Bacillus anthracis Tests Performed by BTEP Culture All work should be performed using BSL-3 practices Culture Traditional biochemicals Gamma phage Capsule Real Time PCR Antibiotic resistance (Etest) NCSLPH