1. Bacillus anthracis Agent Specific Training

2. 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.

3. 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

4. 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.

5. 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)

6. 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.

7. 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

8. 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

9. 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

10. 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

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

12. 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

13. 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

14. 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