1. Anthrax

3. References What You Need to Know http://www.bt.cdc.gov/agent/anthrax/needtoknow.asp Frequently Asked Questions http://www.bt.cdc.gov/agent/anthrax/faq/ Questions & Answers: RISK http://www.bt.cdc.gov/agent/anthrax/faq/risk.asp

4. Epidemiology of the Disease

6. Bacillus anthracis

7. Endospore Free Spores

8. Bacillus anthracis in Skin Lesion

12. Worldwide Geographic Distribution of Anthrax

16. Classic Eschar of Cutaneous Anthrax

20. Dilemmas We Face Inhalational anthrax First, flu-like illness May resolve briefly Recrudescence is often rapidly fatal Antibiotic late in illness cannot reverse toxins Early cultures not revealing Cutaneous Anthrax Skin lesion first Lower mortality Gastrointestinal anthrax undercooked meat of ill animals Diarrhea, bloody

29. for Diagnosed Cases

30. Treatment for Exposed, Unvaccinated Individuals Penicillins Tetracyclines Fluoroquinolones Ciprofloxacin

34. Anthrax Toxin Lethal mode of action due to: Oxygen depletion Secondary shock Increased vascular permeability Which lead to respiratory and cardiac failure

35. Anthrax Toxin (cont’d) Mediated by a temperature sensitive plasmid, pX01 Three components (each a thermolabile protein) Factor 1- Edema factor (EF) Factor II- Protective antigen (PA) Factor III - Lethal factor (LF)

36. Anthrax Toxin (cont’d) PA + LF Lethal activity EF + PA Edema EF + LF Inactive PA + LF + EF Edema, necrosis and death

40. Disinfection after Attack Vegetative form 0.05% Hypochlorite solution (Chlorox) (one Tbsp bleach/gal. of water) Spores Steam sterilization Boiling for 30 min Chlorine dioxide Perhaps some gases