⚠️ Early diagnosis of Anthrax and the prompt initiation of combination antimicrobial therapy are critical for survival. 💨 Inhalational anthrax, in particular, carries a high mortality if untreated and requires immediate critical care involvement.

📖 About

🐏 Anthrax (from Greek “coal”) refers to the black eschar in cutaneous disease.
Caused by Bacillus anthracis, a spore-forming zoonotic bacterium that infects herbivores.
Transmission occurs via contaminated hides, wool, or meat; also relevant in bioterrorism.

🔬 Characteristics

Gram-positive, aerobic, spore-forming bacillus.
🌱 Spores can persist in soil/environment for decades.
🛡️ Polypeptide capsule (D-glutamic acid) is antiphagocytic.
Infection routes: skin, inhalation, ingestion → systemic disease possible.

Eschars

🌍 Source

Contaminated soil, carcasses, and animal products (hides, wool, meat).
Endemic in:
- 🌎 Central & South America
- 🌍 Sub-Saharan Africa
- 🌏 Asia & Eastern Europe
- 🌴 The Caribbean
🔺 Bioterrorism example: US anthrax letters (2001).

🧪 Virulence

🛡️ Protective antigen (PA): enables toxin entry into host cells.
☠️ Lethal factor (LF): cleaves MAP kinase → apoptosis.
💧 Oedema factor (EF): ↑cAMP → fluid leak & immune dysregulation.
Combined → necrosis, oedema, haemorrhage, immune evasion.

🧠 Pathophysiology

🤒 Clinical Forms

🖐️ Cutaneous Anthrax (~95% cases):
- Entry via skin abrasions → painless ulcer + black eschar.
- Can progress to lymphadenitis & systemic infection.
💨 Inhalational Anthrax (“wool sorters’ disease”):
- Flu-like prodrome → rapid respiratory distress, cyanosis, shock.
- Classic sign: widened mediastinum ± pleural effusion.
- Mortality >50% untreated.
🍖 Gastrointestinal Anthrax:
- From undercooked infected meat.
- Nausea, bloody diarrhoea, perforation, high mortality.
🩸 Systemic Anthrax:
- Shock, renal failure, DIC, meningitis (often haemorrhagic & fatal).

🔍 Investigations

🔬 Microscopy: Gram stain, special staining (e.g., Ziehl-Neelsen variant).
🧪 McFadyen’s reaction: polychrome methylene blue → capsule seen.
🧬 PCR & Culture: confirmatory, though culture may be slow.
📷 CXR: widened mediastinum, pleural effusions in inhalational form.
🧪 Bloods & serology: capsular antigen detection.

💊 Management (Infectious Diseases input essential)

🛡️ Prevention: vaccination in military/veterinary at-risk groups.
🚑 Supportive: ABC resuscitation, oxygen, IV fluids, ITU if severe.
💊 Antibiotics:
- First-line: Ciprofloxacin, Levofloxacin, or Doxycycline.
- Combination therapy (e.g., add aminoglycoside/rifampin).
- If susceptible: Benzyl Penicillin may be used (esp. cutaneous).
- ❌ Avoid cephalosporins (resistance).
🧴 Antitoxins: Raxibacumab (monoclonal antibody) or anthrax immunoglobulin for systemic disease.
💉 Prophylaxis: 60 days of ciprofloxacin or doxycycline after spore exposure.
➕ Corticosteroids (e.g., dexamethasone) for meningitis or airway oedema.

💊 Anthrax – Typical Antimicrobial Dosing (verify with BNF/datasheet)

Scenario	Drug & Dose
🖐️ Cutaneous Anthrax (mild, non-systemic)	Ciprofloxacin 500 mg PO BD (7–10 days) OR Doxycycline 100 mg PO BD (7–10 days) 💡 If systemic features → use IV + combination therapy.
💨 Inhalational Anthrax / Systemic infection	Ciprofloxacin 400 mg IV every 12h OR Doxycycline 100 mg IV every 12h ➕ Add 1–2 additional agents (rifampicin, clindamycin, or aminoglycoside) for synergy. Duration: ≥60 days (due to persistent spores).
🧠 Anthrax meningitis (suspected/confirmed)	Ciprofloxacin IV (as above) ➕ Rifampicin IV ➕ Clindamycin IV (Triple therapy recommended).
🧴 Post-exposure prophylaxis (PEP)	Ciprofloxacin 500 mg PO BD for 60 days OR Doxycycline 100 mg PO BD for 60 days. ➕ Anthrax vaccine where available.

📚 References

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Anthrax (Bacillus anthracis)