Prevention of infection spread (epidemiological control)
Patients with suspected anthrax pose a serious epidemiological threat, especially when pulmonary forms develop. The presence of hemoptysis indicates massive external dissemination of the pathogen into the environment.
To prevent nosocomial spread of this particularly dangerous infection, it is necessary to:
- Immediately isolate the severely ill patient in a negative-pressure isolation room in the ICU based strictly in an infectious diseases hospital.
- Thoroughly collect epidemiological history in patients with acute febrile conditions. Special attention is paid to high-risk occupations (market workers), recent contact with livestock products (e.g., purchasing items made of goat down or raw wool), as well as arrival from other regions (transit passengers).
Prevention of iatrogenic generalization (surgical errors)
One of the fatal mistakes in managing patients with cutaneous forms of anthrax is attempting surgical treatment. Often, the primary lesion is mistakenly taken for a furuncle, erysipelas, or phlegmon.
Surgical hazard: Surgical intervention (opening a vesicle or carbuncle) is strictly contraindicated. Such manipulation destroys the local barrier and provokes rapid generalization of the process. In the postoperative period, the patient develops:
- Further avalanche-like spread of edema to the face, neck, and chest.
- Development of acute respiratory and cardiovascular failure.
- Onset of a massive hemorrhagic syndrome.
Upon revision of an anthrax lesion, the surgeon never obtains purulent discharge—the exudate is exclusively serosanguinous in character.
Clinical signs and diagnosis of anthrax sepsis
If the generalization of the infection cannot be prevented, anthrax sepsis develops. Its key markers are:
- Pronounced, rapidly progressive intoxication.
- Hepatosplenomegaly (combined enlargement of the liver and spleen).
- Appearance of meningeal signs.
To confirm the diagnosis, a comprehensive examination is performed:
- Specific laboratory tests: bacteriological examination of blood, CSF, sputum, and carbuncle contents (including bacterioscopy and culture on selective media), biological assay, serological diagnosis.
- General clinical laboratory tests: monitoring of blood gas, electrolyte, acid-base, and biochemical balance.
- Instrumental methods: radiography and ultrasound (US) of the chest and abdominal organs.
Differential diagnostic marker: unlike the causative agent of pneumonic plague, which shows colony growth in 24–48 hours, the anthrax pathogen grows on media much faster—within 6–24 hours.
Intensive care tactics
Due to the extremely unfavorable prognosis caused by the rapid development of shock and multiple organ dysfunction syndrome, treatment is initiated immediately.
- Antibacterial therapy: is prescribed empirically (before official laboratory results are received) for vital indications. Intravenous administration of a combination of several antibacterial drugs is mandatory.
- Pathogenetic treatment: aimed at combating shock. Includes massive detoxification, correction of homeostasis disorders, as well as respiratory and hemodynamic support via hardware and medications.
Differential diagnosis scope
For timely isolation and correct initiation of treatment, anthrax must be differentiated from a number of other pathologies.
When pulmonary syndrome develops (acute flu-like onset, hemoptysis, progressive hypoxia), the following must be ruled out:
- Severe influenza;
- Severe acute respiratory syndrome (SARS);
- Legionellosis;
- Polysegmental pleuropneumonia;
- Pneumonic plague.
In cases of local edema of the face and neck (even if dense, sharply painful, or, conversely, painless with hemorrhagic infiltration), the process should be differentiated from facial erysipelas, conventional furuncles, and phlegmons.
Briefly: answers to topical questions
Which specific microorganism is the causative agent of anthrax?
The causative agent of anthrax is a specific microorganism—the bacterium Bacillus anthracis. This pathogen is capable of forming extremely resistant spores that withstand adverse environmental conditions. Upon diagnosis, the presence of the disease is confirmed by isolating a pure culture of this pathogen from clinical material when seeded on nutrient media, as well as by detecting its antigens or genetic material using modern immunological and molecular methods.
Which specific antibacterial drugs are used for etiotropic treatment of anthrax?
For the etiotropic treatment of anthrax, the sources indicate: ciprofloxacin for the uncomplicated cutaneous form as the drug of choice; latest-generation fluoroquinolones with equivalent efficacy against B. anthracis—levofloxacin, moxifloxacin, trovafloxacin; doxycycline as an alternative drug; penicillins only upon proven sensitivity of the isolated strain—procaine benzylpenicillin, phenoxymethylpenicillin, amoxicillin. For severe and complicated forms, localization of the primary affect on the face and neck, widespread edema, or generalization of the infection, intravenous combination antibacterial therapy is indicated.
Which professions, besides market workers, are in the high-risk group for anthrax infection?
The high-risk group for anthrax infection includes rural residents and workers in contact with animals: veterinarians, milkmaids, hunters, meat-packing plant employees. Risk is also associated with contact with animal raw materials and finished products derived from them: hides, skin, hair, wool, bristles, bones; sources cite an example of working in a sheepskin tanning enterprise. The historical occupational name for anthrax is "ragpicker's disease".
Important rule for differentiating the cutaneous form: "NO PUS — DO NOT OPEN!". Unlike a furuncle, the vesicle in anthrax contains only serosanguinous exudate, and a scalpel will lead to sepsis.
Class and exam questions
How does pulmonary anthrax differ from plague in laboratory settings?
When cultured on selective media, the growth of the anthrax pathogen is recorded very quickly—in 6–24 hours. The plague pathogen requires 24 to 48 hours to grow.
Which symptoms indicate the development of anthrax sepsis?
Generalization of the infection is accompanied by severe intoxication, enlargement of the liver and spleen (hepatosplenomegaly), and the appearance of meningeal signs.
Is it acceptable to wait for culture results before prescribing antibiotics?
No. Due to the rapid development of multiple organ dysfunction syndrome, combination intravenous antibacterial therapy is prescribed strictly empirically, before laboratory data are received.
What else to study on this topic
- Pathogenesis of infectious-toxic shock in particularly dangerous infections
- Protocol for setting up and evaluating the results of a biological assay
- Differential diagnosis of erysipelas and anthrax carbuncle
- Mechanisms of hemorrhagic syndrome formation in sepsis
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