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 Bioterrorism  Holistic-online.com

Frequently Asked Questions About Anthrax

What is anthrax?

What does anthrax look like? 

What is the difference between exposure to B. anthracis and disease caused by B. anthracis?

How much anthrax does it take to make someone sick?

How is anthrax diagnosed?

What are the signs and symptoms of anthrax?

What are the fatality rates for the various forms of anthrax?

What is the average risk of contracting anthrax?

If anthrax is on the ground, can I get it from kicking up dust?

What can the average person do to protect himself/herself?

Can a person get screened or tested for anthrax?

Is anthrax contagious?

What should an individual do about suspicious mail?

If a patient is suspected of being exposed to anthrax, should he or she be quarantined or should other family members be tested?

Treatment

What drugs are FDA approved for PEP and treatment?

What is ciprofloxacin?

What are the side effects of ciprofloxacin?

What is doxycycline?

What are the side effects of doxycycline?

What are the alternative drugs that may be effective against anthrax attacks?

What is anthrax?

Bacillus anthracis, the etiologic agent of anthrax, is a large, gram-positive, non-motile, spore-forming rod-shaped bacteria. The three virulence factors of B. anthracis are edema toxin, lethal toxin, and a capsular antigen. Human anthrax has three major clinical forms: cutaneous, inhalation, and gastrointestinal. If left untreated, anthrax in all forms can lead to septicemia and death.

See Also:

What does anthrax look like? 

In its most destructive form -- an aerosol sprayed into the air -- it is invisible and odorless. Anthrax spores can only be seen through a microscope that magnifies 50 to 100 times.

What is the difference between exposure to B. anthracis and disease caused by B. anthracis?

A person is exposed to B. anthracis when he or she comes in contact with the anthrax bacteria or is present in an environment that contains B. anthracis. A person can be exposed without having disease. Disease caused by B. anthracis occurs when there is some sign of illness, such as the skin lesion that occurs with cutaneous anthrax. A person who is exposed to B. anthracis but given appropriate antibiotics can avoid getting anthrax.

How much anthrax does it take to make someone sick?

According to CDC, roughly 8,000-10,000 spores are needed to be inhaled to make a fatal exposure. However, other experts claim that there is no such thing as a "safe exposure limit" for today's dry, fine anthrax powder. According to them even few spores may make you sick.

See Also: There May Not Be "A Safe Dose for Anthrax Exposure"

How is anthrax diagnosed?

Anthrax is diagnosed by isolating B. anthracis from the blood, skin lesions, or respiratory secretions or by measuring specific antibodies in the blood of persons with suspected cases.

What are the signs and symptoms of anthrax?

Anthrax exposures can be classified into three types based mainly on the route of entry of the anthrax into the human body and some of the clinical manifestations or the symptoms. Symptoms of disease vary depending on how the disease was contracted, but symptoms usually occur within 7 days. 

Cutaneuous anthrax, where your skin surface is exposed to anthrax and you develop a skin lesion.

The incubation period ranges from 1-12 days. The skin infection begins as a small papule, progresses to a vesicle in 1-2 days followed by a necrotic ulcer. The lesion is usually painless, but patients also may have fever, malaise, headache, and regional lymphadenopathy. Most (about 95%) anthrax infections occur when the bacterium enters a cut or abrasion on the skin.

Skin infection begins as a raised bump that resembles a spider bite. It really looks like a swelling on the skin. It can appear anywhere on your body; but often appears on the arms or hands. Lymph glands in the adjacent area may swell. The swelling then develops a central area of ulceration of a depression, and then a scab or eschar, a very dark, blackish-brown scab (1-3 cm in diameter) forms over that central area. It can be painless and it may or may not been accompanied by a fever.

About 20% of untreated cases of cutaneous anthrax will result in death. Deaths are rare if patients are given appropriate antimicrobial therapy.

Inhalational anthrax is the most lethal form of anthrax and results from inhaling spores of the bacteria. The incubation period of inhalational anthrax among humans is unclear, but it is reported to range from 1 to 7 days, possibly ranging up to 60 days.

When a person inhales the spores, it become lodged in the lungs. There, they are picked up by immune-system cells called macrophages, which carry them to the lymph nodes. On the way, the spores mature into bacteria.

The bacteria multiply in the lymph nodes and then enter the bloodstream.
They produce a poison that causes the immune system to produce lethal doses of chemicals that are ordinarily useful to the body.

Initial symptoms of inhalational anthrax may resemble those of a common cold, such as sore throat, mild fever, muscle aches, and malaise. After several days, the symptoms may progress to severe breathing problems and shock, with meningitis frequently developing. Inhalation anthrax is often fatal.

See Also: Inhalational Anthrax

There May Not Be "A Safe Dose for Anthrax Exposure"

Gastrointestinal anthrax usually follows the consumption of raw or undercooked contaminated meat and has an incubation period of 1-7 days. 

Gastrointestinal anthrax is associated with severe abdominal distress followed by fever and signs of septicemia. It is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, and fever are followed by abdominal pain, vomiting of blood, and severe diarrhea. 

Intestinal anthrax results in death in 25% to 60% of cases. The disease can take an oropharyngeal or abdominal form. Involvement of the pharynx is usually characterized by lesions at the base of the tongue, sore throat, dysphagia, fever, and regional lymphadenopathy. Lower bowel inflammation usually causes nausea, loss of appetite, vomiting and fever, followed by abdominal pain, vomiting blood, and bloody diarrhea.

What are the fatality rates for the various forms of anthrax?

According to CDC, early treatment of cutaneous anthrax is usually curative, and early treatment of all forms is important for recovery. 

Patients with cutaneous anthrax have reported fatality rates of 20% without antibiotic treatment. But the fatality rates drops to less than 1% with antibiotic treatment. So, it is very important that you get prompt treatment is you suspect exposure to anthrax bacteria.

We have incomplete information about the fatality rates in case of inhalational anthrax. Unfortunately, the fatality rate, in this case, is extremely high even when appropriate antibiotics are given. We also do not know the impact of the delay in post-exposure prophylaxis or treatment on survival in this type of exposure.

For gastrointestinal anthrax, the fatality rate is estimated to be 25%-60%. We do not know how early antibiotic treatment affects that fatality rate.

What is the average risk of contracting anthrax?

The risk of any average individual in the USA contracting anthrax is infinitesimal. The risk is for people who have been in a place of known exposure. So far, the known places of exposures are one business place in Florida, a couple of locations in New York City, and a governmental office building in Washington. Few postal processing centers near Washington, DC are also affected. Persons who have not been in these circumstances are not at-risk.

If anthrax is on the ground, can I get it from kicking up dust?

Probably not. The spores tend to clump together, so even if inhaled, they do not get deep into the lungs.

Some of the terrorist-manufactured anthrax, however, is very fine and may be chemically treated to prevent them from clumping together. In this case, the anthrax from the ground can be inhaled under optimum conditions. (Similar to what happened to the postal workers. If you were in the vicinity of anthrax contamination, you should immediately seek medical attention.

What can the average person do to protect himself/herself?

According to Dr. Jeffrey P. Koplan, Director of the Centers of Disease Control and Prevention in the USA, the best approach to take in dealing with anthrax, is to know a little bit more about anthrax. Here are some salient facts:

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Anthrax is not contagious.

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Anthrax doesn't spread from person-to-person.

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It's a disease that, once exposed to, is treatable. A number of different antibiotics can be used to treat it.

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Antibiotics are also very effective in preventing a person from ever getting the disease once exposed.

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Cutaneous anthrax is readily treatable. Inhaled anthrax is more deadly.

The best defense is to have a good defense system in our body that wards off infections and entry of unwanted organisms into our body such as bacteria. We recommend that you take steps to boost your immune system. Natural remedies are available to do so and are covered in depth in holisticonline.com Nothing is going to prevent you from getting the intentional inflicting of biological agents such as is the case in bioterrorism. However, you may be able to buy enough time for you to seek medical treatment and also prevent you from having other complications.

Can a person get screened or tested for anthrax?

According to Dr. Jeffrey P. Koplan, Director of the Centers of Disease Control and Prevention in the USA, there is no screening test for anthrax. There is no test that a doctor can do that says a person has been exposed to anthrax or is carrying it.

The only way that anthrax exposure can be determined is through a public health investigation. And in those circumstances, for example, where people work in a given office or on a given floor have been exposed, the public health officials will inform people whether they have been exposed or not. They will also advise you whether you need the treatment with antibiotics.

You may have read, heard or seen reports of blood tests or nasal swabs or other tests for anthrax. According to Dr. Koplan, these are not tests to determine whether an individual should be treated. These nasal swabs and environmental tests are used to determine the extent of exposure in a given building or workplace.

Is anthrax contagious?

Anthrax can not be spread from person-to-person. One person is not contagious to another person. We can only get it from the mechanisms of exposure to the skin, breathing it, or eating it.

What should an individual do about suspicious mail?

A suspicious envelope may be one that you are not used to getting regularly with a known return address. They may have stains on them. Other characteristics of suspicious mail include: You may feel like they have contents including powder that you can feel inside; a different postmark address than the return address; any other kinds of items inside wires or protruding elements.

Here are some tips to identify suspicious packages or letters:

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Excessive postage

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Handwritten or poorly typed addresses

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Incorrect titles

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Title, but no name

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Misspellings of common words

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Oily stains, discolorations or odor

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No return address

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Excessive weight

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Lopsided or uneven envelope

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Protruding wires or aluminum foil

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Excessive security material such as masking tape, string, etc.

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Visual distractions

bullet

Ticking sound

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Marked with restrictive endorsements, such as "Personal" or "Confidential"

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Shows a city or state in the postmark that does not match the return address

If you find something suspicious in your mail be it a package or a letter, be calm. If you've picked it up, put it down. If you have a plastic bag or envelope handy, garbage bag, something for food small enough, just slip it in it and close it. If you don't have such a plastic item available, cover it with a towel or some cloth or even a newspaper --- just cover it so that it is protected over its borders. Wash your hands with soap and water. Call local law enforcement and describe what you've got and can they come and help you.

See Also:

Characteristics of Suspicious Packages and Letters

What should You do if You receive a suspicious parcel in the mail?

If a patient is suspected of being exposed to anthrax, should he or she be quarantined or should other family members be tested?

There is no need to quarantine people suspected of being exposed to B. anthracis or to treat contacts (e.g., household contacts, friends, or coworkers) of people ill with anthrax, unless the contacts were also exposed to the same source of infection.

Treatments

See Also: Bioterrorism and Antibiotics

What drugs are FDA approved for PEP and treatment?

Ciprofloxacin and doxycycline are FDA approved for PEP, and ciprofloxacin, doxycycline, and amoxicillin are FDA approved for treatment. In the current situation of intentional anthrax distribution, doxycycline and ciprofloxacin as the recommended drugs for prophylaxis

What is ciprofloxacin?

Ciprofloxacin is a broad-spectrum antibiotic agent active against several bacteria. It is one of the antibiotics used in the treatment of anthrax. But there are several others. The use of ciprofloxacin is warranted only under the supervision of a physician. Ciprofloxacin is one antibiotic often recommended to prevent anthrax after a person has been exposed to B. anthracis.

What are the side effects of ciprofloxacin?

Ciprofloxacin is a broad spectrum fluoroquinolone indicated for use in reducing the incidence or progression of inhalational anthrax. Adverse health effects include vomiting, diarrhea, headaches, dizziness, sun sensitivity and rash. Central Nervous System effects occur in <1% of patients and may be accentuated by caffeine or theophylline-containing medications.

See Also:

What is doxycycline?

Doxycycline is a broad-spectrum antibiotic agent active against several bacteria. The use of doxycycline is warranted only under the supervision of a physician. 

What are the side effects of doxycycline?

Adverse side effects may include nausea, vomiting, or diarrhea; sensitivity to the sun; dark "furry" tongue, black tongue, or swollen tongue; or vaginal yeast infection. Serious side effects may include an allergic reaction (swelling of your lips, face, or tongue, difficulty breathing); a severe headache; vision changes; confusion; liver damage (yellowing of the skin or eyes, nausea, abdominal pain or discomfort, unusual bleeding or bruising, severe fatigue); blood problems (fever, fatigue, easy bruising or bleeding); or genital sores or itching.

What are the alternative drugs that may be effective against anthrax attacks?

Ciprofloxacin, or Cipro, is the antibiotic most commonly recommended to prevent sickness among people exposed to anthrax. It works well against most types of anthrax in the lab. In addition, Cipro is a drug that most people can take without having too many side effects.

However, for some people, Cipro is a bad choice. If you have had an allergic reaction to Cipro, you should not take it again. Also, Cipro is not generally recommended for pregnant women or small children. Fortunately, there are alternatives.

The Centers for Disease Control and Prevention have recommended the following antibiotics for people exposed to anthrax. For each group, several options are provided. In the event of an exposure, healthcare professionals should consider a person's medication allergies and potential drug interactions before prescribing an antibiotic.

Adult males (ages 18-65):
bulletCiprofloxacin (500 milligrams by mouth twice a day for 60 days) or
bulletDoxycycline (100 milligrams by mouth twice a day for 60 days) or
bulletAmoxicillin (500 milligrams by mouth three times a day for 60 days)

Nonpregnant adult females (ages 18-65):
bulletCiprofloxacin (500 milligrams by mouth twice a day for 60 days) or
bulletDoxycycline (100 milligrams by mouth twice a day for 60 days) or
bulletAmoxicillin (500 milligrams by mouth three times a day for 60 days)

Pregnant adult females
bulletAmoxicillin (500 milligrams by mouth three times a day for 60 days) or
bulletIf allergic to penicillin or amoxicillin, consult with your doctor or a specialist in infectious diseases

Adults over age 65:
bulletDoxycycline (100 milligrams by mouth twice a day for 60 days) or
bulletCiprofloxacin (500 milligrams by mouth twice a day for 60 days) or
bulletAmoxicillin (500 milligrams by mouth three times a day for 60 days)

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