Bacillus anthracis: Difference between revisions
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Bacillus anthracis
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* Meningitis: [[ciprofloxacin]] plus [[meropenem]] plus [[linezolid]] |
* Meningitis: [[ciprofloxacin]] plus [[meropenem]] plus [[linezolid]] |
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** Duration 2-3 weeks, then prophylaxis to complete 60 days |
** Duration 2-3 weeks, then prophylaxis to complete 60 days |
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* Almost universally susceptible to [[ciprofloxacin]] and [[doxycycline]][[CiteRef::maxson2022sy]] |
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* Almost universally susceptible to [[ciprofloxacin]] and [[doxycycline]]<ref>Tucker Maxson, Thiphasone Kongphet-Tran, Thitipong Mongkolrattanothai, Tatiana Travis, Katherine Hendricks, Corinne Parker, Heather P McLaughlin, Julia Bugrysheva, Frank Ambrosio, Pierre Michel, Blake Cherney, Christine Lascols, David Sue, Systematic Review of In Vitro Antimicrobial Susceptibility Testing for ''Bacillus anthracis'', 1947–2019, ''Clinical Infectious Diseases'', Volume 75, Issue Supplement_3, 15 October 2022, Pages S373–S378, <nowiki>https://doi.org/10.1093/cid/ciac520</nowiki></ref> |
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* Generally susceptible to [[penicillin]], though should wait for susceptibility results before using |
* Generally susceptible to [[penicillin]], though should wait for susceptibility results before using |
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* Often resistant to extended-spectrum β-lactams such as [[ceftriaxone]] and [[ceftazidime]], as well as [[aztreonam]] and [[TMP-SMX]] |
* Often resistant to extended-spectrum β-lactams such as [[ceftriaxone]] and [[ceftazidime]], as well as [[aztreonam]] and [[TMP-SMX]] |
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Latest revision as of 17:17, 19 September 2024
Background
Microbiology
- Gram-positive bacillus that is distinguished from other Bacillus by being non-motile and non-hemolytic
- Colonies are gray, flat, and may have a "Medusa head" or "comet" appearance
- The main toxin has subunits A and B
- A subunit may be either EF (edema factor) or LF (lethal factor)
- B subunit is the protective antigen, against which antibodies react
- Lives in soil
- Wild and farm animals that have contact with contaminated soil is a common exposure, including to wool and animal hides
- Can also be acquired by inhalation of spores
Clinical Manifestations
Cutaneous Anthrax
- Caused by inoculation of spores into soft tissue
- Incubation period of 2 to 5 days
- Lesion develops at site of inoculation, starting as erythemaous papule, then ulceration, then eschar
- May progress to sepsis
Pulmonary Anthrax
- Caused by inhalation of spores
- Also known as woolsorter's disease
- Start with malaise, fever, and nonproductive cough, followed by respiratory distress, severe pulmonary edema, and death
Gastrointestinal Anthrax
- Caused by ingestion of spores
- Infects oropharynx or abdomen
- Causes sepsis
Management
- Inhalational anthrax: ciprofloxacin 400 mg IV q12h ± a second antibiotics
- Cutaneous anthrax (mild): ciprofloxacin 500 mg p.o. q12h, doxycycline 100 mg p.o. q12h, or amoxicillin 500-1000 mg p.o. q8h
- Duration typically 7 to 10 days (naturally acquired) or 60 days (bioterrorism-related)
- Meningitis: ciprofloxacin plus meropenem plus linezolid
- Duration 2-3 weeks, then prophylaxis to complete 60 days
- Almost universally susceptible to ciprofloxacin and doxycycline1
- Generally susceptible to penicillin, though should wait for susceptibility results before using
- Often resistant to extended-spectrum β-lactams such as ceftriaxone and ceftazidime, as well as aztreonam and TMP-SMX
References
- ^ Tucker Maxson, Thiphasone Kongphet-Tran, Thitipong Mongkolrattanothai, Tatiana Travis, Katherine Hendricks, Corinne Parker, Heather P McLaughlin, Julia Bugrysheva, Frank Ambrosio, Pierre Michel, Blake Cherney, Christine Lascols, David Sue. Systematic Review of In Vitro Antimicrobial Susceptibility Testing for Bacillus anthracis, 1947–2019. Clinical Infectious Diseases. 2022;75(Supplement_3):S373-S378. doi:10.1093/cid/ciac520.
