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Cutaneous Anthrax

Disease Details

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Description: Cutaneous anthrax is a bacterial infection caused by Bacillus anthracis that typically enters the skin through cuts or abrasions, resulting in a characteristic black eschar (lesion) and surrounding edema.
Type: Cutaneous anthrax is a bacterial infection caused by Bacillus anthracis. It is not a genetically transmitted disease; instead, it is acquired through direct contact with the spores of the bacteria, often via a cut or abrasion on the skin.
Signs And Symptoms: Signs and symptoms of cutaneous anthrax include:

1. A raised, itchy bump resembling an insect bite that appears within 1-12 days after exposure.
2. The bump develops into a vesicle and then a painless ulcer with a characteristic black center (eschar).
3. Swelling around the sore and possible involvement of nearby lymph nodes.
4. Fever, headache, and malaise in some cases.

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Prognosis: Cutaneous anthrax is rarely fatal if treated, because the infection area is limited to the skin, preventing the lethal factor, edema factor, and protective antigen from entering and destroying a vital organ. Without treatment, up to 20% of cutaneous skin infection cases progress to toxemia and death.Before 2001, fatality rates for inhalation anthrax were 90%; since then, they have fallen to 45%. People that progress to the fulminant phase of inhalational anthrax nearly always die, with one case study showing a death rate of 97%. Anthrax meningoencephalitis is also nearly always fatal.Gastrointestinal anthrax infections can be treated, but usually result in fatality rates of 25% to 60%, depending upon how soon treatment commences.
Injection anthrax is the rarest form of anthrax, and has only been seen to have occurred in a group of heroin injecting drug users.
Onset: The onset of cutaneous anthrax typically occurs within 1-7 days after exposure to Bacillus anthracis spores. Initial symptoms often include itching and the appearance of a small, raised bump that may resemble an insect bite. This bump then develops into a vesicle and eventually forms a painless ulcer with a characteristic black necrotic (dead) center, known as an eschar.
Prevalence: Cutaneous anthrax is one of the most common forms of anthrax, but its prevalence is relatively low. It primarily affects individuals who handle contaminated animal products or work in environments where Bacillus anthracis spores are present. While specific prevalence data for cutaneous anthrax can vary by region and occupational exposure, it remains rare in developed countries due to stringent public health measures and control programs in agriculture. However, sporadic outbreaks may occur in areas with inadequate veterinary controls.
Epidemiology: Globally, at least 2,000 cases occur a year.
Intractability: Cutaneous anthrax is generally not considered intractable. It is typically treatable with prompt and appropriate antibiotic therapy. Common antibiotics used include ciprofloxacin, doxycycline, and penicillin. Early treatment is crucial to prevent complications and ensure full recovery.
Disease Severity: Cutaneous anthrax severity typically varies but can be serious if not treated. It usually presents as a painless ulcer with a characteristic black center. Without treatment, there is a risk of severe complications and systemic infection. Treatment with antibiotics generally leads to a good prognosis.
Healthcare Professionals: Disease Ontology ID - DOID:7426
Pathophysiology: Pathophysiology: Cutaneous anthrax is caused by the bacterium Bacillus anthracis. The bacterium's spores enter the skin through cuts or abrasions. Once inside, the spores germinate into vegetative bacilli, which produce toxins including lethal toxin and edema toxin. These toxins cause localized cell death, tissue necrosis, and edema. The infection typically begins as a small, painless papule that progresses to a vesicle and then to an ulcer with a characteristic black eschar (scab) at the center. If untreated, the bacteria and toxins can spread locally and, in rare cases, systemically through the blood, potentially leading to more severe complications.
Carrier Status: Cutaneous anthrax is not typically associated with a carrier status. It is an infection caused by Bacillus anthracis bacteria entering the skin through cuts or abrasions, leading to characteristic sores. There is no asymptomatic carrier state for cutaneous anthrax.
Mechanism: The lethality of the anthrax disease is due to the bacterium's two principal virulence factors: the poly-D-glutamic acid capsule, which protects the bacterium from phagocytosis by host neutrophils; and the tripartite protein toxin, called anthrax toxin, consisting of protective antigen (PA), edema factor (EF), and lethal factor (LF). PA plus LF produces lethal toxin, and PA plus EF produces edema toxin. These toxins cause death and tissue swelling (edema), respectively.
To enter the cells, the edema and lethal factors use another protein produced by B. anthracis called protective antigen, which binds to two surface receptors on the host cell. A cell protease then cleaves PA into two fragments: PA20 and PA63. PA20 dissociates into the extracellular medium, playing no further role in the toxic cycle. PA63 then oligomerizes with six other PA63 fragments forming a heptameric ring-shaped structure named a prepore. Once in this shape, the complex can competitively bind up to three EFs or LFs, forming a resistant complex. Receptor-mediated endocytosis occurs next, providing the newly formed toxic complex access to the interior of the host cell. The acidified environment within the endosome triggers the heptamer to release the LF and/or EF into the cytosol. It is unknown how exactly the complex results in the death of the cell.
Edema factor is a calmodulin-dependent adenylate cyclase. Adenylate cyclase catalyzes the conversion of ATP into cyclic AMP (cAMP) and pyrophosphate. The complexation of adenylate cyclase with calmodulin removes calmodulin from stimulating calcium-triggered signaling, thus inhibiting the immune response. To be specific, LF inactivates neutrophils (a type of phagocytic cell) by the process just described so they cannot phagocytose bacteria. Throughout history, lethal factor was presumed to cause macrophages to make TNF-alpha and interleukin 1, beta (IL1B). TNF-alpha is a cytokine whose primary role is to regulate immune cells, as well as to induce inflammation and apoptosis or programmed cell death. Interleukin 1, beta is another cytokine that also regulates inflammation and apoptosis. The overproduction of TNF-alpha and IL1B ultimately leads to septic shock and death. However, recent evidence indicates anthrax also targets endothelial cells that line serous cavities such as the pericardial cavity, pleural cavity, and peritoneal cavity, lymph vessels, and blood vessels, causing vascular leakage of fluid and cells, and ultimately hypovolemic shock and septic shock.
Treatment: Anthrax cannot be spread from person to person, except in the rare case of skin exudates from cutaneous anthrax. However, a person's clothing and body may be contaminated with anthrax spores. Effective decontamination of people can be accomplished by a thorough wash-down with antimicrobial soap and water. Wastewater is treated with bleach or another antimicrobial agent. Effective decontamination of articles can be accomplished by boiling them in water for 30 minutes or longer. Chlorine bleach is ineffective in destroying spores and vegetative cells on surfaces, though formaldehyde is effective. Burning clothing is very effective in destroying spores. After decontamination, there is no need to immunize, treat, or isolate contacts of persons ill with anthrax unless they were also exposed to the same source of infection.
Compassionate Use Treatment: Compassionate use treatment and off-label or experimental treatments for cutaneous anthrax may include:

1. **Raxibacumab**: This monoclonal antibody targets the protective antigen component of the anthrax toxin. It is primarily approved for inhalational anthrax but can be considered for cutaneous anthrax under compassionate use if first-line treatments are ineffective or unavailable.

2. **Anthrax Immune Globulin Intravenous (AIGIV)**: AIGIV is derived from the plasma of individuals immunized with anthrax vaccine. It helps neutralize bacterial toxins and can be used under emergency or compassionate use protocols.

3. **Monoclonal Antibodies**: In addition to Raxibacumab, other monoclonal antibodies (e.g., obiltoxaximab) might be available under compassionate use for severe cases of cutaneous anthrax.

4. **Combination Therapy**: Experimental approaches may include combining antibiotics (like ciprofloxacin, doxycycline, or levofloxacin) with one of the monoclonal antibodies or AIGIV.

It is important to use these treatments under the guidance of a healthcare professional, especially in the context of compassionate use or experimental protocols.
Lifestyle Recommendations: Lifestyle recommendations for preventing cutaneous anthrax include:

1. **Avoid Contact with Infected Animals**: Stay away from livestock, hides, animal products, and soil that may be contaminated with anthrax spores, especially in areas known for anthrax outbreaks.

2. **Protective Clothing**: Wear protective gloves, masks, and clothing if handling potentially infected animals or animal products.

3. **Hygiene Practices**: Wash hands and any exposed skin thoroughly with soap and water after handling animals or animal products.

4. **Vaccination**: For individuals at higher risk (such as veterinarians, livestock handlers, and laboratory personnel), vaccination against anthrax can be a preventive measure.

5. **Safe Handling of Animal Products**: Ensure that animal products, such as wool and hides, are treated and handled according to safety guidelines to reduce contamination risk.

6. **Wound Care**: Keep any open cuts or abrasions clean and covered, as anthrax spores can enter through broken skin.

Implementing these measures can significantly reduce the risk of contracting cutaneous anthrax.
Medication: For cutaneous anthrax, the primary treatment involves antibiotic therapy. Commonly prescribed antibiotics include:

1. Ciprofloxacin
2. Doxycycline
3. Penicillin

The choice of antibiotic and duration of treatment can vary depending on the severity of the infection and patient-specific factors. Early intervention is crucial for effective management.
Repurposable Drugs: Repurposable drugs for cutaneous anthrax primarily include antibiotics that are effective against Bacillus anthracis, the bacterium that causes the disease. Commonly repurposed antibiotics include:

1. **Ciprofloxacin** - A fluoroquinolone antibiotic that is commonly used and FDA-approved for treating anthrax.
2. **Doxycycline** - A tetracycline antibiotic that is another FDA-approved option for anthrax treatment.
3. **Penicillin** - Historically used and effective, although resistance can be a consideration.
4. **Clindamycin** - Often used as an adjunctive treatment due to its ability to inhibit toxin production.
5. **Amoxicillin** - Can be considered in some less severe cases where strains are known to be sensitive.

These antibiotics can be used effectively to treat cutaneous anthrax and prevent the bacterium from spreading.
Metabolites: Cutaneous anthrax, primarily caused by the bacterium *Bacillus anthracis*, involves the release of several metabolites, particularly anthrax toxin components such as protective antigen (PA), edema factor (EF), and lethal factor (LF). These toxins contribute to the pathogenesis of the disease by disrupting cellular signaling pathways, causing edema, and inducing cell death.
Nutraceuticals: There is currently no well-established evidence supporting the use of nutraceuticals for the treatment or prevention of cutaneous anthrax. The primary treatment for cutaneous anthrax involves antibiotics, and any additional therapies should be considered under the guidance of healthcare professionals.
Peptides: In the context of cutaneous anthrax, peptides and nanoparticles are being investigated for their potential roles in diagnostic and therapeutic approaches. Peptides can be used to develop specific biomarkers or antigens for rapid detection tests. Nanoparticles, on the other hand, are explored for use in targeted drug delivery systems and vaccine formulations. They offer the advantage of enhancing the stability and bioavailability of therapeutic agents while potentially reducing side effects.