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ANTHRAX AND BRUCELLOSIS

SESSION 23
 LEARNING OBJECTIVES
 Define anthrax and brucellosis
 Describe epidemiology and transmission of anthrax
and brucellosis.
 Mention clinical features of anthrax and brucellosis
 Describe methods of diagnosing anthrax and
brucellosis
 Describe management of anthrax and brucellosis
 Explain prevention and control measures of anthrax
and brucellosis
 DEFINITION
Anthrax is a serious infectious disease caused
by gram-positive, rod-shaped bacteria known as
Bacillus anthracis.
Anthrax can be found naturally in soil and
commonly affects domestic and wild animals
around the world.
Although it is rare, people can get sick with
anthrax if they come in contact with infected
animals or contaminated animal products.
 EPIDEMIOLOGY
• The distribution of anthrax is worldwide.
• All animals are susceptible to varying degrees, but the disease is
most prevalent among domestic herbivores including cattle,
sheep, goats and horses.
• Grazing animals become infected with spores formed when the
bacillus is exposed to air. Spores are extremely resistant to climatic
conditions and can survive for years in the soil.
• The disease can affect a large number of animals (epizootic)
especially during periods when cattle are moved from one place to
another e.g. after drought or flooding.
• Anthrax in animals is characterised by a short fever followed by
septicaemia and death.
 TRANSMISSION

 People get infected with anthrax when spores get into the
body.
 When this happens, the spores can be activated and become
anthrax bacteria. Then the bacteria can multiply, spread out in
the body, produce toxins (poisons), and cause severe illness.
 This can happen when people breathe in spores, eat food or
drink water that is contaminated with spores, or get spores in
a cut or scrape in the skin
 TRANSMISSION CONT….
• In humans, anthrax of the skin occurs mostly
in persons handling cattle e.g. farmers,
butchers or workers in the hide-processing
industries.
• Anthrax of the lungs occurs in persons working
with infected wool.
• Anthrax of the bowel occurs in families who
eat the meat of sick or dead animals.
 QUESTION ?

Is Anthrax Contagious?

• No. You cannot catch anthrax from another

person the way you might catch a cold or the
flu. In rare cases, person-to-person
transmission has been reported with
cutaneous anthrax, where discharges from
skin lesions might be infectious
 SIGNS &SYMPTOMS
• The symptoms of anthrax depend on the type of infection and
can take anywhere from 1 day to more than 2 months to
appear. All types of anthrax have the potential, if untreated,
to spread throughout the body and cause severe illness and
even death.
Cutaneous anthrax symptoms can include;-
 A group of small blisters or bumps that may itch
 A painless skin sore (ulcer) with a black center that appears
after the small blisters or bumps ,Most often the sore will be
on the face, neck, arms, or hands
 SIGNS &SYMPTOMS CONT….
Inhalation anthrax presents with:-
• Fever and chills
• Chest discomfort
• Shortness of breath
• Confusion or dizziness
• Cough
• Nausea, vomiting, or stomach pains
• Headache
• Sweats (often drenching)
• Extreme tiredness
• Body aches
 Signs &Symptoms cont….
• Gastrointestinal anthrax symptoms can include:-
• Fever and chills
• Swelling of neck or neck glands
• Sore throat
• Painful swallowing
• Hoarseness
• Nausea and vomiting, especially bloody vomiting
• Diarrhea or bloody diarrhea
• Headache
• Flushing (red face) and red eyes
• Stomach pain
• Fainting
• Swelling of abdomen (stomach
 Diagnosis

• If inhalation anthrax is suspected, chest X-rays or CT scans

can confirm if the patient has mediastinal widening or
pleural effusion, which are X-ray findings typically seen in
patients with inhalation anthrax.
• The only way to confirm a diagnosis of anthrax is to
either,Test directly for Bacillus anthracis in a sample (blood,
skin lesion swab, spinal fluid, or respiratory secretions)  or
Measure antibodies or toxin in blood.
• Samples must be taken before the patient begins taking
antibiotics
 Diagnosis cont…
• The diagnosis is confirmed by finding gram-positive rods in a
specimen (fluid from vesicle, sputum or faeces).
In human, the diagnosis can be achieved in well equipped hospitals as
follows:
• Lesion swab or vesicle fluid will produce colonies in blood agar,
which are composed of tangled chains of square-ended Gram-
positive rods.
• These filamentous colonies are called medusa head colonies.
• Blood cultures readily produce a heavy growth.
• Methylene blue-stained blood smear from septicaemic animals and
humans will often demonstrate bacilli.
 
 Treatment
• The drug of choice for anthrax is Penicillin and is best given intravenously at high
doses to sick patients.
• Otherwise intramuscular penicillin or oral amoxicillin are satisfactory.
• Cotrimoxazole is an effective antibiotic but the bacilli tend to be resistant to
chloramphenicol.
• Ciprofloxacin is the drug of choice in treatment of anthrax acquired from germ
warfare (bio terrorism).
• Children with anthrax should be treated with benzyl penicillin 50,000 IU/kg 6 hourly
intramuscularly.
• Amoxicillin 80 mg/kg/day orally in divided doses every 8 hours (max 500 mg per
dose) can also be used.
• In case of penicillin allergy, erythromycin (500 mg qid for 5 -7days), chloramphenicol
(500mg qid for 5-7 days) or ciprofloxacin 500 mg orally twice daily for 7 days
(10mg/kg/dose every 12 hours if given IV –max dose 400 mg q 12 hours IV) can be
used
 Prevention and control
• The institution of control measures is the responsibility of the Veterinary Department.
• These measures include;
• Proper disposal of infected animals.
• The carcasses must be burnt or buried at least 2 metres deep in the ground in
quicklime
• Inspection of all meat offered for sale
• Immunisation of all susceptible animals every year
• Strict rules for disinfecting skins and hides in the leather-processing industry
• Protect people at risk (workers) with a vaccine for humans
• Control in Humans involves
• Proper meat inspection before consumption
• Use of protective gear in handling skins and hides
• Health education on the danger of eating sick or dead animals
• Isolation is not necessary since the patient is unlikely to infect others.
 .

BRUCELLOSIS
 DEFINITION
Brucellosis:-
A zoonotic infection caused by one of
the species of the genus Brucella.
It is also known as undulant fever or
Malta fever.
 EPIDEMIOLOGY
Brucellosis is caused by bacteria of the Brucella genus.
• The species of Brucella which infect humans are Brucella abortus (from cattle),
Brucella melitensis (from goats, camels and sheep), and Brucella suis (from pigs).
• Brucellosis is an occupation health hazard of farmers, veterinarians, abattoir workers
and butchers.
• It may also be found in people who work in laboratories and in meat inspectors.
• Brucellosis is more common in males than females.
• The incidence in Africa is unknown because many cases may be missed due to lack of
laboratory facilities.
• The infection in animals causes repeated abortion, presenting economic problem
particularly for cattle owners.
• Case fatality rate is less than 2% and death may be due to complications of the
disease.
• Domestic and wild animal reservoirs may serve as sources of infection of livestock and
humans.
 TRANSMISSION

• Eating undercooked meat or consuming unpasteurized/raw dairy products

• Breathing in the bacteria that causes brucellosis may also lead to infection.
This risk is generally greater for people in laboratories that work with the
bacteria. In addition, slaughterhouse and meat-packing employees have also
been known to be exposed to the bacteria and ultimately become infected.
• Bacteria entering the body through skin wounds or mucous membranes OR
through contact with infected animals.
• This poses a problem for workers who have close contact with animals or
animal excretions (newborn animals, fetuses, and excretions that may result
from birth). Such workers may include:-slaughterhouse workers,meat-packing
plant employees,veterinarians
• Person-to-person spread of brucellosis is extremely rare. Infected mothers who
are breast-feeding may transmit the infection to their infants.
 CLINICAL FEATURES
• The incubation period is usually 2-4 weeks.
• Fever lethargy, anorexia and night sweat.
• Hepatosplenomegally
• Other prominent symptoms include:Weakness,Headache
,Weight loss ,Shivering and Generalized aching.
• Arthralgia, particularly of large joints and involvement of the axial
skeletal .
• The clinical presentation is very similar to that of tuberculosis,
particularly when brucella causes para-vertebral or psoas abscess
and careful distinction of the conditions is necessary.
• Inspite of the severity of the illness, mortality is low; death often
results from endocarditis caused by Brucella melitensis.
 CLINICAL FEATURES CONT….
• Other feature that may develop include:
– lymphadenopathy
– Eye problems
– Breast abscesses
– Pneumonitis
– Clots in deep veins
– Endocarditis (
– Meningitis
• Other sites of infections are:
– Epididymo-orchitis and
– Renal involvement
 CLINICAL FEATURES CONT…..
Neurological disease is not frequent but can cause a
wide range of manifestations including:-
• Papilloedema
• Cranial neuritis
• Encephalopathy
• Meningoencephalitis
• Parkinsonian syndrome
• Transient ischaemic episodes and vasculitis
 CLINICAL FEATURES CONT…
– Spinal involvement may present with
• Cord compression due to vertebral abscess
• Cauda equine syndrome
• Myelitis
• Myelopathy
• Peripheral nerve involvement can cause sensory
and/or motor abnormalities affecting either single or
multiple nerve roots
 DIAGNOSIS…
• Bacteriologic culture of blood, other tissues, from
patient discharges or bone marrow samples may
reveal the presence of Brucella organisms, especially
during the acute phase of disease.
• Demonstration of serologic conversion (four-fold rise
in antibody titre) from samples collected two to
three weeks apart is diagnostic for brucellosis.
• Full blood picture will show neutrophilia in acute
disease, later there is neutropenia .
 TREATMENT..
• Treatment duration is 6 weeks in adults and 3 weeks in children
over 8 years .
• A combination of doxycycline (preferred over tetracycline) and
streptomycin is recommended.
• Caution :Streptomycin (ototoxicity) .
• In children under 8 years, cotrimoxazole for 3 weeks and an
aminoglycosides e.g gentamicin IM for 5 days .
• Rifampicin may also be used.
For pregnant women;-
 administer Rifampicin 600-900mg once a day for 6 weeks.
 Streptomycin and tetracycline are contraindicated .
 PREVENTION AND CONTROL...
• Restrict consumption of milk products made from raw
milk( boil milk before use)
• Encourage the use of pasteurized milk and cheeses
made from pasteurized milk.
• Health education to farmers, slaughterhouse
workers, meat processors or butchers on how the
disease is transmitted, the risks of handling infected
animal carcasses and products.
• Proper disposal of placentas, birth fluids,
membranes, and aborted fetuses. .