Short presentation on anthrax outbreak 2012

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1. Anthrax!!!21.8.12 2. Clinical pictureNew in IVDUMixed presentation – not like typical cutaneous anthraxMany cases did not have typical black escharSSI – localised,…
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  • 1. Anthrax!!!21.8.12
  • 2. Clinical pictureNew in IVDUMixed presentation – not like typical cutaneous anthraxMany cases did not have typical black escharSSI – localised, nec fasciitisSwelling (all cases) > pain > malaise > feverSome cases might have no localising sign but may present with generalised symptoms suggestive of infection GI symptoms – abdo pain, nausea, vomiting, diarrhoea, rectal bleeding neuro symptoms - severe headache, hallucinations, fitting, collapse, comaFatality
  • 3. Microbiology involvementThe clinicians may consult microbiology if anthrax is suspected eg.Heroin user, presenting withSevere soft tissue infection – nec fasc, cellulitis, abscess associated with oedemaSigns of severe sepsis without localizing soft tissue infectionmeningitis, esp haemorrhagic meningitisheroin user with clinical or CT evidence of SAH/IC bleedFlu like symptoms  severe resp difficulty /shockChest x-ray signs – mediastinal widening, paratracheal fullness, hilar fullness, pleural effusions, parenchymal infiltratesProgressively enlarging, haemorrhagic pleural effusions (biphasic – prodrome – remission for few days then chest sym)Chest symp with s/s of meningitis/IC bleedDrenching sweatsSkin lesion - lesion starts as a small bump and develops into a characteristic ulcer with a black centre , not painful,oedema
  • 4. Infection controlPerson to person – rarePerson-to-person spread of inhalation anthrax does not occur.Person-to-person spread of cutaneous anthrax is extremely rare. Transmission of cutaneousanthrax has not been recorded in this current outbreakIntestinal anthrax is very rare, but occurs from swallowing spores in contaminated meat fromand animal which has died from anthrax. http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1267549743963
  • 5. Standard Infection Control PrecautionsAll cuts and abrasions should be covered with water proof dressingsPersonal protective equipment should be used in situations where there is potential for splashes and inoculation injuries.wear gloves and aprons when handling the patient’s personal clothing and effectsSingle room placement for anthrax transmission is not necessaryOn removal of PPE, wash hands with liquid soap and waterAny potentially contaminated substance found on the patient, e.g. their personal heroin supply, should be sealed in a plastic bag toprevent environmental and personal contamination (HCW to wear PPE).Decontamination of blood and body fluid spillages - Higher then standard -10,000 ppm av cl - 10 min (check - http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1267549743963 page 4-5)Specimen – cat 3, NO pneumatic system, label “dangerous specimen/high risk” + “anthrax risk”, inform lab in advanceNeedlestick, post mortem, last office – follow above link
  • 6. BCEDTA blood for PCRTissue/material from lesion for gram (urgent) and c/sSerum for toxin/ab testCRP may be normal/lowish – disproportionate to skin change, wcc may not rise, temp may be normalLab guidance - http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1265296979282)Decreasing platelet = deteriorationCoagulopathyIVT refractory renal impairment may occur
  • 7. Timely surgical debridement SSI – IV cip + clind + pen+ fluclox + metro Disseminated – IV cip + clind + pen/vanc Other agents with activity - rifampicin, imipenem, meropenem, chloramphenicol and gentamicin. IVIg (for criteria see page 13 onwards ) Review 10-14 days ----?3 weekshttp://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1259152399460http://www.documents.hps.scot.nhs.uk/giz/anthrax-outbreak/clinical-guidance-for-use-of-anthrax-immune-globulin-v12-1-2010-03-19.pdf
  • 8. Cutaneous anthrax evaluationhttp://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1249454483392Inhalation anthrax evaluationhttp://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947368101
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