• aerobic, facultative anaerobes
• spore forming
• common on skin flora
• opportunistic infection of immunocompromised hosts

• naturally occuring infection (all three t ypes of disease)
  • herbivoires primary reservoir
  • humans incidental host via direct contact with
    • wild, domesticated animals in developing countries
    • imported animal products
    • agriculture and industry manufacturing with tainted materials
• biololgical warfare agent (inhalation)

• cutaneous (95%)
• respiratory
• GI

1. spores deposit in skin, resp. GI mucosa
2. spores germinate in tissues
3. bacteria multiply and produce toxins (toxins inhibit neutrophil function and induce cytotoxic effects)
   • lethal toxin (dominant)
   • edema toxin
   • capsule (block phagocytosis)
4. toxins cause tissue necrosis
5. they will disseminate into blood, lymph
6. lead to systemic toxicity and death

clinical manifestations of cutaneous anthrax

• exposed skin areas
• pruritic papule
• enlarges over several days, progessing to ulcer
• center is black and necrotic
• edema surround the lesion
• often painless, regional lymphadenopathy

• inhale spores (very few)
• germinate/transport lymphatics to hilar/ mediastinal lymph nodes
• toxins cause: necrosis, hemorrhage in mediastinum
  • X ray show widening of mediastinum
  • symptoms: substernal pain, cough
  • signs of stridor, neck/mediastinal edema
• extension of necrosis to pleura lead to pleural effusions
• hematogenous spread

• initial phase: 1-3 dys
  • malaise, fever, dry cough, substernal pressure
• secondary phase
  • sudden onset, rapid progression to death in 1-2 days
  • symptoms of dyspnea, stridor, high fever, diaphoresis
  • GI bleeding can occur
  • mental status change, meningitis can dev.
  • high mortality

• X ray show widened mediastinum
• bloody pleural tap and cultures on blood
• pleural fluid or CSF finds gram positive rods

• meat from infected animals consumed
• ingested spores will germinate in intestinal mucosa
• present in one of two forms:
  • oropharnyngeal (hard palate, post pharynx)
  • abdominal anthrax (large bowel, cecal lesions)

• be able to recog. clinical syndromes
• high clinical suspicion in the right setting crucial to diagnosis/therapy due to high mortality

• treat IV with antibiotics
• prophylaxis should be up to six weeks

• in the immunocompetent, associated with:
  • food posioning
  • traumatic ocular infections

• manifestation of disease via extracellular products
  • enzymes- tissue destruction
  • toxins- diarrhea/emesis
  • antimicrobial agents- help bacteria compete

• emetic
  • incubation period of less than 6 hrs
  • usually fried rice
• diarheal (cramps, nausea, watery stools)
  • incubation period 10-12 hrs with improvement in 24 hours
  • usually contaminated meats or vegetables

• symptoms caused by enterotoxin production
• diagnosis- culture the food

• trauma (soil exposure) or foreign body (particals of dust, soil, metal shrapnel)
• IV drug abuse
• clinical manifestation
  • panophthalmitis
  • ocular abscess
    • rapid in 12-48 hrs (pain, redness, vision change)

• non spore forming
• gram positive rod
• club shaped on graim stain
• most known for its exotoxin

• VF that inhibits protein synthesis
• very potent
• responsible for tonsilar/pharyngeal exudate production of diptheria
• Ab's to toxin are protective

• humans are reservoir
• asymptomatic carrier state on skin and in pharynx
• transmission through bacteria in airborne droplets or contact with secretions/exudate
• at risk times and conditions
  • colder months
  • crowded conditions
  • children under age of 15 if unvaccinated
  • unimmunized or unboosted adolescents/ adults (urban poor, those with no health care, IV drug abusers)

• toxin cause inflammation along with dense necrotic exudate in pharynx/trachea
  • necrotic collection of cells, fibrin, dead resp. epith. cells, RBC's, WBC's, bacteria
• exudate can occlude airway causing obstruction
• soft tissues of neck can swell, causing bull neck
• cervical lymph nodes commonly effected
• once toxin is absorbed, systemic effects at distant sites
  • cardiac toxicity (arrhythmias, heart failure)
  • neurologic toxicity

• use clinical clues to prompt early therapy
  • tonsillitis/pharyngitis with associated membrane with febril toxic appearance
  • cervical adenopathy, cervical swelling (bull neck)
  • paralysis of palate- hoarseness or stridor

• 25 degree tumbling motility
• small gram positive rod
• intracellular pathogenesis
• rare cause of disease, but at risk to select population
• risk for food borne disease

• zoonosis (ubiquitous in nature)
• vertical transmission (no other human to human transmission)
• can be found in up to 70% of raw vegetables, raw milk, fish, meats, poultry
• foods: coleslaw, unpasteurized soft cheeses, ready to eat products/meats, smoked fish

• neonates and elderly
• pregnant women
• impaired cell mediated immunity/ immunosuppression
• HIV positive (low incidence due to prophylactic treatment)

• incubation range 11-70 days
• infection usually begins with contaminated food ingestion
• gastric surgery or H2 blockers can promote infection (increased stomach pH)
• Process
  1. bind to epithelial cells
  2. cross GI mucosa
  3. evades cell mediated immunity, disseminate via blood
  4. survives intracellularly 
  5. likes to go to CNS (meningitis) and placenta

• meningitis
• bacteremia (in immunocompromised host)
• gastroenteritis
• neonatal infection

• tropism for brain, brain stem, and meninges (abscesses)
• high mortality
• at risk- over sixty and neonates, patients on steroids/chemotheraphy
• signs and symptoms
  • seizures
  • usually see monocyte predominance in CSF samples

• if in utero, called granulomatosis infantiseptica
  • leads to immediate spontaneous abortion/ neonatal death
• infection at partuition- meningitis 2 wks post birth or immediate sepsis after delivery

• by 30 wks, major decline in cell mediated immunity
• infections in last trimester lead to:
  • premature labor
  • infant death
• early infection may cause spontaneous abortion

• clinical setting with appropriate host important to recognize to allow
  • empiric therapy
  • treat maternal infection to prevent neonatal death

• major reservoir is swine
• human infection through direct cutaneous contact
• at risk occupation:
  • fishermen
  • butchers
  • veterinarians

• erysipeloid skin lesions
  • violaceous
  • raised and well defined lesion
  • usually associated with lymphadenopathy
• diffuse skin rashes
• endocarditis

• know exposure history
• antibiotics help healing faster