ANTHRAX- Anthrax is an acute disease in animals which can be secondarily transmitted

to humans. - Anthrax is caused by the gram-positive, aerobic spore-forming

bacteria, Bacillus anthracis .  The disease is marked by effusions of blood and fluids in various organs and body cavities and by symptoms of extreme prostration (severe exhaustion and lack of energy or power).  Animal anthrax primarily affects herbivores.  Human anthrax usually results from cutaneous infection caused by the handling of infected animal hides, hair, fur, bone, or wool.  In rare circumstances, human anthrax results from ingestion or inhalation of the spores from contaminated animal products.  Anthrax is considered a pathogen which can be relatively easily and widely distributed and is a potential agent of biological warfare.  The spores can remain dormant but viable for decades.

Other Names:- Woolsorter’s Disease- Woolsorter’s Pneumonia- Ragsorter’s DiseaseCausative Agent:- Bacillus AnthracisSigns and Symptoms: - There are actually 4 forms of anthrax: Cutaneous, Intestinal, Pulmonary

(Inhalatory Anthrax), Cerebral.1. Cutaneous anthrax.  This form of anthrax is severe and is most

common.  Cutaneous anthrax causes lesions, which presents first as an itchy papule that resembles an insect bite.  The papule becomes a hemorrhagic vesicle (a blister) which bursts and discharges a bloody serum.  Within 36 hours, the blister forms a hard but painless, blue-black leathery scab of necrotic tissue, usually 1-3 cm in diameter.  The absence of pain is characteristic of anthrax lesions.  Lymph glands close to the wound might swell. Constitutional symptoms are:  high fever, vomiting, profuse sweating, and extreme loss of strength and exhaustion. 

2. Intestinal anthrax.  Patients present first with chill, high fever and with pain in the head, back and abdomen, and extremities.  Additional initial symptoms include vomiting, vomiting blood, bloody diarrhea, and prostration.  Often, mucous membranes and the skin will hemorrhage. Intestinal anthrax results in death 25% to 60% of the time.

3. Pulmonary anthrax.  Usually caused by the inhalation of dust containing the anthrax spores.  Patients present initially with symptoms similar to the common cold. These symptoms include or progress to:  initial chill, followed by pain in the back and legs, fever, rapid breathing and rapid pulse, shortness of breath, cough, vomiting, and extreme prostration. Pulmonary anthrax usually results in death 1-2 days after the onset of acute symptoms.

4. Cerebral anthrax.  Cerebral anthrax is a secondary result of intestinal or pulmonary anthrax, and it occurs when the anthrax bacilli also invade the capillaries of the brain.  Patients with cerebral anthrax present with the symptoms of pulmonary or intestinal anthrax, but also experience violent delerium which is often associated with hemorrhagic meningitis.

Incubation:- Mostly incubation period of Anthrax lasts from 1 to 7 days, although

incubation periods up to 60 days are possible. Symptoms depend on how the infection was acquired.

Mode of Transmission:- Cutaneous infection is by contact with tissues of animals (cattle, sheep,

goats, horses, pigs and others) dying of the disease; possibly by biting flies that had partially fed on such animals; by contact with contaminated hair, wool, hides or products made from them, such as drums, brushes or rugs; or by contact with soil associated with infected animals or contaminated bone meal used in gardening. Inhalation anthrax results from inhalation of spores in risky industrial processes -- such as tanning hides and processing wool or bone -- where particles of B.anthracis spores may be produced. Intestinal and oropharyngeal anthrax arise from ingestion of contaminated undercooked meat; there is noevidence that milk from infected animals transmits anthrax. The disease spreads among grazing animals through contaminated soil and feed; among omnivorous and carnivorous animals through contaminated meat, bone meal or other feeds; and among wildlife from feeding on carcasses infected with anthrax. Accidental infections may occur among laboratory workers.

Nursing Management:1. Monitor vital signs and hemodynamic parameters closely for circulatory collapse.2. Monitor temperature for response to antibiotic therapy.3. Auscultate chest for crackles, indicating need for better secretion mobilization.4. Monitor oxygen saturation and arterial blood gases periodically to determine

oxygenation status and acid-base balance.5. Monitor level of consciousness and for meningeal signs such as nuchial rigidity.6. Provide supplemental oxygen or mechanical ventilation, as needed.7. Position for maximum chest expansion and reposition frequently to mobilize

secretions.8. Suction frequently and provide chest physiotherapy to clear airways, prevent

atelectasis (Lung Collapse), and maximize oxygen therapy.9. Administer I.V. fluids to encourage oral fluid intake to replace the fluid lost

through hyperthermia and tachypnea.10.For G.I. anthrax, maintain G.I decompression, monitor emesis and liquid stool

output, and medicate for abdominal pain, as needed.11.Advice the patient and family that anthrax is not transmitted person to person;

one must come in contact with the spores to contact infection.

Laboratory Results:- Anthrax serology test; Antibody test for anthrax; Serologic test for B.

Anthracis (Diagnostic Procedures for Anthrax).- These tests are usually required when you are suspected of having Anthrax;

it is done by drawing blood samples and checking for antibodies against B. Anthracis.

Normal Result:- A normal result means no antibodies to the anthrax bacteria were seen in

your blood sample. However, during the early stages of infection, your body

may only produce a few antibodies, which the blood test may miss. The test may need to be repeated in 10 days - 2 weeks.

Abnormal Result:- An abnormal result means antibodies to B. anthracis have been detected and

you may have anthrax disease. However, some people come in contact with the bacteria and do not develop the disease.

- To determine if you have a current infection, your health care provider will look for an increase in the antibody count after a few weeks.

Medical Treatment:-  Primarily high-dose penicillin and isolation.  Other treatments and antibiotics

include:  cephalosporin, chloramphenicol, anti-anthrax globulin, corticosteroids, osmoregulatory solutions, erythromycin, and tetracycline.   Prophylactic tetracycline has been used for some exposed populations. However, although antibiotics kill the anthrax bacteria, by the time characteristic symptoms appear, the bacteria are multiplying wildly in the bloodstream.  The massive amount of toxin produced by these bacteria circulates throughout the bloodstream and cannot be eliminated by killing the bacteria. Antibiotics do not affect the circulating toxin.

Prevention and Control:- Prevention of naturally-occurring anthrax in humans is primarily dependent

on the control of the disease in animals, especially livestock. Animal vaccination is the major means of preventing naturally-occurring epizootics of anthrax, since widespread decontamination of infected soil is impractical. Annual vaccination of livestock in areas with enzootic anthrax is recommended.

- To lower your risk of getting anthrax from a natural source:

1. Do not eat meat that has not been properly slaughtered and cooked.2. Do not work with raw animal hides, fur or skin, especially those of goats,

sheep, or cows.

- To lower your risk of getting anthrax if terrorists release spores on purpose:

1. If you were exposed to a suspicious substance or if you were in an area thought to contain anthrax spores, it may help to wash your skin and hair thoroughly with soap and water. It may also help to change and wash your clothing, or if you cannot wash your clothes immediately, put them in a plastic bag to keep them separate from your other things. In such an emergency, SFDPH will provide specific instructions.

ACUTE VIRAL PAROTITIS (MUMPS)

- Mumps is an infectious disease caused by a virus that typically leads to painful swelling of the salivary glands in front of and below the ears. Mumps typically occurs in children between the ages of two and 12 years who were not vaccinated against mumps. 

Other Names:- Epidemic Parotitis, Viral Parotitis

Causative Agent:- Mumps is an infectious disease caused by a virus that is transmitted by

droplets of mucus or saliva from an infected person. The virus that causes mumps is a member of the paramyxovirus family, the same family that includes the measles virus.

Signs and Symptoms:

- Fever - Headache - Muscle aches - Tiredness - Loss of appetite - Swollen and tender salivary glands under the ears or jaw on one or both sides

of the face (parotitis).

Incubation Period:

- The time between being exposed to the virus and getting sick (incubation period) is usually 12 - 24 days.

Mode of Transmission:- Mumps is spread by droplets of saliva or mucus from the mouth, nose, or

throat of an infected person, usually when the person coughs, sneezes or talks. Items used by an infected person, such as cups or soft drink cans, can also be contaminated with the virus, which may spread to others if those items are shared. In addition, the virus may spread when someone with

mumps touches items or surfaces without washing their hands and someone else then touches the same surface and rubs their mouth or nose. Most mumps transmission likely occurs before the salivary glands begin to swell and within the 5 days after the swelling begins.

Nursing Management:- Reduce or alleviate the symptoms caused by the disease, since MUMPS

resolves on its own without any need for specific treatment.- Provide patient with the right information about the disease and how it is

transmitted to avoid spread of infection.- Teaching client with proper diet such as soft foods and avoiding acidic foods

such as orange juice can help cope with symptom.

Laboratory Results:- No testing is usually required for MUMPS but a Physical exam could already

confirm presence of the swollen gland.

Medical Treatment:- As said above MUMPS resolve on its own but one can help alleviate

symptoms such as acetaminophen for fever and pain.- You can also relieve symptoms with:

Extra fluids Soft foods Warm salt water gargles

Prevention and Control

The MMR (measles, mumps, and rubella) vaccine is the best way to prevent mumps. The MMR vaccine should be routinely given when children are 12-15 months old, and a second dose should be given when they are 4-6 years old. Two doses of the vaccine are more effective against mumps than one dose and prevent most, but not all, cases of mumps and mumps complications.