Current Status and Trends in Prophylaxis and Management of Anthrax Disease

Abstract

Bacillus anthracis has been identified as a potential military and bioterror agent as it is relatively simple to produce, with spores that are highly resilient to degradation in the environment and easily dispersed. These characteristics are important in describing how anthrax could be used as a weapon, but they are also important in understanding and determining appropriate prevention and treatment of anthrax disease. Today, anthrax disease is primarily enzootic and found mostly in the developing world, where it is still associated with considerable mortality and morbidity in humans and livestock. This review article describes the spectrum of disease caused by anthrax and the various prevention and treatment options. Specifically we discuss the following; (1) clinical manifestations of anthrax disease (cutaneous, gastrointestinal, inhalational and intravenous-associated); (2) immunology of the disease; (3) an overview of animal models used in research; (4) the current World Health Organization and U.S. Government guidelines for investigation, management, and prophylaxis; (5) unique regulatory approaches to licensure and approval of anthrax medical countermeasures; (6) the history of vaccination and pre-exposure prophylaxis; (7) post-exposure prophylaxis and disease management; (8) treatment of symptomatic disease through the use of antibiotics and hyperimmune or monoclonal antibody-based antitoxin therapies; and (9) the current landscape of next-generation product candidates under development.

Gambaran Umum, Prevalensi, dan Pencegahan Antraks pada Manusia di Indonesia

“…13 Antraks bersifat enzootik dan termasuk re-emerging disease atau penyakit yang dapat berulang dan tingkat kematian tinggi akibat antraks pada manusia umumnya disebabkan karena tidak terdiagnosis dan tidak tepatnya pengobatan yang dilakukan. 8,14,15 Kementerian Kesehatan RI mengklasifikasikan antraks pada manusia berdasarkan gejala klinisnya menjadi 4 bentuk yaitu antraks kulit (paling sering terjadi), antraks saluran pernafasan, antraks paru-paru, dan antraks meningitis. 16 Infeksi antraks umumnya melalui kontak langsung antara kulit atau membran mukosa dengan spora B. antrachis (ketika menyembelih, memproses bagian, atau kontak dengan produk hewan terinfeksi), mengonsumsi daging hewan terinfeksi, dan menghirup spora antraks.…”

“…27 Kapsul asam poli-γ-D-glutamat berfungsi melindungi bakteri antraks dari fagositosis dan pengawasan sistem imun dengan mekanisme yang mirip dengan bakteri patogenik lainnya. 15 Beberapa faktor diketahui juga berkontribusi terhadap tingkat virulensi B. antrachis yaitu cell surface protein EA1 dan Sap, anthrolysin O, siderophores, dan metal cation transport proteins. 14 Sel vegetatif antraks relatif rentan atau mempunyai kemampuan bertahan hidup yang rendah di sebagian besar kondisi lingkungan, sedangkan bentuk spora lebih resisten.…”

Teixobactin Provides Protection against Inhalation Anthrax in the Rabbit Model

“…anthracis , the Gram-positive bacteria responsible for anthrax infection, has been a focus of the biodefense community for many years because of its past and potentially future use as a bioweapon [ 1 , 2 ]. Inhalation anthrax, which is one of four forms of the disease (the others are cutaneous, gastrointestinal, and injectional), is initiated upon inhalation of anthrax spores into the lungs [ 3 ]. While in alveolar spaces, the spores are phagocytosed by macrophages and dendritic cells that then migrate to regional lymph nodes.…”

“…In the lymph nodes, the spores germinate, and the resultant bacteria multiply and eventually disseminate into the lymphatics, after which the bacteria enter the bloodstream (bacteremia). From circulation, the bacteria are capable of infecting various organs causing significant, widespread tissue pathology [ 3 ]. This ultimately leads to death of the host.…”

“…In recent years, there has been a renewed interest in this bacterial agent due to the growing concern for the development of multidrug-resistant (MDR) B. anthracis strains that could be used as bioweapons. While various antibiotics are currently effective against B. anthracis [ 3 , 9 , 10 ], some of which are included in the Strategic National Stockpile (SNS), these antibiotics could be rendered futile if the bacteria were genetically altered to become resistant [ 11 ]. Consequently, there is a continual need to discover and/or develop new therapeutics to combat this potential threat.…”