AssessmentsBacillus anthracis (Anthrax)
Bacillus anthracis (Anthrax)
USMLE® Step 1 style questions USMLE
A 30-year-old man presents to the emergency department due to severe shortness of breath and a cough with blood in the sputum. The patient started feeling tired and having myalgias a few days ago. The shortness of breath began yesterday and has worsened ever since. The patient does not smoke or drink alcohol, and is employed on a horse farm. Chest X-ray demonstrates pulmonary infiltrates and a widened mediastinum. Sputum culture reveals a Gram-positive bacterium with a polypeptide capsule. Which of the following organisms is the most likely cause of this patient’s condition?
Content Reviewers:Viviana Popa, MD
With Bacillus anthracis, bacillus means little rod and anthracis means coal.
Not a good reputation!
Ok, now B. Anthracis has a thick peptidoglycan cell wall, which takes in purple dye when Gram stained - so this is a gram-positive bacteria.
Also, it is a non-motile bacteria and a facultative anaerobe, meaning it can survive with or without oxygen.
B. Anthracis is also a non beta-hemolytic bacteria, because when cultivated on a medium called blood agar, B. Anthracis colonies don’t cause beta-hemolysis, where hemolysis, or breakdown of the red blood cells that surround the colonies makes the blood agar change color from red to transparent yellow.
Finally, Bacillus Anthracis is a spore-forming bacteria, so it can undergo endosporulation when it feels threatened by the environment, like when the temperature becomes too high or too low, in case of extreme dryness, or when there’s harmful radiation around.
Endosporulation means that the bacteria starts by replicating its DNA, and then it forms a wall inside the cell, isolating the big portion of the cell, let’s call it the mother cell, from the small portion of the cell.
Next, the forespore gets completely engulfed by the mother cell, something like a cell within a cell.
Finally, inside the dying mother cell, the forespore loses water and accumulates calcium, and at the same time gets wrapped in a super tough cortex from the dying mother cell.
At this point, the endospore is able to resist heat, due to the presence of dipicolinic acid found in the core of the Bacillus anthracis spore, harsh chemicals, digestive enzymes, and even antibiotics.
Finally, as the mother cell dies off, the endospore is released outside.
Surprisingly, an endospore can last over a thousand years out, waiting for favorable conditions to come, and then germinate into the bacterial, or vegetative form, which can then grow, divide and infect organisms, causing anthrax.
For example, when the bacteria reach the alveoli, which are the tiny air-filled sacs where gas exchange occurs in the lungs, they are eaten up by lung macrophages and transported via lymphatic vessels to the nearby mediastinal lymph nodes.
A similar process occurs in both the skin and GI tract.
Basically, the cell bursts, releasing the bacteria into the surrounding tissues.
Now, in terms of pathogenesis, first the active form of the bacteria produces a poly-D-glutamic acid capsule that has anti-phagocytic properties, so once it is released from the macrophage it cannot be ingested by another macrophage again.
Next, B. anthracis secretes an anthrax toxin, which is composed of three proteins: protective antigen, lethal factor, and edema factor.
The protein called protective antigen gets secreted from the bacteria and then binds to the surrounding immune cells via a cell surface protein called either ANTXR1 or tumor endothelial marker 8.
It turns out that protective antigen gets its name because if a person has antibodies to this protein they are considered immune to B. Anthracis.
After binding, protective antigen forms a channel in the immune cell membrane that allows for two additional proteins called lethal factor and edema factor to enter the intracellular space.
These enzymes help cells make NADPH, which is an important cofactor in other biochemical pathways that allow cells to generate energy in the form of ATP.
So when lethal factor cleaves these enzymes, cells can't generate ATP anymore, and eventually die through apoptosis or programmed cell death.
Edema factor gets its name from the edema it creates surrounding the black eschar.
Bacillus anthracis is an encapsulated, spore-forming, gram-positive bacteria bacterium that’s known to cause anthrax. Anthrax can cause severe pulmonary, gastrointestinal, or cutaneous illnesses in humans. Anthrax can be transmitted via ingestion, inhalation, and skin invasion by the bacteria or its spores, often via direct interaction with infected animals.
It is more seen in agricultural regions where livestock are infected with the bacteria. Depending on the affected organs, it can present with a black necrotic skin lesion; fever, respiratory distress, abdominal pain, septic shock, and death if a bloodstream infection occurs.