Anthrax

Last reviewed: 6 Jan 2023
Last updated: 23 Nov 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • necrotic skin lesions (cutaneous)
  • painless lesions (cutaneous)
  • oedema (cutaneous)
  • influenza-like illness (inhalation)
  • respiratory symptoms (inhalation)
  • oropharyngeal ulceration (ingestion)
More key diagnostic factors

Other diagnostic factors

  • lymphadenopathy
  • hypotension
  • gastrointestinal symptoms (ingestion)
Other diagnostic factors

Risk factors

  • environmental exposure
  • occupational exposure
  • biological terrorism
  • under-cooked meat ingestion
  • heroin use
More risk factors

Diagnostic investigations

1st investigations to order

  • culture and Gram stain
  • real-time polymerase chain reaction (RT-PCR)
  • serology
  • anthrax lethal factor (LF) toxin mass spectrometry
  • biopsy
  • FBC
  • chest x-ray
More 1st investigations to order

Investigations to consider

  • CT chest
More investigations to consider

Treatment algorithm

ACUTE

mild cutaneous anthrax

inhalation, ingestion, or severe cutaneous anthrax

anthrax meningitis

Contributors

Authors

Kari Simonsen, MD, MBA

Professor of Pediatric Infectious Diseases

University of Nebraska Medical Center

Omaha

NE

Disclosures

KS declares that she has no competing interests.

Clayton Mowrer, DO, MBA

Fellow

Division of Internal Medicine/Pediatric Infectious Diseases

University of Nebraska Medical Center

Omaha

NE

Disclosures

CM declares that he has no competing interests.

Acknowledgements

Dr Kari Simonsen and Dr Clayton Mowrer would like to gratefully acknowledge Dr Daniel Boyle, Dr Brian Wolf, Dr Teresa Zembower, and Dr Pavani Reddy, previous contributors to this topic.

Disclosures

DB, BW, TZ, and PR declare that they have no competing interests.

Peer reviewers

Timothy Benton, MD

Regional Chairman

Residency Program Director

Associate Professor

Family and Community Medicine

Texas Tech University Health Sciences Center at the Permian Basin

Odessa

TX

Disclosures

TB declares that he has no competing interests.

Raffaele D’Amelio, MD

Professor of Internal Medicine

Director: Unit Clinical Immunology and Allergy

Department of Clinical and Molecular Medicine

Sapienza University of Rome, S. Andrea University Hospital

Rome

Italy

Disclosures

RD declares that he has no competing interests.

Ali Hassoun, MD, FACP, FIDSA, AAHIVS

Infectious Disease Specialist

Alabama Infectious Diseases Center

Huntsville

AL

Disclosures

AH declares that he has no competing interests.

Tim Brooks, MA, LMSSA, MB BChir, MSc, FRCPath, FRSPH

Head of Novel & Dangerous Pathogens

Novel and Dangerous Pathogens

HPA Centre for Emergency Preparedness and Response

Salisbury

UK

Disclosures

TB declares that he has no competing interests.

  • Anthrax images
  • Differentials

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    • Ecthyma gangrenosum
    • Orf (ecthyma contagiosum)
    More Differentials
  • Guidelines

    • Health information for international travel (Yellow Book) - anthrax
    • Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices, 2019
    More Guidelines
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