CDC updates advice for prevention and treatment of anthrax
The Centers for Disease Control and Prevention (CDC) has updated its 2014 recommendations for the post-exposure prophylaxis (PEP) and treatment of anthrax. The CDC based the updates on systematic reviews of studies involving in vitro antimicrobial drug activity against Bacillus anthracis, in vivo antimicrobial drug efficacy for PEP and treatment, in vivo and human anthrax antitoxin efficacy for PEP and treatment, and survival data.
The updated recommendations include an expanded list of alternative antimicrobial drugs that can be used if first-line drugs are contraindicated, not tolerated, ineffective, or unavailable.
The CDC has also issued new recommendations for the management of anthrax meningitis which includes the use of mannitol or hypertonic saline for cerebral oedema, corticosteroids as clinically indicated, and therapies that target intracranial bleeding and swelling.
No changes were made to previously published recommendations for critical care measures and clinical assessment tools or procedures, or to recommendations for the use of the anthrax vaccine.
The updated guidance highlights the recent approval of the adjuvanted anthrax vaccine adsorbed for PEP. The vaccine has the advantage of a reduced number of doses compared to the traditional anthrax vaccine adsorbed (AVA) vaccine.
Anthrax still occurs in agricultural regions of the Americas, southern and eastern Europe, central and southwestern Asia, and sub-Saharan Africa. A large-scale outbreak of anthrax is currently ongoing in Zambia.[1]
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)
Other diagnostic factors
- lymphadenopathy
- signs of meningitis
- hypotension
- gastrointestinal symptoms (ingestion)
Risk factors
- environmental exposure
- occupational exposure
- biological terrorism
- under-cooked meat ingestion
- heroin use
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
Investigations to consider
- CT chest
Treatment algorithm
cutaneous anthrax without signs/symptoms of meningitis
systemic anthrax with or without 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 organisational financial interests for sponsored clinical trials for COVID-19 vaccines (Pfizer/BioNTech), investigational antibiotics (Melinta Therapeutics), and RSV vaccine (Sanofi/AstraZeneca), none of which are related to anthrax.
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.
Differentials
- Bacterial furunculosis
- Ecthyma gangrenosum
- Orf (ecthyma contagiosum)
More DifferentialsGuidelines
- CDC Yellow Book: health information for international travel - anthrax
- CDC guidelines for the prevention and treatment of anthrax
More Guidelines
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