When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Anthrax

Last reviewed: 1 Nov 2024
Last updated: 03 Jun 2024

Summary

Definition

History and exam

Key diagnostic factors

  • history of exposure
  • necrotic skin lesions (cutaneous)
  • painless lesions (cutaneous)
  • edema (cutaneous)
  • influenza-like illness (inhalation)
  • respiratory symptoms (inhalation)
  • oropharyngeal ulceration (ingestion)
Full details

Other diagnostic factors

  • lymphadenopathy
  • signs of meningitis
  • hypotension
  • gastrointestinal symptoms (ingestion)
Full details

Risk factors

  • environmental exposure
  • occupational exposure
  • biologic terrorism
  • undercooked meat ingestion
  • heroin use
Full details

Diagnostic tests

1st tests to order

  • culture and Gram stain
  • real-time polymerase chain reaction (RT-PCR)
  • serology
  • anthrax lethal factor (LF) toxin mass spectrometry
  • biopsy
  • CBC
  • chest x-ray
Full details

Tests to consider

  • CT chest
Full details

Treatment algorithm

ACUTE

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 organizational 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.

  • Anthrax images
  • Differentials

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

    • CDC Yellow Book: health information for international travel - anthrax
    • CDC guidelines for the prevention and treatment of anthrax
    More Guidelines
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer