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)
Other diagnostic factors
- lymphadenopathy
- hypotension
- gastrointestinal symptoms (ingestion)
Risk factors
- environmental exposure
- occupational exposure
- biologic terrorism
- undercooked 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
- CBC
- chest x-ray
Investigations to consider
- CT chest
Treatment algorithm
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.
Differentials
- Bacterial furunculosis
- Ecthyma gangrenosum
- Orf (ecthyma contagiosum)
More DifferentialsGuidelines
- CDC Yellow Book: health information for international travel - anthrax
- Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices, 2019
More Guidelines
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