Anthrax is a notifiable condition. Bacillus anthracis spores are potential agents of biologic warfare as they are easily disseminated and are resistant to heat, light, and radiation.
Cutaneous anthrax is the most common type, accounting for approximately 95% of cases. Inhalation, ingestion, and injection anthrax, as well as anthrax meningitis, are less common.
Microbiology and pathology testing are used to confirm the diagnosis. Chest x-ray and CT scan are useful diagnostic tools in cases of inhalation anthrax.
Initial therapy includes treatment with empiric antibiotics and appropriate supportive therapy. Once susceptibilities are available, antibiotic treatment can be modified. Antitoxins may be used in some patients.
A rare infection caused by the spore-forming, gram-positive soil organism Bacillus anthracis. Cutaneous disease as a result of direct inoculation is the most common manifestation; however, fatal systemic illness due to spore ingestion, inhalation, or injection can occur. Exotoxin production can lead to shock, hypotension, and sudden death, necessitating early diagnosis and therapy. Inhalation anthrax is also known as woolsorters' disease.
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
- gastrointestinal symptoms (ingestion)
- environmental exposure
- occupational exposure
- biologic terrorism
- undercooked meat ingestion
- heroin use
1st investigations to order
- culture and Gram stain
- real-time polymerase chain reaction (RT-PCR)
- anthrax lethal factor (LF) toxin mass spectrometry
- chest x-ray
Investigations to consider
- CT chest
mild cutaneous anthrax
inhalation, ingestion, or severe cutaneous anthrax
- Bacterial furunculosis
- Ecthyma gangrenosum
- Orf (ecthyma contagiosum)
- 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
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