eMedicine Specialties > Emergency Medicine > Warfare - Chemical, Biological, Radiological, Nuclear and Explosives

CBRNE - Anthrax Infection: Follow-up

Author: Hilarie Cranmer, MD, MPH, FACEP, Director, Global Women's Health Fellowship, Associate Director, Harvard International Emergency Medicine Fellowship, Department of Emergency Medicine, Brigham and Women's Hospital; Director, Humanitarian Studies Program, Harvard Humanitarian Initiative; Assistant Professor, Harvard University School of Medicine
Coauthor(s): Mauricio Martinez, MD, Assistant Medical Director, Department of Emergency Medicine, Winchester Medical Center
Contributor Information and Disclosures

Updated: Oct 26, 2009

Follow-up

Further Inpatient Care

  • Patients should be admitted into the ICU for hemodynamic monitoring and management of septic and hemorrhagic shock, the final common pathway for endstage anthrax infection. In addition, progressive respiratory insufficiency may necessitate the use of ventilatory support.

Further Outpatient Care

  • For PEP in adults, the CDC recommends vaccination and the use of oral fluoroquinolones (ciprofloxacin, 500 mg bid; levofloxacin, 500 mg qd; or ofloxacin, 400 mg bid). Doxycycline is an acceptable alternative. Prophylaxis should continue until exposure to B anthracis is excluded or for a period of 4 weeks if exposure is confirmed. Three doses of vaccine should be administered during the 4-week period (at time 0, 2, and 4 wk postexposure). If a vaccine is not available, the antibiotic treatment should continue for at least 60 days. A second option is treatment for 100 days. A third option is 100 days of antibiotic prophylaxis with vaccine.

Prognosis

  • Inhalational anthrax and its subsequent systemic infection have a mortality rate approaching 100%. If treatment is initiated in the incubation period of 1-6 days and before the manifestation of symptoms, mortality can decrease to 1%.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Vaccine: Better protection, more extensive testing, more rigorous FDA approval, reduction of adverse effects, and a simpler dosing schedule are needed. No human studies are available that document efficacy of available vaccines.
  • Early diagnosis is difficult and a high index of suspicion is required.
 


More on CBRNE - Anthrax Infection

Overview: CBRNE - Anthrax Infection
Differential Diagnoses & Workup: CBRNE - Anthrax Infection
Treatment & Medication: CBRNE - Anthrax Infection
Follow-up: CBRNE - Anthrax Infection
Multimedia: CBRNE - Anthrax Infection
References
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References

  1. Inglesby TV, O'Toole T, Henderson DA, Bartlett JG, Ascher MS, Eitzen E. Anthrax as a biological weapon, 2002: updated recommendations for management. JAMA. May 1 2002;287(17):2236-52. [Medline].

  2. Food and Drug Administration. 17.5 FDA-Approved Medication Guide. Levaquin (levofloxacin). Accessed August 6, 2009. [Full Text].

  3. CDC. Vaccines and Preventable Diseases:Anthrax Vaccination. Vaccines:VPF-VAD/Anthrax/mainpage. Available at http://www.cdc.gov/vaccines/vpd-vac/anthrax/default.htm#vacc. Accessed July 9, 2009.

  4. Abramova FA, Grinberg LM, Yampolskaya OV, Walker DH. Pathology of inhalational anthrax in 42 cases from the Sverdlovsk outbreak of 1979. Proc Natl Acad Sci U S A. Mar 15 1993;90(6):2291-4. [Medline].

  5. Bell DM, Kozarsky PE, Stephens DS. Clinical issues in the prophylaxis, diagnosis, and treatment of anthrax. Emerg Infect Dis. Feb 2002;8(2):222-5. [Medline].

  6. CDC. Centers for Disease Control and Prevention Anthrax Fact Sheets & Overviews. CDC Anthrax Fact Sheets & Overviews. Available at http://www.bt.cdc.gov/agent/anthrax/basics/factsheets.asp. Accessed July 9, 2009.

  7. Dixon TC, Meselson M, Guillemin J, Hanna PC. Anthrax. N Engl J Med. Sep 9 1999;341(11):815-26. [Medline].

  8. Fennelly KP, Davidow AL, Miller SL, et al. Airborne infection with Bacillus anthracis--from mills to mail. Emerg Infect Dis. Jun 2004;10(6):996-1002. [Medline]. [Full Text].

  9. Shepard CW, Soriano-Gabarro M, Zell ER, et al. Antimicrobial postexposure prophylaxis for anthrax: adverse events and adherence. Emerg Infect Dis. Oct 2002;8(10):1124-32. [Medline].

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Further Reading

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Keywords

anthrax, Bacillus anthracis, , black bane, the fifth plague, wool-sorter's disease, woolsorter's disease, anthrax infection, inhalation anthrax, cutaneous anthrax, GI anthrax, gastrointestinal anthrax, oropharyngeal anthrax, meningeal anthrax, postexposure prophylaxis, PEP, biologic warfare agent, influenzalike illness, malignantpustules, black eschar

acute respiratory distress, hypoxemia, cyanosis, hypothermia, shock, enlarged mediastinal lymph nodes, subarachnoid hemorrhage, pleural effusions, meningismus, ileus, GI hemorrhage, dysphagia, oral bleeding,biological weapon, biological terrorism, biological warfare, biowarfare

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Contributor Information and Disclosures

Author

Hilarie Cranmer, MD, MPH, FACEP, Director, Global Women's Health Fellowship, Associate Director, Harvard International Emergency Medicine Fellowship, Department of Emergency Medicine, Brigham and Women's Hospital; Director, Humanitarian Studies Program, Harvard Humanitarian Initiative; Assistant Professor, Harvard University School of Medicine
Hilarie Cranmer, MD, MPH, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Massachusetts Medical Society, Physicians for Human Rights, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Mauricio Martinez, MD, Assistant Medical Director, Department of Emergency Medicine, Winchester Medical Center
Mauricio Martinez, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

James Li, MD, Former Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Board of Directors, Remote Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Barry J Sheridan, DO, Chief, Department of Emergency Medical Services, Brooke Army Medical Center
Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP, Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine
Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Association of Military Surgeons of the US
Disclosure: Nothing to disclose.

 
 
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