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

CBRNE - Anthrax Infection: Multimedia

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

Multimedia

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Media file 1: Anthrax infection. Inhalation anthrax. Chest radiograph with widened mediastinum 22 hours before death. Image courtesy of Dr P.S. Brachman, Public Health Image Library, CDC, Atlanta, Ga.

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Anthrax infection. Inhalation anthrax. Chest radiograph with widened mediastinum 22 hours before death. Image courtesy of Dr P.S. Brachman, Public Health Image Library, CDC, Atlanta, Ga.

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Media file 2: Anthrax infection. Cutaneous anthrax showing the typical black eschar. Photo courtesy of the Public Health Image Library, CDC, Atlanta, Ga.

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Anthrax infection. Cutaneous anthrax showing the typical black eschar. Photo courtesy of the Public Health Image Library, CDC, Atlanta, Ga.

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Media file 3: Anthrax infection. Polychrome methylene blue stain of Bacillus anthracis. Image courtesy of AVIP agency, Office of the Army Surgeon General, United States.

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Anthrax infection. Polychrome methylene blue stain of Bacillus anthracis. Image courtesy of AVIP agency, Office of the Army Surgeon General, United States.

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Media file 4: Anthrax infection. Histopathology of mediastinal lymph node showing a microcolony of Bacillus anthracis on Giemsa stain. Image courtesy of Dr Marshall Fox, Public Health Image Library, CDC, Atlanta, Ga.

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Anthrax infection. Histopathology of mediastinal lymph node showing a microcolony of Bacillus anthracis on Giemsa stain. Image courtesy of Dr Marshall Fox, Public Health Image Library, CDC, Atlanta, Ga.

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Media file 5: Anthrax infection. Cutaneous anthrax. Image courtesy of AVIP agency, Office of the Army Surgeon General, United States.

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Anthrax infection. Cutaneous anthrax. Image courtesy of AVIP agency, Office of the Army Surgeon General, United States.

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Media file 6: Anthrax infection. Skin lesion of anthrax on face. Photo courtesy of the Public Health Image Library, CDC, Atlanta, Ga.

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Anthrax infection. Skin lesion of anthrax on face. Photo courtesy of the Public Health Image Library, CDC, Atlanta, Ga.

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Media file 7: Anthrax infection. Histopathology of large intestine showing marked hemorrhage in the mucosa and submucosa. Image courtesy of Dr Marshall Fox, Public Health Image Library, CDC, Atlanta, Ga.

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Anthrax infection. Histopathology of large intestine showing marked hemorrhage in the mucosa and submucosa. Image courtesy of Dr Marshall Fox, Public Health Image Library, CDC, Atlanta, Ga.

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Media file 8: Anthrax infection. Histopathology of the large intestine showing submucosal thrombosis and edema. Image courtesy of Dr Marshall Fox, Public Health Image Library, CDC, Atlanta, Ga.

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Anthrax infection. Histopathology of the large intestine showing submucosal thrombosis and edema. Image courtesy of Dr Marshall Fox, Public Health Image Library, CDC, Atlanta, Ga.

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Media file 9: Anthrax infection. Histopathology of mediastinal lymph node showing mediastinal necrosis. Image courtesy of Dr Marshall Fox, Public Health Image Library, CDC, Atlanta, Ga.

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Anthrax infection. Histopathology of mediastinal lymph node showing mediastinal necrosis. Image courtesy of Dr Marshall Fox, Public Health Image Library, CDC, Atlanta, Ga.

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Media file 10: Anthrax infection. Hemorrhagic meningitis resulting from inhalation anthrax. Photo courtesy of the Public Health Image Library, CDC, Atlanta, Ga.

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Anthrax infection. Hemorrhagic meningitis resulting from inhalation anthrax. Photo courtesy of the Public Health Image Library, CDC, Atlanta, Ga.

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Media file 11: Anthrax infection. Histopathology of hemorrhagic meningitis in anthrax. Image courtesy of Dr Marshall Fox, Public Health Image Library, CDC, Atlanta, Ga.

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Anthrax infection. Histopathology of hemorrhagic meningitis in anthrax. Image courtesy of Dr Marshall Fox, Public Health Image Library, CDC, Atlanta, Ga.

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Media file 12: Anthrax infection. Bioterrorist Agents. Signs and symptoms. Chart courtesy of North Carolina Statewide Program for Infection Control and Epidemiology (SPICE), copyright University of North Carolina at Chapel Hill.

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Anthrax infection. Bioterrorist Agents. Signs and symptoms. Chart courtesy of North Carolina Statewide Program for Infection Control and Epidemiology (SPICE), copyright University of North Carolina at Chapel Hill.

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Media file 13: Seven-month-old infant with anthrax. In this infant, the infection progressed rapidly with significant edema developing the day after exposure. This large hemorrhagic lesion developed within 3 more days. The infant was febrile and was admitted to the hospital on the second day after the symptoms appeared. On September 28, 2001, the infant had visited the mother's workplace. On September 29, nontender massive edema and a weeping erosion developed.

On September 30, a 2-cm sore developed over the edematous area. (Note that edema preceded the primary lesion.) On October 2, an ulcer or eschar formed, and the lesion was diagnosed as a spider bite. Hemolytic anemia and thrombocytopenia developed, and the patient was hospitalized. Serum was drawn on October 2; the polymerase chain reaction results were positive for Bacillus anthracis.

On October 13, skin biopsy results were positive with immunohistochemical testing for the cell wall antigen. Note that the initial working diagnosis was a Loxosceles reclusa spider bite with superimposed cellulitis. Courtesy of American Academy of Dermatology with permission of NEJM.

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Seven-month-old infant with anthrax. In this infant, the infection progressed rapidly with significant edema developing the day after exposure. This large hemorrhagic lesion developed within 3 more days. The infant was febrile and was admitted to the hospital on the second day after the symptoms appeared. On September 28, 2001, the infant had visited the mother's workplace. On September 29, nontender massive edema and a weeping erosion developed.

On September 30, a 2-cm sore developed over the edematous area. (Note that edema preceded the primary lesion.) On October 2, an ulcer or eschar formed, and the lesion was diagnosed as a spider bite. Hemolytic anemia and thrombocytopenia developed, and the patient was hospitalized. Serum was drawn on October 2; the polymerase chain reaction results were positive for Bacillus anthracis.

On October 13, skin biopsy results were positive with immunohistochemical testing for the cell wall antigen. Note that the initial working diagnosis was a Loxosceles reclusa spider bite with superimposed cellulitis. Courtesy of American Academy of Dermatology with permission of NEJM.

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Media file 14: Fourth patient with cutaneous anthrax in New York City, October 2001. This dry ulcer was present. Photo used with permission of the patient. Courtesy of American Academy of Dermatology. Courtesy of Sharon Balter of the New York City Department of Health.

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Fourth patient with cutaneous anthrax in New York City, October 2001. This dry ulcer was present. Photo used with permission of the patient. Courtesy of American Academy of Dermatology. Courtesy of Sharon Balter of the New York City Department of Health.

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Media file 15: Note the hemorrhage that is associated with cutaneous anthrax lesions. The early ulcer has a moist base. Courtesy of American Academy of Dermatology.

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Note the hemorrhage that is associated with cutaneous anthrax lesions. The early ulcer has a moist base. Courtesy of American Academy of Dermatology.

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Media file 16: Note the central ulcer and eschar. Courtesy of American Academy of Dermatology.

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Note the central ulcer and eschar. Courtesy of American Academy of Dermatology.

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Media file 17: An example of a central ulcer and eschar with surrounding edema. Courtesy of American Academy of Dermatology with permission from Boni Elewski, MD.

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An example of a central ulcer and eschar with surrounding edema. Courtesy of American Academy of Dermatology with permission from Boni Elewski, MD.

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Media file 18: Note the black eschar. Courtesy of American Academy of Dermatology. Courtesy of Gorgas Course in Clinical Tropical Medicine.

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Note the black eschar. Courtesy of American Academy of Dermatology. Courtesy of Gorgas Course in Clinical Tropical Medicine.

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Media file 19: Anthrax with facial edema. Courtesy of American Academy of Dermatology.

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Anthrax with facial edema. Courtesy of American Academy of Dermatology.

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

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].
Food and Drug Administration. 17.5 FDA-Approved Medication Guide. Levaquin (levofloxacin). Accessed August 6, 2009. [Full Text].
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.
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].
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].
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.
Dixon TC, Meselson M, Guillemin J, Hanna PC. Anthrax. N Engl J Med. Sep 9 1999;341(11):815-26. [Medline].
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].
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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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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eMedicine Specialties > Emergency Medicine > Warfare - Chemical, Biological, Radiological, Nuclear and Explosives

CBRNE - Anthrax Infection: Multimedia

Multimedia

Anthrax infection. Inhalation anthrax. Chest radiograph with widened mediastinum 22 hours before death. Image courtesy of Dr P.S. Brachman, Public Health Image Library, CDC, Atlanta, Ga.

Anthrax infection. Cutaneous anthrax showing the typical black eschar. Photo courtesy of the Public Health Image Library, CDC, Atlanta, Ga.

Anthrax infection. Polychrome methylene blue stain of Bacillus anthracis. Image courtesy of AVIP agency, Office of the Army Surgeon General, United States.

Anthrax infection. Histopathology of mediastinal lymph node showing a microcolony of Bacillus anthracis on Giemsa stain. Image courtesy of Dr Marshall Fox, Public Health Image Library, CDC, Atlanta, Ga.

Anthrax infection. Cutaneous anthrax. Image courtesy of AVIP agency, Office of the Army Surgeon General, United States.

Anthrax infection. Skin lesion of anthrax on face. Photo courtesy of the Public Health Image Library, CDC, Atlanta, Ga.

Anthrax infection. Histopathology of large intestine showing marked hemorrhage in the mucosa and submucosa. Image courtesy of Dr Marshall Fox, Public Health Image Library, CDC, Atlanta, Ga.

Anthrax infection. Histopathology of the large intestine showing submucosal thrombosis and edema. Image courtesy of Dr Marshall Fox, Public Health Image Library, CDC, Atlanta, Ga.

Anthrax infection. Histopathology of mediastinal lymph node showing mediastinal necrosis. Image courtesy of Dr Marshall Fox, Public Health Image Library, CDC, Atlanta, Ga.

Anthrax infection. Hemorrhagic meningitis resulting from inhalation anthrax. Photo courtesy of the Public Health Image Library, CDC, Atlanta, Ga.

Anthrax infection. Histopathology of hemorrhagic meningitis in anthrax. Image courtesy of Dr Marshall Fox, Public Health Image Library, CDC, Atlanta, Ga.

Anthrax infection. Bioterrorist Agents. Signs and symptoms. Chart courtesy of North Carolina Statewide Program for Infection Control and Epidemiology (SPICE), copyright University of North Carolina at Chapel Hill.

Fourth patient with cutaneous anthrax in New York City, October 2001. This dry ulcer was present. Photo used with permission of the patient. Courtesy of American Academy of Dermatology. Courtesy of Sharon Balter of the New York City Department of Health.

Note the hemorrhage that is associated with cutaneous anthrax lesions. The early ulcer has a moist base. Courtesy of American Academy of Dermatology.

Note the central ulcer and eschar. Courtesy of American Academy of Dermatology.

An example of a central ulcer and eschar with surrounding edema. Courtesy of American Academy of Dermatology with permission from Boni Elewski, MD.

Note the black eschar. Courtesy of American Academy of Dermatology. Courtesy of Gorgas Course in Clinical Tropical Medicine.

Anthrax with facial edema. Courtesy of American Academy of Dermatology.

More on CBRNE - Anthrax Infection

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor