Overview
What are the signs and symptoms of inhalational anthrax?
What are the routes of exposure to anthrax?
What are the signs and symptoms of cutaneous anthrax?
What are the signs and symptoms of oropharyngeal anthrax?
What are the signs and symptoms of intestinal anthrax?
What is the pathophysiology of anthrax meningitis?
What is the pathophysiology of anthrax?
What is the pathophysiology of cutaneous anthrax?
What is the pathophysiology of intestinal anthrax?
What is the pathophysiology of inhalational anthrax?
Which factors increase the risk for inhalation anthrax?
What is the prevalence of anthrax in the US?
What is the global prevalence of anthrax?
Which patient groups are at highest risk for anthrax?
What is the prognosis of anthrax?
Presentation
Which clinical history findings are characteristic of cutaneous anthrax?
Which clinical history findings are characteristic of anthrax?
Which clinical history findings are characteristic of oropharyngeal anthrax?
Which clinical history findings are characteristic of intestinal anthrax?
Which clinical history findings are characteristic of inhalational anthrax?
What are the signs and symptoms of inhalational anthrax?
Which clinical history findings are characteristic of septicemic anthrax?
Which physical findings are characteristic of anthrax?
Which physical findings are characteristic of cutaneous anthrax?
Which physical findings are characteristic of oropharyngeal anthrax?
Which physical findings are characteristic of intestinal anthrax?
Which physical findings are characteristic of inhalational anthrax?
DDX
How is cutaneous anthrax differentiated from bubonic plague?
How is inhalational anthrax differentiated from zoonotic atypical pneumonias?
How is intestinal anthrax differentiated from dysentery?
How is anthrax differentiated from ulceroglandular tularemia?
How is cutaneous anthrax differentiated from syphilis?
Which conditions should be included in the differential diagnoses of anthrax?
What are the differential diagnoses for Anthrax?
Workup
What is the role of gram stain and blood culture in the diagnosis of anthrax?
What is the role of enzyme-linked immunosorbent assay (ELISA) in the diagnosis of anthrax?
What is the role of imaging in the diagnosis of anthrax?
What is the role of lumbar puncture in the diagnosis of anthrax?
Which histologic findings are characteristic of anthrax?
Treatment
What guidelines have been published for the treatment of cutaneous anthrax?
What are the CDC guidelines for anthrax postexposure prophylaxis (PEP)?
How is cutaneous anthrax treated?
How is systemic anthrax without meningitis treated?
How is anthrax meningitis treated?
What is included in prehospital care for anthrax?
What is included in emergency department (ED) care for anthrax?
Which specialist consultations are beneficial to patients with anthrax?
What is included in postexposure prophylaxis (PEP) against anthrax?
Which high-risk groups should be vaccinated against anthrax?
How is the anthrax vaccine administered for pre-exposure prophylaxis?
How is the anthrax vaccine administered for postexposure prophylaxis?
Medications
What is the role of medications in the treatment of anthrax?
Which medications in the drug class Vaccines are used in the treatment of Anthrax?
Which medications in the drug class Antidotes, Other are used in the treatment of Anthrax?
Which medications in the drug class Corticosteroids are used in the treatment of Anthrax?
Which medications in the drug class Antibiotics, Other are used in the treatment of Anthrax?
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Polychrome methylene blue stain of Bacillus anthracis. Image courtesy of Anthrax Vaccine Immunization Program Agency, Office of the Army Surgeon General, United States.
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Histopathology of mediastinal lymph node showing a microcolony of Bacillus anthracis on Giemsa stain. Image courtesy of Marshall Fox, MD, Public Health Image Library, US Centers for Disease Control and Prevention, Atlanta, Georgia.
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Cutaneous anthrax. Image courtesy of Anthrax Vaccine Immunization Program Agency, Office of the Army Surgeon General, United States.
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Skin lesion of anthrax on face. Image courtesy of the Public Health Image Library, US Centers for Disease Control and Prevention, Atlanta, Georgia.
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Skin lesions of anthrax on neck. Cutaneous anthrax showing the typical black eschar. Image courtesy of the Public Health Image Library, US Centers for Disease Control and Prevention, Atlanta, Georgia.
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Histopathology of large intestine showing marked hemorrhage in the mucosa and submucosa. Image courtesy of Marshall Fox, MD, Public Health Image Library, US Centers for Disease Control and Prevention, Atlanta, Georgia.
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Histopathology of the large intestine showing submucosal thrombosis and edema. Image courtesy of Marshall Fox, MD, Public Health Image Library, US Centers for Disease Control and Prevention, Atlanta, Georgia.
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Inhalation anthrax. Chest radiograph with widened mediastinum 22 hours before death. Image courtesy of P.S. Brachman, MD, Public Health Image Library, US Centers for Disease Control and Prevention, Atlanta, Georgia.
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Histopathology of mediastinal lymph node showing mediastinal necrosis. Image courtesy of Marshall Fox, MD, Public Health Image Library, US Centers for Disease Control and Prevention, Atlanta, Georgia.
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Hemorrhagic meningitis resulting from inhalation anthrax. Image courtesy of the Public Health Image Library, US Centers for Disease Control and Prevention, Atlanta, Georgia.
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Anthrax infection. Histopathology of hemorrhagic meningitis in anthrax. Image courtesy of Marshall Fox, MD, Public Health Image Library, US Centers for Disease Control and Prevention, Atlanta, Georgia.
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Microscopic picture of anthrax showing gram-positive rods. Image courtesy of Ramon E. Moncada, MD.
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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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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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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 central ulcer and eschar. Courtesy of American Academy of Dermatology.
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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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Note the black eschar. Courtesy of American Academy of Dermatology. Courtesy of Gorgas Course in Clinical Tropical Medicine.
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Anthrax with facial edema. Courtesy of American Academy of Dermatology.