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Last Updated: 2/6/2013  

Anthrax

Anthrax is an infectious diseased caused by Bacillus anthracis. The disease occurs in three forms: cutaneous, gastrointestinal, and inhalational. The cutaneous form is the most common and the least severe. Anthrax is identified by laboratory-confirmed isolation of B. anthracis from an infected tissue or by at least two other supportive laboratory tests in a patient with clinically compatible signs of anthrax.

Diagnosis
  • Obtain a travel or exposure history in patients with suspected anthrax, including travel to the Middle East, Africa, South America, or Asia, exposure to wool, hides, or animals from endemic areas, or potential exposure in a laboratory.

  • Consider cutaneous anthrax in patients with an enlarging, painless lesion with eschar surrounded by edema, usually on the neck, face, hands, or arms.

  • Consider the diagnosis of inhalational anthrax in patients with a febrile illness with respiratory symptoms and an appropriate exposure history.

  • Consider GI anthrax in patients with fever, GI symptoms, and an appropriate exposure history.

  • Obtain appropriate lab studies in patients with suspected anthrax, including culture of blood or infected material, and acute and convalescent titers.

  • Obtain a chest x-ray in patients with suspected inhalational anthrax; consider a chest CT in certain patients.

Therapy
  • Administer postexposure vaccine and 60 days of prophylaxis with doxycycline or ciprofloxacin to persons who have been exposed to anthrax during a biological attack.

  • Treat mild cutaneous anthrax with oral doxycycline or ciprofloxacin.

  • Treat inhalational anthrax, anthrax meningitis, GI anthrax, and severe cutaneous disease with intravenous ciprofloxacin plus one or two additional intravenous antibiotics.

  • Consider therapeutic thoracentesis in patients with pleural effusions due to inhalational anthrax.

DOI: 10.7326/d892
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Sandro Cinti, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Barbara Robinson-Dunn, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Niklas Mackler, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Nicholas John Vietri, MD, MS has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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