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Last Updated: 8/6/2015  


Anthrax is an infectious disease 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.

  • 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 as a chest CT is more sensitive, especially early in the disease process.

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

  • Treat mild cutaneous anthrax with oral doxycycline or ciprofloxacin (or other similar fluoroquinolone).

  • Treat inhalational anthrax, anthrax meningitis, GI anthrax, and severe cutaneous disease with intravenous ciprofloxacin (or other similar fluoroquinolone) plus two or more 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.
Author(s) and Disclosures:
Sandro Cinti, MD has nothing to disclose. Barbara Robinson-Dunn, PhD has nothing to disclose. Niklas Mackler, MD has nothing to disclose. Nicholas John Vietri, MD, MS has nothing to disclose.

One or more of the present or past ACP Smart Medicine physician editors worked on this module and had nothing to disclose: Davoren Chick, MD, FACP; Deborah Korenstein, MD, FACP; Marjorie Lazoff, MD, FACP; Richard Lynn, MD, FACP.

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