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Section 3. Summaries of Infectious Diseases
Anthrax
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Depending on the route of infection,
anthrax disease can occur in 3 forms: cutaneous, inhalational,
and gastrointestinal.
Cutaneous anthrax begins as a pruritic
papule or vesicle that enlarges and ulcerates in 1 to 2 days,
with subsequent formation of a central black eschar. The lesion
characteristically is painless, with surrounding edema, hyperemia,
and regional lymphadenopathy. Patients may have associated fever,
malaise, and headache.
Inhalational anthrax is the most lethal
form of disease. A prodrome of fever, sweats, nonproductive
cough, chest pain, headache, myalgias, malaise, and nausea and
vomiting may occur initially, but more distinctive clinical
symptoms occur 2 to 5 days later, in some cases following a
period of improvement. These manifestations include dyspnea,
hypoxia, and fulminant shock occurring as a result of hemorrhagic
mediastinal lymphadenitis, hemorrhagic pleural effusions, bacteremia,
and toxemia. A widened mediastinum is the classic finding on
imaging of the chest; pleural effusions and hemorrhagic infiltrates
can be present, but initially changes on chest radiography may
be subtle.
Gastrointestinal tract disease can present as 2 clinical
syndromes, intestinal and oropharyngeal. Patients with the intestinal
form have symptoms of nausea, anorexia, vomiting, and fever
progressing to severe abdominal pain, massive ascites, hematemesis,
and bloody diarrhea. Oropharyngeal anthrax may include posterior
oropharyngeal ulcers that typically are unilateral and associated
with marked neck swelling, regional adenopathy, and sepsis.
Hemorrhagic meningitis can result from hematogenous spread of
the organism after acquiring any form of disease. The case-fatality
rate for patients with appropriately treated cutaneous anthrax
usually is <1%, but for inhalational or gastrointestinal
tract disease, mortality often exceeds 50% and approaches 100%
for meningitis.
ETIOLOGY: Bacillus anthracis is an aerobic, gram-positive,
encapsulated, spore-forming, nonmotile rod. Spore size is
. . . [Go to Full Text]
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