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Section 3. Summaries of Infectious Diseases
Anthrax
Clinical ManifestationsEtiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
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CLINICAL MANIFESTATIONS
Depending on the route of infection, anthrax can occur in 3 forms: cutaneous, inhalation, 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. Inhalation anthrax is a frequently lethal form of the disease and is a medical emergency. A nonspecific prodrome of fever, sweats, nonproductive cough, chest pain, headache, myalgia, malaise, and nausea and vomiting may occur initially, but illness progresses to the fulminant phase 2 to 5 days later. In some cases, a period of improvement can intervene between prodromal symptoms and overwhelming illness. Fulminant manifestations include hypotension, dyspnea, hypoxia, cyanosis, and 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 or 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 are associated with marked, often unilateral neck swelling, regional adenopathy, fever, and sepsis. Hemorrhagic meningitis can result from hematogenous spread of the organism after acquiring any form of disease and may develop without any other apparent clinical presentation. The case-fatality rate for patients with appropriately treated cutaneous anthrax usually is less than 1%, but for inhalation or gastrointestinal
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