anthrax (woolsorter's disease)

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Introduction

Infection with Bacillus anthracis. The name anthrax from the Greek for 'coal' refers to the black eschar seen on affected skin.

Etiology

* even a single case of inhalation anthrax should raise suspicion of bioterrorism[9]

Epidemiology

  • endemic in Iran, Turkey, Pakistan, Sudan
    • natural resistance of humans is > than that of livestock
  • cutaneous form of anthrax is most common in humans
    • 3 cases in 9 years in USA (1984-1993)
  • gastrointestinal anthrax is rare (never documented in USA)
  • large epidemics have occurred in the former Soviet Union
  • exposure of 84 workers to live anthrax at CDC in June 2014, due to safety protocol breach[14]

Pathology

* histopathology images[16]

Clinical manifestations

* less common in viral respiratory tract infection[7] rhinorrhea & sore throat less common with inhalation anthrax No clinical features reliably distinguish anthrax from community-acquired pneumonia[7]

Laboratory

Diagnostic procedures

Radiology

Differential diagnosis

(see differential diagnosis of anthrax)

Management

# levofloxacin & ofloxacin also seem to be effective[5]

* doxycycline is the preferred agent in this class

Notes

More general terms

More specific terms

Additional terms

References

  1. DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 865
  2. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 897
  3. Dixon TC et al Anthrax. NEJM 341:815, 1999 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10477781
  4. Centers for Disease Control and Prevention (CDC). Update: Investigation of anthrax associated with intentional exposure and interim public health guidelines, October 2001. MMWR 50:889, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11686472
    Centers for Disease Control and Prevention (CDC) Update: Investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy, October 2001. MMWR 50:909, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11699843
  5. 5.0 5.1 Prescriber's Letter 8(11):61 2001
  6. 6.0 6.1 Journal Watch 21(23):185, 2001
  7. 7.0 7.1 7.2 7.3 Journal Watch 23(20):164, 2003 Hupert N et al Accuracy of screening for inhalational anthrax after a bioterrorist attack. Ann Intern Med 139(Sep 2):337, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12965942
    Sox HC A triage algorithm for inhalational anthrax. Ann Intern Med 139(Sep 2):379, 2003 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/12965947 <Internet> http://www.annals.org.cgi/content/full/139/5_Part_1/379
  8. Migone T-S et al Raxibacumab for the treatment of inhalational anthrax. N Engl J Med 2009 Jul 9; 361:135. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19587338
    Nabel GJ. Protecting against future shock - Inhalational anthrax. N Engl J Med 2009 Jul 9; 361:191. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19587345
  9. 9.0 9.1 9.2 9.3 9.4 Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16, 17, 18. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015, 2018.
  10. 10.0 10.1 Wright JG et al Use of Anthrax Vaccine in the United States Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009 Morbidity and Mortality Weekly Report (MMWR); July 23, 2010 / 59(rr06);1-30 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20651644 <Internet> http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5906a1.htm corresponding NGC guideline withdrawn Jan 2016
  11. Inglesby TV, O'Toole T, Henderson DA et al Anthrax as a biological weapon, 2002: updated recommendations for management. JAMA. 2002 May 1;287(17):2236-52. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11980524
  12. Bartlett JG, Inglesby TV Jr, Borio L. Management of anthrax. Clin Infect Dis. 2002 Oct 1;35(7):851-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12228822
  13. Bush LM, Abrams BH, Beall A, Johnson CC. Index case of fatal inhalational anthrax due to bioterrorism in the United States. N Engl J Med. 2001 Nov 29;345(22):1607-10 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11704685
  14. 14.0 14.1 Physician's First Watch, June 23, 2014 Elia J, Sadoughi S, Hefner JE David G. Fairchild, MD, MPH, Editor-in-Chief Over 80 Anthrax Exposures at CDC After Safety Breach - Public Not at Risk. Massachusetts Medical Society http://www.jwatch.org
  15. 15.0 15.1 Bower WA et al Clinical Framework and Medical Countermeasure Use During an Anthrax Mass-Casualty Incident. MMWR. Recommendations and Reports Dec 4, 2015 / 64(RR04);1-28 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6404a1.htm
  16. 16.0 16.1 16.2 16.3 Cunha BA, Bronze MS. (images) Medscape: Anthrax http://emedicine.medscape.com/article/212127-overview
  17. Hendricks KA, Wright ME, Shadomy SV et al Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis. 2014 Feb;20(2) PMID: https://www.ncbi.nlm.nih.gov/pubmed/24447897 Free PMC Article
  18. Bush LM, Perez MT. The anthrax attacks 10 years later. Ann Intern Med. 2012 Jan 3;156(1 Pt 1):41-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21969275
  19. 19.0 19.1 Harmon J, Kapitanyan R Poisoning Clues on the Skin: 10 Cases Medscape. April 6, 2017 http://reference.medscape.com/features/slideshow/acutepoisonings
  20. Harmon J, Kapitanyan R Poisoning Clues on the Skin: 8 Cases. Medscape. March 8, 2021 https://reference.medscape.com/slideshow/poisoning-clues-6013719
  21. Savransky V, Ionin B, Reece J. Current status and trends in prophylaxis and management of anthrax disease. Pathogens. 2020;9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32408493