Fact Sheet: Anthrax Information for Health Care Providers

• Encapsulated, aerobic, gram-positive, spore-forming, rod-shaped (bacillus) bacterium

• Skin or cutaneous (most common)
• Respiratory tract or inhalation (rare)
• Gastrointestinal (GI) tract (rare)
• Oropharyngeal form (least common)

• Skin: direct skin contact with spores; in nature, contact with infected animals or animal products (usually related to occupational exposure)
• Respiratory tract: inhalation of aerosolized spores
• GI: consumption of undercooked or raw meat products or dairy products from infected animals
• NO person-to-person transmission of inhalation or GI anthrax

• Report suspected or confirmed anthrax cases immediately to your local or state department of health.

• Local skin involvement after direct contact with spores or bacilli
• Localized itching followed by 1) papular lesion that turns vesicular and 2) subsequent development of black eschar within 7–10 days of initial lesion

(See Cutaneous Anthrax Treatment Protocol for specific therapy)

• Obtain specimens for culture BEFORE initiating antimicrobial therapy.
• Do NOT use extended-spectrum cephalosporins or trimethoprim/sulfamethoxazole because anthrax may be resistant to these drugs.

• Standard contact precautions. Avoid direct contact with wound or wound drainage.

• Usually <1 week; may be prolonged for weeks (up to 2 months)

• Non-specific symptoms such as low-grade fever, nonproductive cough, malaise, fatigue, myalgias, profound sweats, chest discomfort (upper respiratory tract symptoms are rare)
• Maybe rhonchi on exam, otherwise normal
• Chest X-ray:
• mediastinal widening
• pleural effusion (often)
• infiltrates (rare)

• 1–5 days after onset of initial symptoms
• May be preceded by 1–3 days of improvement
• Abrupt onset of high fever and severe respiratory distress (dyspnea, stridor, cyanosis)
• Shock, death within 24–36 hours

• Coordinate all aspects of testing, packaging, and transporting with public health laboratory/Laboratory Response Network (LRN).
• Obtain specimens appropriate to system affected:
  • blood (essential)
  • pleural fluid
  • cerebral spinal fluid (CSF)
  • skin lesion

• Gram-positive bacilli on unspun peripheral blood smear or CSF
• Aerobic blood culture growth of large, gram-positive bacilli provides preliminary identification of Bacillus species.

(See Inhalational Anthrax Treatment Protocol for specific therapy)

• Obtain specimens for culture BEFORE initiating antimicrobial therapy.
• Initiate antimicrobial therapy immediately upon suspicion.
• Do NOT use extended-spectrum cephalosporins or trimethoprim/sulfamethoxazole because anthrax may be resistant to these drugs.
• Supportive care including controlling pleural effusions

• Standard contact precautions

• Usually 1–7 days

• Nausea, anorexia, vomiting, and fever progressing to severe abdominal pain, hematemesis, and diarrhea that is almost always bloody
• Acute abdomen picture with rebound tenderness may develop.
• Mesenteric adenopathy on computed tomography (CT) scan likely. Mediastinal widening on chest X-ray has been reported

• 2–4 days after onset of symptoms, ascites develops as abdominal pain decreases.
• Shock, death within 2–5 days of onset

• Coordinate all aspects of testing, packaging, and transporting with public health laboratory/LRN.
• Obtain specimens appropriate to system affected:
  • blood (essential)
  • ascitic fluid

• Gram-positive bacilli on unspun peripheral blood smear or ascitic fluid
• Pharyngeal swab for pharyngeal form
• Aerobic blood culture growth of large, gram-positive bacilli provides preliminary identification of Bacillus species.

(See Inhalational Anthrax Treatment Protocol for specific therapy)

• Obtain specimens for culture BEFORE initiating antimicrobial therapy.
• Early (during initial phase) antimicrobial therapy is critical.
• Do NOT use extended-spectrum cephalosporins or trimethoprim/sulfamethoxazole because anthrax may be resistant to these drugs.

• Standard precautions

• Usually 1–7 days

• Fever and marked unilateral or bilateral neck swelling caused by regional lymphadenopathy
• Severe throat pain and dysphagia
• Ulcers at the base of the tongue, initially edematous and hyperemic

• Ulcers may progress to necrosis
• Swelling can be severe enough to compromise the airway

• Coordinate all aspects of testing, packaging, and transporting with public health laboratory/LRN.
• Obtain specimens appropriate to system affected:
  • blood (essential)
  • throat

• Aerobic blood culture growth of large, gram-positive bacilli provides preliminary identification of Bacillus species.

• Obtain specimens for culture BEFORE initiating antimicrobial therapy.
• Do NOT use extended-spectrum cephalosporins or trimethoprim/sulfamethoxazole because anthrax may be resistant to these drugs.
• Supportive care including controlling ascites

• Standard contact precautions