Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 23 2021


Images anthrax.jpg
  • Snapshot
    • A 40-year-old farmer from rural China presents to a local hospital for fever and cough. He reports to have had a nonproductive cough for a few days and feels more short of breath and lightheaded this morning. He works frequently with sheep on the countryside. On physical exam, his temperature is 102.2°F (39.0°C), blood pressure is 100/70 mm Hg, pulse is 96/min, and respirations are 22/min. On physical exam, there is bilateral rhonchi in the lung bases. Chest radiograph reveals a widened mediastinum and bilateral infiltrates.
  • Introduction
    • Classification
      • Bacillus anthracis
        • spore-forming and exotoxin-forming gram + rod
        • capsule protects against phagocytosis
          • the only bacterial with polypeptide capsule (poly-D-glutamate)
      • transmission
        • inhalation of spores
        • direct contact of spores to a skin break
        • ingestion of spores
    • Associated conditions
      • cutaneous anthrax
        • most common
      • pulmonary anthrax
        • “woolsorter’s disease”
      • gastrointestinal anthrax
    • Prevention
      • post-exposure prophylaxis
        • 3 doses of anthrax vaccine
        • 60 days of a single antibiotic
          • ciprofloxacin or doxycycline are first line
  • Epidemiology
    • Incidence
      • more common in areas where animal vaccination rates are low
      • bioterrorism
    • Risk factors
      • intravenous drug use (e.g., heroin)
      • occupational exposure to unvaccinated animals
      • occupational exposure to animal hides
    • Pathogenesis
      • edema toxin performs the same function as adenylate cyclase, ↑ cAMP and results in
        • black eschar with edematous borders
        • vasodilation and hypotension
      • infection may spread via lymphatics
  • Presentation
    • Symptoms
      • pulmonary anthrax
        • flu-like syndrome with non-productive cough
        • nausea and vomiting
        • hemoptysis
        • chest pain
      • gastrointestinal anthrax
        • nausea and vomiting
        • dysentery
        • abdominal pain
    • Physical exam
      • cutaneous anthrax
        • initial lesion is a painless and pruritic papule with central vesicle or bulla
        • this progresses to painless and necrotic black eschar
          • surrounded by edema
        • eschar sloughs off at day 14
      • pulmonary anthrax
        • mediastinitis
        • shock
        • hypoxia
        • dyspnea
      • lymphadenopathy
  • Imaging
    • Chest radiography
      • indication
        • pulmonary anthrax
      • findings
        • pleural effusion
        • pulmonary consolidation
        • widened mediastinum
  • Studies
    • Labs
      • multiple methods of detection
        • “medusa head” appearance on microscopy
          • halo of projections
        • culture of blood, pleural fluid, or eschar
        • positive Gram stain of affected tissue
          • box-car like appearance
        • polymerase chain reaction
        • anti-protective antigen immunoglobulin G on enzyme-linked immunosorbent assay
        • biopsy with immunohistochemistry staining
      • marked hemoconcentration
    • Making the diagnosis
      • most cases are diagnosed clinically and confirmed with
        • positive culture, serology, or immunohistochemistry
        • detection of Bacillus anthracis DNA in tissue
  • Differential
    • Community-acquired pneumonia
      • distinguishing factor
        • less likely to have nausea, vomiting, pallor, or unexplained mediastinal widening on chest radiography
  • Treatment
    • Management approach
      • antibiotics should be given in the prodromal phase of the disease
      • cutaneous anthrax can be treated with 1 antibiotic
      • systemic anthrax can be treated with 2 antibiotics
    • Medical
      • ciprofloxacin or doxycycline
        • indication
          • all patients
        • doxycycline adverse effects
          • gastrointestinal upset, photosensitivity, teeth discoloration, and inhibition of bone growth in children
          • photosensitivity
        • ciprofloxacin adverse effects
          • gastrointestinal upset, risk of tendon rupture, and QT prolongation
      • protein synthesis inhibitor
        • indications
          • systemic anthrax
          • combination therapy with fluoroquinolone or doxycycline
        • mechanism
          • reduces toxin production
        • drugs
          • clindamycin
          • linezolid
      • antitoxins
        • indication
          • all patients
        • drugs
          • monoclonal antibodies
            • raxibacumab
          • anthrax immunoglobulin
  • Complications
    • Bacteremia from cutaneous anthrax
    • Death
  • Prognosis
    • Biphasic nature of pulmonary anthrax
      • prodromal symptoms
      • fulminant bactermic phase
        • often leads to death within days
1 of 0
1 of 2
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options