Daily Bolus of LR: anthrax

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February 7, 2011 by dailybolusoflr

Bacillus anthracis is the gram positive spore forming bacterium responsible for the disease known as anthrax.
It is found in grass eating mammals
Humans can become infected in nature by contact (inhalational or cutaneous) with spores on animals (wool sorters) or by eating contaminated (GI) animals.
Anthrax is more well known in the US for its relationship to the 2001 terrorist attacks where letters were sent to news stations and newspapers as well as to political officials containing anthrax spores.  These occurred in the weeks after the 2001 terrorist attacks on 9/11.
(Note: the woman on the cover was the first case of cutaneous anthrax in NY.  She worked at the NY Post and developed a necrotic sore on her right middle finger, which she insisted was where her cat scratched her.  The NYU ED resident (hmmm..) and ED attending had the derm attending come and see the patient and no one knew what it was.  Didn’t quite look like a cat bite, but I guess you never know what those little buggers carry in their mouths.  She was biopsied, started on abx and d/c.  Three days later when reports of inhalational anthrax cases were noted in Florida, the astute ED resident and attending called the patient and mentioned their concerns that she might have cutaneous anthrax.  At this point, she remembered some funny letter she had opened while at work!  This was her photo on the cover of the paper the following day…and yes, that IS her middle finger.)
Cutaneous anthrax
·         Starts as painless pustule with associated smaller vesicular lesions, usually along the border
·         Typically the pustule develops into a necrotic appearing ulceration within 1 week
·         There is often significant edema
·         Often associated with constitutional sx and local lymphadenopathy
·         Treatment is cipro, doxy or amoxicillin for 60 days
Inhalational anthrax
·         Starts as a mild flu like illness
·         Severe respiratory distress and sepsis
·         CXR classic findings have mediastinal lympadenopathy
·         Treatment is supportive with antibiotics similar to those above
See full size image http://www.bepast.org/docs/photos/Anthrax/Cutaneous%20anthrax%20with%20ulceration.jpg
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions

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