Anthrax

Background

Gm positive rod, tough spores

Inhalational Anthrax: Russian accident at Sverdlovsk

-Incubation Period is 10 days

-No one < 24 died

Ddx

Cutaneous (painless):

-Ecthyma gangrenosum

-Rat-bite fever (Streptobacillus monilifomis and Spirillum minus)

-Ulceroglandular tularemia

-Plague

-Glanders (Pseudomonas peudomallei)

-Rickettsialpox (Rickettsia akari)

-Orf (parapox virus)

-Staph lymphadenitis

-TB

-Leprosy

-Buruli ulcer (Mycobact ulcerans)

Inhalational:

-Acute bacterial mediastinitis

-Mycoplasma

-Legionnaire's

-Psittacosis

-Tularemia

-Q fever (Coxiella burnetti)

-Viral pneumonia

-Histoplasmosis

-Coccidiomycosis

-Ruptured aortic aneurysm

-SVC syndrome

-Silicosis

-Sarcoidosis

Imaging

CXR/CT- Widened mediastinum representing hemorrhagic mediastinitis

Treatment

Cipro 500 mg bid or 30 mg/kg div q12

Levo 500 mg qd

Doxycycline 100 mg bid

x 60 days

PLUS vaccine: inactivated, cell-free immediately, 2 wks and then 4 wks

Source

7/2/09 PANI