Anthrax

Background

1. Gm positive rod, tough spores
2. Inhalational Anthrax: Russian accident at Sverdlovsk
3. Incubation Period is 10 days
4. No one < 24 died

Differential Diagnosis

1. Cutaneous (painless)
   1. Ecthyma gangrenosum
   2. Rat-bite fever (Streptobacillus monilifomis and Spirillum minus)
   3. Ulceroglandular tularemia
   4. Plague
   5. Glanders (Pseudomonas peudomallei)
   6. Rickettsialpox (Rickettsia akari)
   7. Orf (parapox virus)
   8. Staph lymphadenitis
   9. TB
   10. Leprosy
   11. Buruli ulcer (Mycobact ulcerans)
2. Inhalational
   1. Acute bacterial mediastinitis
   2. Mycoplasma
   3. Legionnaire's
   4. Psittacosis
   5. Tularemia
   6. Q fever (Coxiella burnetti)
   7. Viral pneumonia
   8. Histoplasmosis
   9. Coccidiomycosis
   10. Ruptured Aortic Dissection
   11. SVC syndrome
   12. Silicosis
   13. Sarcoidosis

Lower Respiratory Zoonotic Infections

• Psittacosis
• Anthrax (Bacillus anthracis)
• Brucellosis (Brucella species)
• Q fever (C. burnetti)
• Pasteurellosis (Pasteurella multocida)
• Melioidosis (Burkholderia pseudomallei)
• Rocky Mountain Spotted Fever (R. rickettsii)
• Pulmonic Plague (Yersinia pestis)
• Influenza A
• Hantavirus

Imaging

CXR/CT- Widened mediastinum representing hemorrhagic mediastinitis

Treatment

Postexposure Prophylaxis

Patient should be vaccinated at day #0, #14, #28

• Ciprofloxacin 500mg PO q12hrs daily x 60 days OR
• Doxycycline 100mg PO q12hrs x 60 days

Cutaneous Anthrax (not systemically ill)

• Ciprofloxacin 500mg PO q12hrs x 60 days
• Doxycycline 100mg PO q12hrs x 60 days

Inhalation or Cutaneous with systemic illness

• Ciprofloxacin 400mg IV q12hrs x 60 days (1st line) OR
• Doxycycline 100mg IV q12hrs x 60days (only if allergic to ciprofloxacin) PLUS
  • Clindamycin 900mg IV q8hrs

Pediatric Postexpsoure Prophylaxis

• Ciprofloxacin 15mg/kg PO q12hrs x 60 days
• Doxycycline 2.2mg/kg PO q12hrs x 60 days

Pediatric Cutaneous Anthrax (not ill)

• Same as post exposure dosing and duration

Pediatric Inhalational or Cutaneous (systemically ill

• Ciprofloxacin 15mg/kg IV q12hrs (1st line) OR
• Doxycycline 2.2mg/kg IV q12hrs (only if allergic to cipro) PLUS
  • Clindamycin 7.5mg/kg q6hrs daily

See Also

Bioterrorism