Anthrax

==Background ==Gm positive rod, tough sporesInhalational 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 q12Levo 500 mg qdDoxycycline 100 mg bidx 60 days PLUS vaccine: inactivated, cell-free immediately, 2 wks and then 4 wks ==Source ==7/2/09 PANI