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