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

Imaging

CXR/CT- Widened mediastinum representing hemorrhagic mediastinitis

Treatment

1. Cipro 500 mg bid or 30 mg/kg div q12
   1. (Peds)-20-30mg/kg IV q12h
2. Levo 500 mg qd
3. Doxycycline 100 mg bid
   1. (Peds) 2.5mg/kg IV q12h
4. x 60 days

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

Prophylaxis

1. Cipro (Adult)-500mg PO BID
   1. (Peds)-20-30mg/kg/d PO BID
2. Doxy (Adult) 100mgPO BID
   1. (Peds) 2.5mg/kg PO BID

See Also

Bioterrorism