Anthrax

GENERAL PRINCIPLES

Spores from the gram-positive Bacillus anthracis germinate at the site of entry into the body.

DIAGNOSIS

Clinical Presentation

• Cutaneous anthrax (ventilation equipment.

DIAGNOSIS

• The classic triad consists of an absence of fever, clear sensorium, and symmetric descending flaccid paralysis with cranial nerve involvement, beginning with ptosis, diplopia, and dysarthria, and progressing to loss of gag reflex and diaphragmatic function with respiratory failure, followed by diffuse skeletal muscle paralysis. Sensation remains intact. Paralysis can last from weeks to months.

• Diagnosis is confirmed by detection of toxin in serum. Notify local infection control and public health departments.

TREATMENT

• Treatment is primarily supportive and may require mechanical ventilation in the setting of respiratory failure. Wound botulism requires extensive surgical debridement.

• Further progression of paralysis can be halted by early administration of botulinum antitoxin, available through the state public health department or the CDC. Antitoxin is reserved only for cases where there is a high suspicion for botulism based on clinical presentation and exposure history. Routine postexposure prophylaxis with antitoxin is not recommended because of the high incidence (10%) of hypersensitivity reactions and limited supply.