Anthrax

#med #disease #y2023 #id

Presentation :

Patients with inhalational anthrax infection present with malaise, myalgia, fever, cough, dyspnea, and substernal chest discomfort; radiographic imaging reveals a widened mediastinum resulting from hemorrhagic mediastinal lymphadenopathy.
Meningitis occurs in up to 50% of persons.
Cutaneous anthrax: classic black eschar lesion, caused by skin contact with spores

Diagnosis is made by culture or polymerase chain reaction (PCR) of blood, tissues, or fluid samples

All patients with systemic anthrax should be hospitalized.
- Systemic anthrax is defined as cutaneous anthrax with systemic involvement; gastrointestinal, injection, or inhalation anthrax; anthrax meningitis; or bacteremia.
- Because inhalation anthrax can have a prodromal phase followed by a fulminant phase characterized by sudden decompensation, hospitalized patients should have careful hemodynamic monitoring, including continuous pulse oximetry and telemetry.

Post-exposure prophylaxis:
- Preferred: Doxycycline 100mg q12h or Ciprofloxacin 500mg q12h
- Alternatives: Levofloxacin 750 mg q24h, Moxifloxacin 400mg q24h, Clindamycin 600mg q8h
*Systemic Anthrax Treatment:
- Ciprofloxacin is first line but can also use levofloxacin, moxifloxacin, carbapenems.
- PLUS a protein synthesis inhibitor like Clindamycin or Linezolid (preferred for possible/confirmed meningitis)
- IF possible/confirmed meningitis ADD carbapenem for second bactericidal agent
- PLUS antitoxins Raxibacumab and Obiltoxaximab
  - inhibit binding of protective antigen and translocation of the two primary toxins, lethal toxin (LT) and edema toxin, into cells
  - Supplies of raxibacumab and obiltoxaximab are held in the United States Strategic National Stockpile for use by the CDC in the event of an anthrax emergency