0071643192.pdf

EMS AND DISASTER MEDICINE

Forms of disease:

■ Cutaneous anthrax
■ Most common
■ Pharyngeal or gastrointestinal anthrax
■ Inhalational anthrax
■ Most deadly

PATHOPHYSIOLOGY

■ Exposure to spore via skin or (worse) inhalation →spores germinate into bacilli
→transported to regional lymph nodes→release toxins→symptoms.

Prevention

■ Vaccine available to military at risk only
■ Ciprofloxacin or doxycycline prophylaxis for 30 days (with vaccination) or
60 days (no vaccination)

SYMPTOMS/EXAM

Cutaneous Anthrax

■ Painless papules that become vesicular with significant edema
■ Progresses to ulcerated black eschar after 1 week (see Figure 20.5)
■ Constitutional symptoms and lymphadenopathy

Cutaneous anthrax is the most

common form of anthrax.

Inhalational anthrax is the

most deadly form of anthrax.

FIGURE 20.5. Cutaneous anthrax. (A) A black eschar with a central hemorrhagic ulcer-
ation on the thumb associated with massive edema of the hand. (B) A nodular lymphangitis
extending proximally from the primary lesion on the thumb.

(Reproduced, with permission, from Wolff K, Johnson RA, Suurmond D. Fitzpatrick’s Color
Atlas & Synopsis of Clinical Dermatology, 5th ed. New York: McGraw-Hill, 2005:631.)