0071643192.pdf

EMS AND DISASTER MEDICINE^906

Pharyngeal or Gastrointestinal Anthrax

■ Ulcers and edema of pharynx followed in 5 days by abdominal pain, upper

and lower GI bleeding

Inhalational Anthrax

■ Mild flu-like symptoms that rapidly progress to respiratory distress and septic

shock

DIAGNOSIS

■ Primarily a clinical diagnosis

■ CXR (inhalational disease, see Figure 20.6)

■ Mediastinal lymphadenopathy (CT is more sensitive than CXR)

■ Possible pleural effusions

■ May be clear of infiltrates

■ Gram stain and culture of skin lesions

■ Tissue or pleural fluid evaluation

TREATMENT

■ Supportive and symptomatic care

■ Simple cutaneous anthrax (nontoxic): Ciprofloxacin, doxycycline, or

amoxicillin

■ Toxic patients or inhalational disease; require triple antibiotic therapy

■ Ciprofloxacin or doxycycline plus

■ Two other antibiotics (eg, rifampin, clindamycin)

■ Antibiotic therapy must continue for 60 days.

Plague

Organism:Y. pestis, a Gram-negative bacillus.

Plague is normally a disease of rodents transmitted to humans by inhalation of

flea feces or bite of infected flea.

FIGURE 20.6. Inhalational anthrax. Arrow indicates mediastinal lymphadenopathy.

(Reproduced, with permission, from Mayer TA, et al. “Clinical Presentation of Inhalational

Anthrax Following Bioterrorism Exposure: Report of 2 Surviving Patients.” JAMA.

2001;286:2549–2553. Copyright © 2001, American Medical Association. All rights reserved.)

Anthrax treatment requires

prolonged (60 days) antibiotic

therapy.