5-90
Plan:
Treatment:
Primary: Doxycycline 100 mg po bid x 10 days
Alternative: Erythromycin 500 mg po qid x 10 days (use for pregnant women, children <8 years)
Patient Education
General: Doxycycline and erythromycin may cause GI upset. Relapsing fever acquired during pregnancy
can lead to stillbirth, abortion.
Activity: Watch for photosensitivity while taking doxycycline. Avoid sun and use sunscreen.
Diet: Avoid taking milk products when taking doxycycline.
Medications: Start antibiotics when afebrile or near the end of a febrile period to avoid a potential Jarisch-
Herxheimer reaction (fever, tachycardia, mild hypotension, chills, vasodilatation within 2 hours of treatment;
peaking at 7-8 hours and resolving in one day). Give Tylenol 2 hours before antibiotics and 2 hours after.
Prevention and Hygiene: Prevent tick bites (spray interior of tick-infested dwelling infested with insecticide).
Give Tetracycline 500 mg qid x 2-3 days after tick bite in endemic areas to reduce the risk of infection.
No Improvement/Deterioration: Return promptly for reevaluation.
Follow-up Actions
Evacuation/Consultation Criteria: Refer patients who develop complications.
Bacterial Infections
ID: Anthrax
COL Naomi Aronson, MC, USAIntroduction: Anthrax is an acute bacterial (spore-forming Bacillus anthracis) infection transmitted through
broken skin or mucous membranes, inhalation, or ingestion (rare). Fatally infects herbivores (sheep, cattle,
horses, pigs, goats, water buffalo, elephants, zebras or antelopes) that shed the bacilli into the environment.
Spores remain viable in contaminated soil for years. Dried skins, hides, wool, bone or bone products can
transmit infection. Veterinarians, farmers, tannery, wool workers are occupationally exposed. There are three
forms of disease, dictated by entry site; 95% of cases are cutaneous. Less common gastrointestinal and
pulmonary anthrax infections are generally fatal within days.
Subjective: Symptoms
Cutaneous anthrax: Acute (< 1 week): Local pruritus, papule with vesicles Sub-acute (1-2 weeks): Ulcer
that dries to a black painless eschar, brawny edema, regional adenopathy Chronic (> 2 weeks): Without
treatment, 80% resolve over 6 weeks.
Pulmonary anthrax (acute symptoms only): Fever; URI-like cough and chest discomfort; 36-48 hours after
infection may observe stridor; respiratory distress; shock and death.
Gastrointestinal anthrax (acute symptoms only): Neck swelling, fever, painful swallowing, nausea,
vomiting, severe abdominal pain, gastrointestinal hemorrhage and death.
Focused History: Is anybody else in your unit sick with the same symptoms? (If Pulmonary Sx, consider
biowarfare exposure; if GI Sx, consider ingestion of infected meat.) Do you have abdominal pain or bleeding?
If so, did you eat rare meat from an animal that may have died from illness? (GI cases usually occur
in outbreaks with a history of eating raw/undercooked meat 48 hours before.) Have you handled animal
carcasses recently or local products made from animal hides or wool? (cutaneous exposure) How long have
you been sick? (Life threatening forms of anthrax may be fatal in 1 week; skin symptoms can last 6 weeks.)
Did you have a rash that turned into a painless sore? (typical for cutaneous cases)
Objective: Signs
Inspection
Cutaneous anthrax: Acute(< 1 week): Papule with vesicles forms an ulcer Sub acute (1-2 weeks): Non-