Materiały źródłowe

• #1 Human Anthrax: Update of the Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10046981/

  Anthrax is one of the most important zoonotic diseases which primarily infects herbivores and occasionally humans. […] The symptoms of anthrax in the early stage mimics many diseases and as a consequence it is important to confirm the diagnosis using a bacterial culture or a molecular test. […] The procedures for the diagnosis of anthrax should be as follows: patients history, clinical examination for signs and symptoms, routine laboratory examination, radiological examinations and microbiological testing. […] Suspected cases should be confirmed by the collection of appropriate samples from the patients lesions and subsequent laboratory examination according to the WHO Guidance. […] The identification of the pathogen is based on a combination of microscopy and culture. […] The use of DNA amplification-based PCR (Polymerase Chain Reaction) and Real-time PCR tests can be used for the definitive and rapid diagnosis of B. anthracis in clinical and environmental specimens. […] While the detection of an antibody response to the pathogens toxins has little diagnostic value in the early stages of the disease, serum samples should be obtained at 0 to 7 days of illness and at 14 to 28 days to allow the clinical team to confirm diagnosis.

• #2 Clinical Overview of Anthrax | Anthrax | CDC

  https://www.cdc.gov/anthrax/hcp/clinical-overview/index.html

  Healthcare providers in the United States rarely see a patient with anthrax. […] CDC guidance is available to help doctors diagnose anthrax, take patient histories to determine how exposure may have occurred, and order necessary diagnostic tests. […] The only ways to confirm an anthrax diagnosis are to: Measure antibodies or toxin in blood […] Test for B. anthracis in blood, skin lesion swab, cerebrospinal fluid, or respiratory secretions. […] If inhalation anthrax is suspected, chest X-rays or CT scans can assist with diagnosis if the patient has commonly associated signs including mediastinal widening or pleural effusion. […] Patient samples should be taken before the patient begins taking antibiotics if it does not delay the start of treatment.

• #3 Human Anthrax: Update of the Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10046981/

  Anthrax is one of the most important zoonotic diseases which primarily infects herbivores and occasionally humans. […] The symptoms of anthrax in the early stage mimics many diseases and as a consequence it is important to confirm the diagnosis using a bacterial culture or a molecular test. […] The procedures for the diagnosis of anthrax should be as follows: patients history, clinical examination for signs and symptoms, routine laboratory examination, radiological examinations and microbiological testing. […] Suspected cases should be confirmed by the collection of appropriate samples from the patients lesions and subsequent laboratory examination according to the WHO Guidance. […] The identification of the pathogen is based on a combination of microscopy and culture. […] The use of DNA amplification-based PCR (Polymerase Chain Reaction) and Real-time PCR tests can be used for the definitive and rapid diagnosis of B. anthracis in clinical and environmental specimens. […] While the detection of an antibody response to the pathogens toxins has little diagnostic value in the early stages of the disease, serum samples should be obtained at 0 to 7 days of illness and at 14 to 28 days to allow the clinical team to confirm diagnosis.

• #4 Human Anthrax: Update of the Diagnosis and Treatment

  https://www.mdpi.com/2075-4418/13/6/1056

  Anthrax is one of the most important zoonotic diseases which primarily infects herbivores and occasionally humans. The symptoms of anthrax in the early stage mimics many diseases and as a consequence it is important to confirm the diagnosis using a bacterial culture or a molecular test. The procedures for the diagnosis of anthrax should be as follows: patient’s history, clinical examination for signs and symptoms, routine laboratory examination, radiological examinations and microbiological testing. Suspected cases should be confirmed by the collection of appropriate samples from the patient’s lesions and subsequent laboratory examination according to the WHO Guidance. These samples include swabs from cutaneous lesions, blood, sputum, pulmonary effusion or bronchial biopsy specimens in cases of suspected inhalational anthrax. The identification of the pathogen is based on a combination of microscopy and culture. The vegetative form of the bacteria appears as a Gram-positive rod-shaped organism. Confirmation of the presence of a capsule which surrounds virulent forms of the bacterium can be confirmed using polychrome methylene blue or Indian ink. The organism can grow on a range of general culture media including blood agar. For specimens in which the bacteria are likely to present in the company of other micro-organisms, a selective agar is recommended such as Polymyxin-Lysozyme-EDTA-Thallous acetate (PLET) agar. The use of DNA amplification-based PCR (Polymerase Chain Reaction) and Real-time PCR tests can be used for the definitive and rapid diagnosis of B. anthracis in clinical and environmental specimens. Diagnostic targets include specific DNA regions in the following genes: pagA (pXO1), capB (pXO2), capC (pXO2) and Ba813 (chromosomal). Rapid DNA-based methods are particularly useful for the confirmation of the cause of infection in patients who have been treated with antibiotics which would prevent the bacteria from growing on culture. In addition to DNA-based methods, immunological approaches can also be employed to diagnose the presence of the pathogen. The recommended antibiotic regimens in adult cases are as follows: procaine penicillin G, 0.6–1.2 M units intramuscularly every 12–24 h; amoxicillin 500 mg orally every 6–8 h; doxycycline 100 mg intravenously or orally every 12 h; ciprofloxacin 200–400 mg intravenously every 12 h, followed by 500–750 mg orally every 12 h. If such regimens are followed, cutaneous lesions usually become sterile within the first 24 h with edema regressing within 24 to 48 h. However, it should be noted that although due to early treatment the size of the lesion will be limited, the evolutionary stages of the lesion will not be altered. Ciprofloxacin and doxycycline are considered to be the first-choice agents in cases of biological weapon or bio-terrorism-related anthrax.

• #5 Collecting Samples to Send to Laboratories | Anthrax | CDC

  https://www.cdc.gov/anthrax/php/lab-testing/index.html

  Clinicians ideally should collect patient samples before starting treatment. […] Consult your state or local health department to determine steps for diagnosing anthrax. […] Anthrax is confirmed through testing at laboratories in the Laboratory Response Network. […] Culturing B. anthracis from clinical specimens is the gold standard for diagnosing anthrax. […] Healthcare providers in the United States rarely see a patient with anthrax. […] Call CDC’s Emergency Operations Center at 770-488-7100 for an anthrax testing consultation. […] To accurately diagnose anthrax, samples ideally should be taken before the patient starts antibiotic treatment. […] Blood samples can help diagnose inhalation and gastrointestinal anthrax, especially if a patient shows signs of systemic infection. Blood will be tested using real-time polymerase chain reaction (PCR) to confirm an anthrax diagnosis.

• #6 Clinical Overview of Anthrax | Anthrax | CDC

  https://www.cdc.gov/anthrax/hcp/clinical-overview/index.html

  Healthcare providers in the United States rarely see a patient with anthrax. […] CDC guidance is available to help doctors diagnose anthrax, take patient histories to determine how exposure may have occurred, and order necessary diagnostic tests. […] The only ways to confirm an anthrax diagnosis are to: Measure antibodies or toxin in blood […] Test for B. anthracis in blood, skin lesion swab, cerebrospinal fluid, or respiratory secretions. […] If inhalation anthrax is suspected, chest X-rays or CT scans can assist with diagnosis if the patient has commonly associated signs including mediastinal widening or pleural effusion. […] Patient samples should be taken before the patient begins taking antibiotics if it does not delay the start of treatment.

• #7 Anthrax – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507773/

  The CDC has developed detailed recommendations for patient evaluation by suspected anthrax exposure and clinical syndrome. […] The laboratory personnel must be warned that the tissue may contain anthrax so that they take appropriate precautions. […] Cutaneous anthrax is diagnosed with a methylene blue stain which reveals a gram-positive rod that is not motile. […] Chest x-ray in patients with inhalational anthrax may reveal enlarged mediastinum. […] All cases of inhalation anthrax should be considered a bioterror event and appropriate decontamination steps should be in place. […] Anthrax is a reportable infection and the local authorities and the CDC must be notified immediately. […] In brief, treatment for inhalational anthrax requires a multidrug regimen with one bactericidal agent + 1 protein-synthesis inhibitor.

• #8 Clinical Overview of Anthrax | Anthrax | CDC

  https://www.cdc.gov/anthrax/hcp/clinical-overview/index.html

  Healthcare providers in the United States rarely see a patient with anthrax. […] CDC guidance is available to help doctors diagnose anthrax, take patient histories to determine how exposure may have occurred, and order necessary diagnostic tests. […] The only ways to confirm an anthrax diagnosis are to: Measure antibodies or toxin in blood […] Test for B. anthracis in blood, skin lesion swab, cerebrospinal fluid, or respiratory secretions. […] If inhalation anthrax is suspected, chest X-rays or CT scans can assist with diagnosis if the patient has commonly associated signs including mediastinal widening or pleural effusion. […] Patient samples should be taken before the patient begins taking antibiotics if it does not delay the start of treatment.

• #9 Collecting Samples to Send to Laboratories | Anthrax | CDC

  https://www.cdc.gov/anthrax/php/lab-testing/index.html

  Clinicians ideally should collect patient samples before starting treatment. […] Consult your state or local health department to determine steps for diagnosing anthrax. […] Anthrax is confirmed through testing at laboratories in the Laboratory Response Network. […] Culturing B. anthracis from clinical specimens is the gold standard for diagnosing anthrax. […] Healthcare providers in the United States rarely see a patient with anthrax. […] Call CDC’s Emergency Operations Center at 770-488-7100 for an anthrax testing consultation. […] To accurately diagnose anthrax, samples ideally should be taken before the patient starts antibiotic treatment. […] Blood samples can help diagnose inhalation and gastrointestinal anthrax, especially if a patient shows signs of systemic infection. Blood will be tested using real-time polymerase chain reaction (PCR) to confirm an anthrax diagnosis.

• #10 Anthrax Workup: Approach Considerations, Gram Stain and Blood Culture, Enzyme-Linked Immunosorbent Assay

  https://emedicine.medscape.com/article/212127-workup

  Bacillus anthracis is present in high numbers in the ulcer/eschar of cutaneous anthrax, in bloody pleural fluid in inhalational anthrax, in the cerebrospinal fluid (CSF) in anthrax meningitis, and in the blood in septicemic anthrax. Specimens may be stained or cultured to demonstrate the organism. Culture is performed on sheep blood or peptone agar. In persons exposed to antibiotics, immunohistochemical examination of the suspected fluid (eg pleural fluid, CSF, cutaneous biopsy) is performed using antibodies to B anthracis cell wall and capsule. […] The diagnosis of cutaneous anthrax is usually suggested by the characteristic appearance of skin lesions. As spore germination occurs within macrophages at the site of inoculation, anthrax bacilli are isolated easily from the vesicular lesions and can be observed on Gram stain. If prior treatment with antibiotics has occurred, the best way to determine infection is to perform serologic testing and punch biopsy at the edge of the lesion and examine by silver staining and immunohistochemical testing.

• #11 Human Anthrax: Update of the Diagnosis and Treatment

  https://www.mdpi.com/2075-4418/13/6/1056

  Anthrax is one of the most important zoonotic diseases which primarily infects herbivores and occasionally humans. The symptoms of anthrax in the early stage mimics many diseases and as a consequence it is important to confirm the diagnosis using a bacterial culture or a molecular test. The procedures for the diagnosis of anthrax should be as follows: patient’s history, clinical examination for signs and symptoms, routine laboratory examination, radiological examinations and microbiological testing. Suspected cases should be confirmed by the collection of appropriate samples from the patient’s lesions and subsequent laboratory examination according to the WHO Guidance. These samples include swabs from cutaneous lesions, blood, sputum, pulmonary effusion or bronchial biopsy specimens in cases of suspected inhalational anthrax. The identification of the pathogen is based on a combination of microscopy and culture. The vegetative form of the bacteria appears as a Gram-positive rod-shaped organism. Confirmation of the presence of a capsule which surrounds virulent forms of the bacterium can be confirmed using polychrome methylene blue or Indian ink. The organism can grow on a range of general culture media including blood agar. For specimens in which the bacteria are likely to present in the company of other micro-organisms, a selective agar is recommended such as Polymyxin-Lysozyme-EDTA-Thallous acetate (PLET) agar. The use of DNA amplification-based PCR (Polymerase Chain Reaction) and Real-time PCR tests can be used for the definitive and rapid diagnosis of B. anthracis in clinical and environmental specimens. Diagnostic targets include specific DNA regions in the following genes: pagA (pXO1), capB (pXO2), capC (pXO2) and Ba813 (chromosomal). Rapid DNA-based methods are particularly useful for the confirmation of the cause of infection in patients who have been treated with antibiotics which would prevent the bacteria from growing on culture. In addition to DNA-based methods, immunological approaches can also be employed to diagnose the presence of the pathogen. The recommended antibiotic regimens in adult cases are as follows: procaine penicillin G, 0.6–1.2 M units intramuscularly every 12–24 h; amoxicillin 500 mg orally every 6–8 h; doxycycline 100 mg intravenously or orally every 12 h; ciprofloxacin 200–400 mg intravenously every 12 h, followed by 500–750 mg orally every 12 h. If such regimens are followed, cutaneous lesions usually become sterile within the first 24 h with edema regressing within 24 to 48 h. However, it should be noted that although due to early treatment the size of the lesion will be limited, the evolutionary stages of the lesion will not be altered. Ciprofloxacin and doxycycline are considered to be the first-choice agents in cases of biological weapon or bio-terrorism-related anthrax.

• #12 Practical and effective diagnosis of animal anthrax in endemic low-resource settings | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008655

  Practical yet accurate diagnostic solutions are greatly needed to quantify anthrax impacts. We validated microscopic and molecular methods for the detection of Bacillus anthracis in field-collected blood smears and identified alternative samples suitable for anthrax confirmation in the absence of blood smears. […] Azure B microscopy represents an accurate diagnostic test for animal anthrax that can be performed with basic laboratory infrastructure and in the field. When blood smears are unavailable, PCR using skin tissues provides a valuable alternative for confirmation. […] Our study demonstrates that microscopy using azure B staining on field-prepared blood smears from suspected anthrax-affected animal carcasses from endemic areas yields very high sensitivity and optimal specificity.

• #13 Practical and effective diagnosis of animal anthrax in endemic low-resource settings | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008655

  In contrast, the sensitivities of Giemsa and Rapi-Diff II for detecting the capsule of B. anthracis were poor and their use should be discouraged for anthrax confirmation. […] Our results demonstrate that azure B provides a user-friendly alternative to the officially recommended PMB stain for microscopic detection of B. anthracis, matching it on scientific criteria (sensitivity, specificity, and inter-observer agreement) and out-performing it on convenience criteria. […] Where blood smears can be taken from suspected anthrax cases, microscopy using azure B stained slides should be the method of choice for case confirmation. Furthermore, we found that stained smear samples can also be used reliably for PCR detection. […] This study, conducted in field conditions in an anthrax-endemic area, has shown that microscopy using azure B in place of PMB is highly sensitive and specific for detecting B. anthracis in blood smears from animal carcasses, and more user-friendly because of the availability of azure B.

• #14 Human Anthrax: Update of the Diagnosis and Treatment

  https://www.mdpi.com/2075-4418/13/6/1056

  Anthrax is one of the most important zoonotic diseases which primarily infects herbivores and occasionally humans. The symptoms of anthrax in the early stage mimics many diseases and as a consequence it is important to confirm the diagnosis using a bacterial culture or a molecular test. The procedures for the diagnosis of anthrax should be as follows: patient’s history, clinical examination for signs and symptoms, routine laboratory examination, radiological examinations and microbiological testing. Suspected cases should be confirmed by the collection of appropriate samples from the patient’s lesions and subsequent laboratory examination according to the WHO Guidance. These samples include swabs from cutaneous lesions, blood, sputum, pulmonary effusion or bronchial biopsy specimens in cases of suspected inhalational anthrax. The identification of the pathogen is based on a combination of microscopy and culture. The vegetative form of the bacteria appears as a Gram-positive rod-shaped organism. Confirmation of the presence of a capsule which surrounds virulent forms of the bacterium can be confirmed using polychrome methylene blue or Indian ink. The organism can grow on a range of general culture media including blood agar. For specimens in which the bacteria are likely to present in the company of other micro-organisms, a selective agar is recommended such as Polymyxin-Lysozyme-EDTA-Thallous acetate (PLET) agar. The use of DNA amplification-based PCR (Polymerase Chain Reaction) and Real-time PCR tests can be used for the definitive and rapid diagnosis of B. anthracis in clinical and environmental specimens. Diagnostic targets include specific DNA regions in the following genes: pagA (pXO1), capB (pXO2), capC (pXO2) and Ba813 (chromosomal). Rapid DNA-based methods are particularly useful for the confirmation of the cause of infection in patients who have been treated with antibiotics which would prevent the bacteria from growing on culture. In addition to DNA-based methods, immunological approaches can also be employed to diagnose the presence of the pathogen. The recommended antibiotic regimens in adult cases are as follows: procaine penicillin G, 0.6–1.2 M units intramuscularly every 12–24 h; amoxicillin 500 mg orally every 6–8 h; doxycycline 100 mg intravenously or orally every 12 h; ciprofloxacin 200–400 mg intravenously every 12 h, followed by 500–750 mg orally every 12 h. If such regimens are followed, cutaneous lesions usually become sterile within the first 24 h with edema regressing within 24 to 48 h. However, it should be noted that although due to early treatment the size of the lesion will be limited, the evolutionary stages of the lesion will not be altered. Ciprofloxacin and doxycycline are considered to be the first-choice agents in cases of biological weapon or bio-terrorism-related anthrax.

• #15 Comparing microbiological and molecular diagnostic tools for the surveillance of anthrax | medRxiv

  https://www.medrxiv.org/content/10.1101/2024.04.02.24305203v1.full-text

  Using qPCR on blood smears, 52.1% (890 samples) tested positive for B. anthracis based on one or a combination of genetic markers which included the 25 positive controls. […] The BAPA+lef+Ba-1 combination showed 100% specificity, sensitivity, and accuracy. […] Systematically combining microscopy and molecular markers holds promise for notably reducing false positives, thereby significantly enhancing the detection and surveillance of diseases like anthrax in southern Africa and beyond and reducing the need for propagation of the bacteria in culture.

• #16 Comparing microbiological and molecular diagnostic tools for the surveillance of anthrax | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0012122

  The diagnosis of anthrax, a zoonotic disease caused by Bacillus anthracis can be complicated by detection of closely related species. Conventional diagnosis of anthrax involves microscopy, culture identification of bacterial colonies and molecular detection. […] Using blood smears from 20122020 from wildlife mortalities (n = 1708) in Kruger National Park in South Africa where anthrax is endemic, we contrasted anthrax diagnostic results based on qPCR, microscopy, and culture. […] This study identified B. cereus sensu lato, which included B. cereus and B. anthracis, Peribacillus spp., and Priestia spp. clusters using gyrB gene in selected bacterial isolates positive for pagA region using BAPA probe. […] Using qPCR on blood smears, 52.1% (890 samples) tested positive for B. anthracis based on one or a combination of genetic markers which included the 25 positive controls.

• #17 Anthrax Workup: Approach Considerations, Gram Stain and Blood Culture, Enzyme-Linked Immunosorbent Assay

  https://emedicine.medscape.com/article/212127-workup

  In October 2001, blood cultures were positive for anthrax in all 8 patients who did not receive antibiotics. Serologic diagnosis of anthrax can be made using a microhemagglutination test specific for the protective antigen (PA) component of the toxin. Any Gram stain results suggestive of anthrax should be reported to the CDC. […] Several biochemical tests aid in differentiating B anthracis from other members of the species (chief among them is Bacillus cereus, which has been associated with outbreaks of human food poisoning). B anthracis is characterized by the absence of hemolysis on sheep blood agar, lack of motility, absence of salicin fermentation, gelatin hydrolysis, and lack of growth on phenylethyl alcohol medium. […] Enzyme-linked immunosorbent assay (ELISA) serologic diagnosis is also available. The ELISA for edema and lethal toxins is positive if a single acute-phase titer is highly elevated or if a fourfold greater rise in the titer is observed between acute and convalescent specimens.

• #18 Anthrax Nursing Care Management & Care Plan – Nurseslabs

  https://nurseslabs.com/anthrax/

  Bacillus anthracis is present in high numbers in the ulcer/eschar of cutaneous anthrax, in bloody pleural fluid in inhalational anthrax, in the cerebrospinal fluid (CSF) in anthrax meningitis, and in the blood in septicemic anthrax. […] The preferred diagnostic procedure for cutaneous anthrax is staining the ulcer exudate with methylene blue or Giemsa stain; B anthracis readily grows on blood agar, and staining microbiologically differentiates the organism from nonB anthracis bacilli. […] Enzyme-linked immunosorbent assay (ELISA) serologic diagnosis is also available; the ELISA for edema and lethal toxins is positive if a single acute-phase titer is highly elevated or if a fourfold greater rise in the titer is observed between acute and convalescent specimens. […] If inhalational anthrax is suspected, obtain a chest radiograph or computed tomography (CT) scan; the appearance on chest radiograph or CT scan may suggest the diagnosis, especially if other predisposing disorders that might result in a widening mediastinum (eg, dissecting aortic aneurysm, bacterial mediastinitis) are absent.

• #19 Human Anthrax: Update of the Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10046981/

  Anthrax is one of the most important zoonotic diseases which primarily infects herbivores and occasionally humans. […] The symptoms of anthrax in the early stage mimics many diseases and as a consequence it is important to confirm the diagnosis using a bacterial culture or a molecular test. […] The procedures for the diagnosis of anthrax should be as follows: patients history, clinical examination for signs and symptoms, routine laboratory examination, radiological examinations and microbiological testing. […] Suspected cases should be confirmed by the collection of appropriate samples from the patients lesions and subsequent laboratory examination according to the WHO Guidance. […] The identification of the pathogen is based on a combination of microscopy and culture. […] The use of DNA amplification-based PCR (Polymerase Chain Reaction) and Real-time PCR tests can be used for the definitive and rapid diagnosis of B. anthracis in clinical and environmental specimens. […] While the detection of an antibody response to the pathogens toxins has little diagnostic value in the early stages of the disease, serum samples should be obtained at 0 to 7 days of illness and at 14 to 28 days to allow the clinical team to confirm diagnosis.

• #20 Anthrax – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anthrax/diagnosis-treatment/drc-20356209

  Your doctor will ask you what kind of work you do, along with other questions to determine the likelihood of your having been exposed to anthrax. He or she will first want to rule out other, more-common conditions that may be causing your signs and symptoms, such as flu (influenza) or pneumonia. […] You may have a rapid flu test to quickly diagnose a case of influenza. If other tests are negative, you may have further tests to look specifically for anthrax, such as: […] A sample of fluid from a suspicious lesion on your skin or a small tissue sample (biopsy) may be tested in a lab for signs of cutaneous anthrax. […] You may have a small amount of blood drawn that’s checked in a lab for anthrax bacteria. […] Your doctor may request a chest X-ray or computed tomography (CT) scan to help diagnose inhalation anthrax.

• #21 Collecting Samples to Send to Laboratories | Anthrax | CDC

  https://www.cdc.gov/anthrax/php/lab-testing/index.html

  Plasma is the preferred sample for anthrax lethal factor (LF) toxin testing for all types of anthrax. […] Serum can be used to test for an immune response to anthrax and to test for anthrax LF toxin. […] A full thickness biopsy of a papule or vesicle, including adjacent skin, can be used to diagnose cutaneous anthrax. […] A bronchial or pleural biopsy should be obtained for patients with symptoms of inhalation anthrax. […] Always collect two separate swabs, one for real-time PCR, and one for culture. […] The Laboratory Response Network (LRN) can assist clinical care providers and health departments by conducting diagnostic testing to confirm anthrax. […] The LRN is essential to quickly confirming an anthrax diagnosis.

• #22 Anthrax – Infections – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/infections/bacterial-infections-gram-positive-bacteria/anthrax

  Symptoms suggest the infection, and identifying the bacteria in samples taken from infected tissue confirms the diagnosis. […] If inhalation anthrax is suspected, chest x-ray or computed tomography (CT) is done. […] Samples of blood, infected skin, fluids around the lungs, or stool are removed and examined with a microscope or cultured (enabling bacteria, if present, to multiply). Anthrax bacteria, if present, can be readily identified. […] Doctors suspect skin anthrax based on its typical appearance. Knowing that people have had contact with animals or animal products or were in an area where other people developed anthrax supports the diagnosis. […] The longer anthrax treatment is delayed, the greater the risk of death. Thus, treatment is usually started as soon as doctors suspect that people have anthrax.

• #23 Anthrax – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anthrax/diagnosis-treatment/drc-20356209

  Your doctor will ask you what kind of work you do, along with other questions to determine the likelihood of your having been exposed to anthrax. He or she will first want to rule out other, more-common conditions that may be causing your signs and symptoms, such as flu (influenza) or pneumonia. […] You may have a rapid flu test to quickly diagnose a case of influenza. If other tests are negative, you may have further tests to look specifically for anthrax, such as: […] A sample of fluid from a suspicious lesion on your skin or a small tissue sample (biopsy) may be tested in a lab for signs of cutaneous anthrax. […] You may have a small amount of blood drawn that’s checked in a lab for anthrax bacteria. […] Your doctor may request a chest X-ray or computed tomography (CT) scan to help diagnose inhalation anthrax.

• #24 Clinical Overview of Anthrax | Anthrax | CDC

  https://www.cdc.gov/anthrax/hcp/clinical-overview/index.html

  Healthcare providers in the United States rarely see a patient with anthrax. […] CDC guidance is available to help doctors diagnose anthrax, take patient histories to determine how exposure may have occurred, and order necessary diagnostic tests. […] The only ways to confirm an anthrax diagnosis are to: Measure antibodies or toxin in blood […] Test for B. anthracis in blood, skin lesion swab, cerebrospinal fluid, or respiratory secretions. […] If inhalation anthrax is suspected, chest X-rays or CT scans can assist with diagnosis if the patient has commonly associated signs including mediastinal widening or pleural effusion. […] Patient samples should be taken before the patient begins taking antibiotics if it does not delay the start of treatment.

• #25 Anthrax Workup: Approach Considerations, Gram Stain and Blood Culture, Enzyme-Linked Immunosorbent Assay

  https://emedicine.medscape.com/article/212127-workup

  In patients with inhalational anthrax, a chest radiograph typically shows widening of the mediastinum and pleural effusions, whereas the parenchyma may appear normal. In a review of the 11 patients infected by anthrax in October 2001, chest radiographs from the initial examination showed mediastinal widening, paratracheal and hilar fullness, and pleural effusions or infiltrates. In some patients, the initial findings were subtle and not detected immediately. […] The preferred diagnostic procedure for cutaneous anthrax is staining the ulcer exudate with methylene blue or Giemsa stain. B anthracis readily grows on blood agar, and staining microbiologically differentiates the organism from non B anthracis bacilli. […] In patients with cutaneous anthrax who have fever and systemic symptoms that suggest extracutaneous spread, blood culture may be indicated. Treat blood cultures as biohazard II specimens. Blood culture and Gram stain are high-yield tests in infected persons who have not taken antibiotics. Sputum from patients seldom yields positive smears or cultures. A Gram stain is the easiest means of initially identifying suggested cases. Anthrax appears as a large, gram-positive rod.

• #26 Anthrax – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anthrax/diagnosis-treatment/drc-20356209

  To diagnose gastrointestinal anthrax, your doctor may check a sample of your stool for anthrax bacteria. […] In this test, your doctor inserts a needle into your spinal canal and withdraws a small amount of fluid. A spinal tap is recommended any time doctors suspect systemic anthrax other than cutaneous due to the possibility of meningitis.

• #27 Anthrax: Cause, Symptoms, Diagnosis

  https://www.webmd.com/cold-and-flu/what-is-anthrax

  If your doctor thinks you have anthrax, you’ll get a test to check to see if you have anthrax antibodies or toxins in your blood. You might also get other tests, depending on the part of your body that’s affected. […] If you have skin symptoms, your doctor may take a small sample of the affected skin to test in a lab. You might get an X-ray of your chest or CT scan if your doctor thinks you might have inhalation anthrax. And a stool test can look for signs of anthrax bacteria in order to diagnose gastrointestinal anthrax. […] If you might have meningitis caused by anthrax, you may need to get a spinal tap, in which your doctor takes a bit of your spinal fluid to test.

• #28 Anthrax Differential Diagnoses

  https://emedicine.medscape.com/article/212127-differential

  Early diagnosis is difficult, and a high index of suspicion is required. The differential diagnosis varies among cutaneous, inhalational, and intestinal anthrax. […] Physicians must differentiate cutaneous anthrax from bubonic plague or lymphocutaneous tularemia. […] Do not confuse inhalational anthrax with the zoonotic atypical pneumonias. […] Intestinal anthrax is a difficult diagnosis that must be distinguished from dysentery. […] A history of ingesting meat possibly contaminated with anthrax is helpful in suspected cases of intestinal anthrax. […] Stool examination provides rapid confirmation of bacillary or amebic dysentery. […] The chancre of primary syphilis may also be confused with cutaneous anthrax. […] Exudates from the ulcers of both ulceroglandular tularemia and cutaneous anthrax reveal organisms when properly stained.

• #29 Anthrax – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anthrax/diagnosis-treatment/drc-20356209

  To diagnose gastrointestinal anthrax, your doctor may check a sample of your stool for anthrax bacteria. […] In this test, your doctor inserts a needle into your spinal canal and withdraws a small amount of fluid. A spinal tap is recommended any time doctors suspect systemic anthrax other than cutaneous due to the possibility of meningitis.

• #30 Anthrax Workup: Approach Considerations, Gram Stain and Blood Culture, Enzyme-Linked Immunosorbent Assay

  https://emedicine.medscape.com/article/212127-workup

  If inhalational anthrax is suspected, obtain a chest radiograph or computed tomography (CT) scan. The appearance on chest radiograph or CT scan may suggest the diagnosis, especially if other predisposing disorders that might result in a widening mediastinum (eg, dissecting aortic aneurysm, bacterial mediastinitis) are absent. […] If anthrax meningitis is suspected, perform a lumbar puncture to obtain CSF for stain and culture. The CSF in patients with anthrax meningitis is grossly hemorrhagic with few polymorphonuclear neutrophils (PMNs) and numerous gram-positive bacilli. […] The characteristic finding in anthrax is the presence of the organisms in the capillaries at the infection site; therefore, if a patient is infected, expect B anthracis in the capillaries of the skin, intestines, liver, spleen, lungs, or leptomeninges. Pathological findings are not in proportion to the numbers of bacilli present, which is best explained by the effects of one or more of the toxins associated with B anthracis. Hemorrhage may be evident.

• #31 Anthrax – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anthrax/diagnosis-treatment/drc-20356209

  To diagnose gastrointestinal anthrax, your doctor may check a sample of your stool for anthrax bacteria. […] In this test, your doctor inserts a needle into your spinal canal and withdraws a small amount of fluid. A spinal tap is recommended any time doctors suspect systemic anthrax other than cutaneous due to the possibility of meningitis.

• #32 Anthrax Differential Diagnoses

  https://emedicine.medscape.com/article/212127-differential

  Early diagnosis is difficult, and a high index of suspicion is required. The differential diagnosis varies among cutaneous, inhalational, and intestinal anthrax. […] Physicians must differentiate cutaneous anthrax from bubonic plague or lymphocutaneous tularemia. […] Do not confuse inhalational anthrax with the zoonotic atypical pneumonias. […] Intestinal anthrax is a difficult diagnosis that must be distinguished from dysentery. […] A history of ingesting meat possibly contaminated with anthrax is helpful in suspected cases of intestinal anthrax. […] Stool examination provides rapid confirmation of bacillary or amebic dysentery. […] The chancre of primary syphilis may also be confused with cutaneous anthrax. […] Exudates from the ulcers of both ulceroglandular tularemia and cutaneous anthrax reveal organisms when properly stained.

• #33 Anthrax – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507773/

  Anthrax vaccines for humans and animals are available. […] The vaccine may also be recommended more broadly to exposed community members as a component of a public health response after a bioterrorism event. […] The differential diagnosis of inhalational anthrax includes community-acquired pneumonia, influenza, respiratory syncytial virus, pneumonic plague, and tularemia. […] The majority of cases of anthrax have been cutaneous and these usually resolve with or without treatment. […] However, inhalational anthrax is life-threatening and carries a poor prognosis. […] Anthrax is a serious infection which can rapidly prove fatal. […] The best outcomes will occur if an interprofessional team approach is used to evaluate and treat patients with an anthrax infection.

• #34 Anthrax – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anthrax/diagnosis-treatment/drc-20356209

  Your doctor will ask you what kind of work you do, along with other questions to determine the likelihood of your having been exposed to anthrax. He or she will first want to rule out other, more-common conditions that may be causing your signs and symptoms, such as flu (influenza) or pneumonia. […] You may have a rapid flu test to quickly diagnose a case of influenza. If other tests are negative, you may have further tests to look specifically for anthrax, such as: […] A sample of fluid from a suspicious lesion on your skin or a small tissue sample (biopsy) may be tested in a lab for signs of cutaneous anthrax. […] You may have a small amount of blood drawn that’s checked in a lab for anthrax bacteria. […] Your doctor may request a chest X-ray or computed tomography (CT) scan to help diagnose inhalation anthrax.

• #35 Medical Countermeasures | BARDA-Supported Rapid Anthrax Test Receives FDA Clearance

  https://medicalcountermeasures.gov/newsroom/2023/sensitox/

  BARDA-Supported Rapid Anthrax Test Receives FDA Clearance […] The SensiTox B. anthracis Toxin Test is a rapid immunofluorescence-based assay intended to be used as an aid in the diagnosis of inhalation anthrax. Inhalation anthrax is considered the deadliest form of anthrax and is almost always fatal without treatment. The test is intended for use with whole blood specimens collected from individuals with signs and symptoms of inhalation anthrax and a likelihood of exposure. Due to the severity of inhalation anthrax, detecting the infection quickly and early has the potential to improve patient outcomes by enabling rapid initiation of life-saving treatment. […] The SensiTox B. anthracis Toxin Test detects Lethal Factor and Lethal Toxin, biomarkers associated with B. anthracis infection.

• #36 CDC says new test speeds diagnosis of anthrax | CIDRAP

  https://www.cidrap.umn.edu/anthrax/cdc-says-new-test-speeds-diagnosis-anthrax

  The Food and Drug Administration (FDA) has approved a new and faster blood test to help confirm a diagnosis of anthrax infection, federal health officials announced today. […] The Anthrax Quick ELISA test can identify antibodies to Bacillus anthracis in less than an hour, compared with about 4 hours for previous tests, according to the Centers for Disease Control and Prevention (CDC). […] „Before FDA approval of the new test, very few laboratories other than the CDC and the US Army had the ability to test blood for antibodies to anthrax,” the CDC announcement said. „The new test will be available shortly for use in state and private laboratories.” […] „The test was shown to detect 100% of the anthrax patients tested in clinical trials, with less than a 1% chance of false positive results,” Immunetics officials said in a news release. […] Any clinical or public health laboratory can use the test without special equipment or training, the Immunetics statement said.

• #37 BaDx Anthrax Detection – Global Chemical and Biological Security

  https://gcbs.sandia.gov/tools/badx/

  Developed at Sandia National Laboratories, BaDx is a credit-card-sized pathogen detector used to identify Bacillus anthracis (anthrax). Unlike previous anthrax diagnostic tools that required 110 million spores for a proper reading, BaDx is able to detect the bacteria with as few as 100 spores. […] BaDx allows animal and public health professionals to enhance diagnostic capabilities in clinics, homes, and hospitals through regular testing of naturally occurring outbreaks. […] BaDxs ease of use helps those in low-resource environments, where the supplementary infrastructure once needed for anthrax diagnostics (e.g., laboratories) is substandard or nonexistent. […] Those who were deterred from regular testing due to cost constraints are now able to perform more frequent diagnostics, as BaDxs cost is about one-third that of other available anthrax tests.

• #38 BaDx Anthrax Detection – Global Chemical and Biological Security

  https://gcbs.sandia.gov/tools/badx/

  Developed at Sandia National Laboratories, BaDx is a credit-card-sized pathogen detector used to identify Bacillus anthracis (anthrax). Unlike previous anthrax diagnostic tools that required 110 million spores for a proper reading, BaDx is able to detect the bacteria with as few as 100 spores. […] BaDx allows animal and public health professionals to enhance diagnostic capabilities in clinics, homes, and hospitals through regular testing of naturally occurring outbreaks. […] BaDxs ease of use helps those in low-resource environments, where the supplementary infrastructure once needed for anthrax diagnostics (e.g., laboratories) is substandard or nonexistent. […] Those who were deterred from regular testing due to cost constraints are now able to perform more frequent diagnostics, as BaDxs cost is about one-third that of other available anthrax tests.

• #39 Collecting Samples to Send to Laboratories | Anthrax | CDC

  https://www.cdc.gov/anthrax/php/lab-testing/index.html

  Clinicians ideally should collect patient samples before starting treatment. […] Consult your state or local health department to determine steps for diagnosing anthrax. […] Anthrax is confirmed through testing at laboratories in the Laboratory Response Network. […] Culturing B. anthracis from clinical specimens is the gold standard for diagnosing anthrax. […] Healthcare providers in the United States rarely see a patient with anthrax. […] Call CDC’s Emergency Operations Center at 770-488-7100 for an anthrax testing consultation. […] To accurately diagnose anthrax, samples ideally should be taken before the patient starts antibiotic treatment. […] Blood samples can help diagnose inhalation and gastrointestinal anthrax, especially if a patient shows signs of systemic infection. Blood will be tested using real-time polymerase chain reaction (PCR) to confirm an anthrax diagnosis.

• #40 Collecting Samples to Send to Laboratories | Anthrax | CDC

  https://www.cdc.gov/anthrax/php/lab-testing/index.html

  Plasma is the preferred sample for anthrax lethal factor (LF) toxin testing for all types of anthrax. […] Serum can be used to test for an immune response to anthrax and to test for anthrax LF toxin. […] A full thickness biopsy of a papule or vesicle, including adjacent skin, can be used to diagnose cutaneous anthrax. […] A bronchial or pleural biopsy should be obtained for patients with symptoms of inhalation anthrax. […] Always collect two separate swabs, one for real-time PCR, and one for culture. […] The Laboratory Response Network (LRN) can assist clinical care providers and health departments by conducting diagnostic testing to confirm anthrax. […] The LRN is essential to quickly confirming an anthrax diagnosis.

• #41 Collecting Samples to Send to Laboratories | Anthrax | CDC

  https://www.cdc.gov/anthrax/php/lab-testing/index.html

  Clinicians ideally should collect patient samples before starting treatment. […] Consult your state or local health department to determine steps for diagnosing anthrax. […] Anthrax is confirmed through testing at laboratories in the Laboratory Response Network. […] Culturing B. anthracis from clinical specimens is the gold standard for diagnosing anthrax. […] Healthcare providers in the United States rarely see a patient with anthrax. […] Call CDC’s Emergency Operations Center at 770-488-7100 for an anthrax testing consultation. […] To accurately diagnose anthrax, samples ideally should be taken before the patient starts antibiotic treatment. […] Blood samples can help diagnose inhalation and gastrointestinal anthrax, especially if a patient shows signs of systemic infection. Blood will be tested using real-time polymerase chain reaction (PCR) to confirm an anthrax diagnosis.

• #42 Anthrax – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507773/

  Anthrax is categorized as a category A priority pathogen by the Centers for Disease Control and Prevention because it is potentially capable of being disseminated as a bioweapon. […] The pathogenesis of anthrax follows the route of infection with three primary forms in humans: cutaneous, GI, and inhalational. […] Inhalational anthrax leads to accumulation of B. anthracis spores within the lung alveoli. […] Cutaneous anthrax results from inoculation of B. anthracis spores through the abraded skin into subcutaneous tissues. […] GI anthrax occurs due to ingestion of contaminated meat, with spores introduced into the gastrointestinal tract, causing bacterial replication, mucosal ulcerations, and bleeding. […] The damage to tissues is caused by the anthrax toxins, of which the edema toxin is most lethal.

• #43 Anthrax – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507773/

  The CDC has developed detailed recommendations for patient evaluation by suspected anthrax exposure and clinical syndrome. […] The laboratory personnel must be warned that the tissue may contain anthrax so that they take appropriate precautions. […] Cutaneous anthrax is diagnosed with a methylene blue stain which reveals a gram-positive rod that is not motile. […] Chest x-ray in patients with inhalational anthrax may reveal enlarged mediastinum. […] All cases of inhalation anthrax should be considered a bioterror event and appropriate decontamination steps should be in place. […] Anthrax is a reportable infection and the local authorities and the CDC must be notified immediately. […] In brief, treatment for inhalational anthrax requires a multidrug regimen with one bactericidal agent + 1 protein-synthesis inhibitor.

• #44 Anthrax – Infections – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/infections/bacterial-infections-gram-positive-bacteria/anthrax

  Symptoms suggest the infection, and identifying the bacteria in samples taken from infected tissue confirms the diagnosis. […] If inhalation anthrax is suspected, chest x-ray or computed tomography (CT) is done. […] Samples of blood, infected skin, fluids around the lungs, or stool are removed and examined with a microscope or cultured (enabling bacteria, if present, to multiply). Anthrax bacteria, if present, can be readily identified. […] Doctors suspect skin anthrax based on its typical appearance. Knowing that people have had contact with animals or animal products or were in an area where other people developed anthrax supports the diagnosis. […] The longer anthrax treatment is delayed, the greater the risk of death. Thus, treatment is usually started as soon as doctors suspect that people have anthrax.

• #45 Anthrax – Infections – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/infections/bacterial-infections-gram-positive-bacteria/anthrax

  Symptoms suggest the infection, and identifying the bacteria in samples taken from infected tissue confirms the diagnosis. […] If inhalation anthrax is suspected, chest x-ray or computed tomography (CT) is done. […] Samples of blood, infected skin, fluids around the lungs, or stool are removed and examined with a microscope or cultured (enabling bacteria, if present, to multiply). Anthrax bacteria, if present, can be readily identified. […] Doctors suspect skin anthrax based on its typical appearance. Knowing that people have had contact with animals or animal products or were in an area where other people developed anthrax supports the diagnosis. […] The longer anthrax treatment is delayed, the greater the risk of death. Thus, treatment is usually started as soon as doctors suspect that people have anthrax.

• #46 Anthrax – Infections – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/infections/bacterial-infections-gram-positive-bacteria/anthrax

  Symptoms suggest the infection, and identifying the bacteria in samples taken from infected tissue confirms the diagnosis. […] If inhalation anthrax is suspected, chest x-ray or computed tomography (CT) is done. […] Samples of blood, infected skin, fluids around the lungs, or stool are removed and examined with a microscope or cultured (enabling bacteria, if present, to multiply). Anthrax bacteria, if present, can be readily identified. […] Doctors suspect skin anthrax based on its typical appearance. Knowing that people have had contact with animals or animal products or were in an area where other people developed anthrax supports the diagnosis. […] The longer anthrax treatment is delayed, the greater the risk of death. Thus, treatment is usually started as soon as doctors suspect that people have anthrax.

• #47 Anthrax (Bacillus Anthracis) Causes, Symptoms, Diagnosis, Treatment

  https://www.medicinenet.com/anthrax/article.htm

  In most cases, early treatment can cure anthrax. The cutaneous (skin) form of anthrax can be treated with common antibiotics such as penicillin, tetracycline, erythromycin (Ilotycin, Ery-Ped, Ery-Tab), and ciprofloxacin (Cipro). The pulmonary form of anthrax is a medical emergency. Early and continuous intravenous therapy with antibiotics may be lifesaving. In a bioterrorism attack, individuals exposed to anthrax will be given antibiotics before they become sick. A vaccine exists but is not yet available to the general public. Most experts think that the vaccine will also be given to exposed individuals who are victims of a bioterrorist attack. Of note, anthrax is a reportable disease. That means that local or state health agencies must be notified if a case of anthrax is diagnosed. These agencies can better characterize the anthrax so that the affected individual can receive the most effective treatment for that particular organism. […]

• #48 Anthrax (Bacillus Anthracis) Causes, Symptoms, Diagnosis, Treatment

  https://www.medicinenet.com/anthrax/article.htm

  In most cases, early treatment can cure anthrax. The cutaneous (skin) form of anthrax can be treated with common antibiotics such as penicillin, tetracycline, erythromycin (Ilotycin, Ery-Ped, Ery-Tab), and ciprofloxacin (Cipro). The pulmonary form of anthrax is a medical emergency. Early and continuous intravenous therapy with antibiotics may be lifesaving. In a bioterrorism attack, individuals exposed to anthrax will be given antibiotics before they become sick. A vaccine exists but is not yet available to the general public. Most experts think that the vaccine will also be given to exposed individuals who are victims of a bioterrorist attack. Of note, anthrax is a reportable disease. That means that local or state health agencies must be notified if a case of anthrax is diagnosed. These agencies can better characterize the anthrax so that the affected individual can receive the most effective treatment for that particular organism. […]

• #49 Anthrax (Bacillus Anthracis) Causes, Symptoms, Diagnosis, Treatment

  https://www.medicinenet.com/anthrax/article.htm

  The prognosis for anthrax infections depends on the type of infection and how rapidly antibiotic treatment is initiated. The worst prognosis is for the pulmonary form of anthrax caused by inhaling spores from the environment or from „weaponized” anthrax preparations. The other forms of anthrax have a range of outcomes from good to poor, depending upon how quickly diagnosis and treatment occurs and how severe the infection effects the various organ systems.

• #50 Anthrax (Bacillus Anthracis) Causes, Symptoms, Diagnosis, Treatment

  https://www.medicinenet.com/anthrax/article.htm

  In most cases, early treatment can cure anthrax. The cutaneous (skin) form of anthrax can be treated with common antibiotics such as penicillin, tetracycline, erythromycin (Ilotycin, Ery-Ped, Ery-Tab), and ciprofloxacin (Cipro). The pulmonary form of anthrax is a medical emergency. Early and continuous intravenous therapy with antibiotics may be lifesaving. In a bioterrorism attack, individuals exposed to anthrax will be given antibiotics before they become sick. A vaccine exists but is not yet available to the general public. Most experts think that the vaccine will also be given to exposed individuals who are victims of a bioterrorist attack. Of note, anthrax is a reportable disease. That means that local or state health agencies must be notified if a case of anthrax is diagnosed. These agencies can better characterize the anthrax so that the affected individual can receive the most effective treatment for that particular organism. […]

• #51 Anthrax (Bacillus Anthracis) Causes, Symptoms, Diagnosis, Treatment

  https://www.medicinenet.com/anthrax/article.htm

  In most cases, early treatment can cure anthrax. The cutaneous (skin) form of anthrax can be treated with common antibiotics such as penicillin, tetracycline, erythromycin (Ilotycin, Ery-Ped, Ery-Tab), and ciprofloxacin (Cipro). The pulmonary form of anthrax is a medical emergency. Early and continuous intravenous therapy with antibiotics may be lifesaving. In a bioterrorism attack, individuals exposed to anthrax will be given antibiotics before they become sick. A vaccine exists but is not yet available to the general public. Most experts think that the vaccine will also be given to exposed individuals who are victims of a bioterrorist attack. Of note, anthrax is a reportable disease. That means that local or state health agencies must be notified if a case of anthrax is diagnosed. These agencies can better characterize the anthrax so that the affected individual can receive the most effective treatment for that particular organism. […]

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