Am J Respir Crit Care Med. 2011 Aug 18;
Authors: Sweeney DA, Hicks CW, Cui X, Li Y, Eichacker PQ
Bacillus anthracis infection is rare in developed countries. However recent outbreaks in the US and Europe and potential use of the bacteria for bioterrorism have focused interest on it. Furthermore, while anthrax was known to typically occur as one of three syndromes related to entry site of (i.e., cutaneous, gastrointestinal or inhalational), a fourth syndrome including severe soft tissue infection in injectional drug users is emerging. Although shock has been described with cutaneous anthrax, it appears much more common with gastrointestinal, inhalational (5 of 11 patients in the US outbreak of 2001) and injectional anthrax. Based in part on case series, the estimated relative mortalities of cutaneous, gastrointestinal, inhalational and injectional anthrax are: <1%, 25-60%, 46% and 33% respectively. Nonspecific early symptomatology makes initial identification of anthrax cases difficult. Clues to anthrax infection include: history of exposure to herbivore animal products; heroin use; or clustering of patients with similar respiratory symptoms concerning for a bioterrorist event. Once anthrax is suspected, the diagnosis can usually be made with gram stain and culture from blood or surgical specimens followed by confirmatory testing (e.g., PCR or immunohistochemistry). While antibiotic therapy (largely quinolone-based) is the mainstay of anthrax treatment, the use of adjunctive therapies such as anthrax toxin antagonists are a consideration.
PMID: 21852539 [PubMed - as supplied by publisher]