Anthrax physical examination
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Risk calculators and risk factors for Anthrax physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
The physical findings of anthrax infection depend on the mode of anthrax exposure in the patient (cutaneous, ingestion, inhalation, injection). Common findings associated with cutaneous anthrax infection include fever, tachycardia, skin rash with formation of a typical scar, edema and lymphadenopathy; with gastrointestinal anthrax infection include fever, tachycardia, mucosal ulcer and edema in case of oropharyngeal lesion and edema and pallor in more severe cases; with inhalation anthrax infection includes: fever, tachycardia, bradypnea in severe cases, pallor, cyanosis and decreased heart and lung sounds in the presence of pleural effusion; and with anthrax infection due to injection include fever, typical skin scar at the site of injection, edema and subcutaneous and/or muscular abscess.
Cutaneous Anthrax
Vitals
Temperature
Pulse
- Tachycardia is often present
Blood Pressure
- Hypotension may be present in severe systemic cases
Skin
- A rash is often present.
- The rash initially appears as a small papule. A ring of vesicles develops around the papule, often with exudate. Between days 5 - 7, the initial papule ulcerates to form a typical scar.
- Cutaneous lesions are single, but sometimes two or more lesions are present.
- Cutaneous lesions are seen on exposed unprotected regions of the body, mostly on the face, neck, hands and wrists.
- Edema may be present
- Regional lymphadenitis may be present
Neck
- Lymphadenopathy may be present, particularly if initial lesion is located near the neck
Abdomen
- Abdominal tenderness may be present, particularly if there is exuberant vomiting
Extremities
- Edema may be present, particularly around the site of the initial lesion
Neurologic
- The mental status may be altered in case of severe systemic anthrax
Gastrointestinal Anthrax
Vitals
Temperature
- A fever is often present
- Tachycardia is often present
Blood Pressure
- Hypotension may be present in severe systemic cases
Respiratory Rate
- Bradypnea may be present in severe cases
Skin
- Edema may be present, particularly in the neck region
- Pallor may be present in cases of systemic anthrax with shock
Throat
- The throat may be erythematous if the lesion is located on the oropharyngeal mucosa
- Exudate may be present if the lesion is located on oropharyngeal mucosa
- Tonsillar inflammation may be present if the lesion is located on oropharyngeal mucosa
Neck
- Painful lymph nodes may be present
- Edema may be present in oropharyngeal anthrax
Abdomen
- Abdominal distention may be present
- Abdominal tenderness may be present
Extremities
- Edema may be present
Neurologic
- The mental status may be altered in case of severe systemic anthrax
- Coma may be present
Inhalation Anthrax
Vitals
Temperature
- A fever is often present
- Tachycardia is often present
Blood Pressure
- Hypotension may be present in severe systemic cases
Respiratory Rate
- Bradypnea may be present in more severe cases
Skin
- Cyanosis may be present
Neck
- Edema may be present
- Regional lymphadenopathy may be present
Auscultation
- Heart and lung sounds may be decreased in the presence of pleural effusion
Extremities
Neurologic
- The mental status may be altered in case of severe systemic anthrax
- Coma may be present
Injection Anthrax
Vitals
Temperature
- A fever is often present
Pulse
- Tachycardia is often present
Blood Pressure
- Hypotension may be present in severe systemic cases
Skin
- A rash is often present. The rash initially appears as a group of small blisters located on the site of injection. Afterwards, a skin sore with black center replaces the blisters, surrounded by an area of edema
- Regional lymphadenitis may be present
- A nodular abscess is often palpated on the site where the drug was injected
Neck
- Lymphadenopathy may be present, particularly if the initial lesion is located in that region
Abdomen
- Abdominal tenderness may be present, particularly if there is exuberant vomiting
Extremities
- Edema may be present, particularly around the initial lesion
Neurologic
- The mental status may be altered in case of severe systemic anthrax
Gallery
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![Day 1 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)[2]](/images/f/f0/Cutaneous_A1.png)
Day 1 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)[2]
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![Day 2 - 3 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)[2]](/images/a/ae/CutaneousA2.png)
Day 2 - 3 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)[2]
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![Day 4 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)[2]](/images/8/8e/CutaneousA3.png)
Day 4 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)[2]
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![Day 6 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)[2]](/images/9/90/CutaneousA4.png)
Day 6 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)[2]
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![Day 11 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)[2]](/images/b/b4/CutaneousA5.png)
Day 11 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)[2]
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!["Female patient shown here on the 24th day of a Bacillus anthracis infection involving her left eye.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/f/f7/CutaenousA58.jpg)
"Female patient shown here on the 24th day of a Bacillus anthracis infection involving her left eye.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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![Female patient shown here on the 5th day of a Bacillus anthracis infection involving her left eye.” Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/9/92/CutaneousA59.jpg)
Female patient shown here on the 5th day of a Bacillus anthracis infection involving her left eye.” Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Female patient shown here on the 5th day of a Bacillus anthracis infection involving her left eye.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/f/fc/CutaneousA60.jpg)
"Female patient shown here on the 5th day of a Bacillus anthracis infection involving her left eye.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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![Symptoms of cutaneous anthrax due to B. anthracis.” Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/5/59/CutaneousA61.jpg)
Symptoms of cutaneous anthrax due to B. anthracis.” Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Symptoms of cutaneous anthrax due to B. anthracis.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/e/ec/CutaneousA62.jpg)
"Symptoms of cutaneous anthrax due to B. anthracis.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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![High magnification of 12,483X, this scanning electron micrograph (SEM) depicted spores from the Sterne strain of Bacillus anthracis bacteria.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/3/38/CutaneousA69.jpg)
High magnification of 12,483X, this scanning electron micrograph (SEM) depicted spores from the Sterne strain of Bacillus anthracis bacteria.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Anthrax lesion on the skin of the forearm caused by the bacterium Bacillus anthracis”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/3/33/Milzbrand.jpg)
"Anthrax lesion on the skin of the forearm caused by the bacterium Bacillus anthracis”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Anthrax lesion on the neck”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/0/0c/CutaneousA79.jpg)
"Anthrax lesion on the neck”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Anthrax lesion on volar surface of right forearm”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/8/8e/Anthrax-6.jpg)
"Anthrax lesion on volar surface of right forearm”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Anthrax, skin of left forearm”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/b/b4/CutaneousA106.jpg)
"Anthrax, skin of left forearm”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Anthrax, skin of right forearm, 4th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/e/e4/CutaneousA107.jpg)
"Anthrax, skin of right forearm, 4th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Anthrax, skin of face, 13th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/4/49/CutaneousA109.jpg)
"Anthrax, skin of face, 13th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Anthrax, skin of face, 11th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/0/0f/CutaneousA110.jpg)
"Anthrax, skin of face, 11th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Anthrax, skin of face, 8th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/3/36/CutaneousA111.jpg)
"Anthrax, skin of face, 8th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Anthrax, skin of face, 6th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/2/23/CutaneousA112.jpg)
"Anthrax, skin of face, 6th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Anthrax, skin of face, 4th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/d/d6/CutaneousA113.jpg)
"Anthrax, skin of face, 4th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Anthrax, skin of right forearm, 7th day.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/5/55/CutaneousA114.jpg)
"Anthrax, skin of right forearm, 7th day.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Anthrax, skin of right forearm, 5th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/e/e4/CutaneousA115.jpg)
"Anthrax, skin of right forearm, 5th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Anthrax, skin of right forearm, 12th day.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/4/4b/CutaneousA116.jpg)
"Anthrax, skin of right forearm, 12th day.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Cutaneous anthrax lesion on neck of man”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/f/f3/CutaneousA118.jpg)
"Cutaneous anthrax lesion on neck of man”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Cutaneous anthrax, lesion on the left forearm”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/e/e3/CutaneousA119.jpg)
"Cutaneous anthrax, lesion on the left forearm”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Anthrax skin lesion on face of man. Cutaneous”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/8/84/CutaneousA133.jpg)
"Anthrax skin lesion on face of man. Cutaneous”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
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!["Anthrax skin lesion on neck of man. Cutaneous”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/images/3/31/CutaneousA134.jpg)
"Anthrax skin lesion on neck of man. Cutaneous”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]
![Day 1 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)[2]](/index.php/File:Cutaneous_A1.png)
![Day 2 - 3 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)[2]](/index.php/File:CutaneousA2.png)
![Day 4 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)[2]](/index.php/File:CutaneousA3.png)
![Day 6 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)[2]](/index.php/File:CutaneousA4.png)
![Day 11 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)[2]](/index.php/File:CutaneousA5.png)
!["Female patient shown here on the 24th day of a Bacillus anthracis infection involving her left eye.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaenousA58.jpg)
![Female patient shown here on the 5th day of a Bacillus anthracis infection involving her left eye.” Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA59.jpg)
!["Female patient shown here on the 5th day of a Bacillus anthracis infection involving her left eye.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA60.jpg)
![Symptoms of cutaneous anthrax due to B. anthracis.” Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA61.jpg)
!["Symptoms of cutaneous anthrax due to B. anthracis.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA62.jpg)
![High magnification of 12,483X, this scanning electron micrograph (SEM) depicted spores from the Sterne strain of Bacillus anthracis bacteria.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA69.jpg)
!["Anthrax lesion on the skin of the forearm caused by the bacterium Bacillus anthracis”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:Milzbrand.jpg)
!["Anthrax lesion on the neck”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA79.jpg)
!["Anthrax lesion on volar surface of right forearm”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:Anthrax-6.jpg)
!["Anthrax, skin of left forearm”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA106.jpg)
!["Anthrax, skin of right forearm, 4th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA107.jpg)
!["Anthrax, skin of face, 13th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA109.jpg)
!["Anthrax, skin of face, 11th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA110.jpg)
!["Anthrax, skin of face, 8th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA111.jpg)
!["Anthrax, skin of face, 6th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA112.jpg)
!["Anthrax, skin of face, 4th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA113.jpg)
!["Anthrax, skin of right forearm, 7th day.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA114.jpg)
!["Anthrax, skin of right forearm, 5th day”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA115.jpg)
!["Anthrax, skin of right forearm, 12th day.”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA116.jpg)
!["Cutaneous anthrax lesion on neck of man”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA118.jpg)
!["Cutaneous anthrax, lesion on the left forearm”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA119.jpg)
!["Anthrax skin lesion on face of man. Cutaneous”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA133.jpg)
!["Anthrax skin lesion on neck of man. Cutaneous”Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[3]](/index.php/File:CutaneousA134.jpg)
References
- ↑ Spencer RC (2003). "Bacillus anthracis". J Clin Pathol. 56 (3): 182–7. PMC 1769905. PMID 12610093.
- ↑ 2.0 2.1 2.2 2.3 2.4 "World Health Organization".
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 "Public Health Image Library (PHIL), Centers for Disease Control and Prevention".