Anthrax physical examination

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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 type of disease present in that patient. Common findings of 1) cutaneous type includes: fever, tachycardia, skin rash with formation of a typical scar, edema and lymphadenopathy; 2)gastrointestinal type includes: fever, tachycardia, mucosal ulcer and edema in case of oropharyngeal lesion and edema and pallor in more severe cases; 3)inhalation type includes: fever, tachycardia, bradypnea in severe cases, pallor, cyanosis and decreased heart and lung sounds in the presence of pleural effusion; and 4)injection anthrax includes: fever, typical skin scar on the site of injection, edema and subcutaneous and/or muscular abscess.

Physical Examination

Appearance of the Patient

The appearance of the patients and physical exam will depend on the type of anthrax present in that patient.

Vitals

Temperature

Cutaneous Anthrax

• A fever is often present

Gastrointestinal Anthrax

• A fever is often present

Inhalation Anthrax

• A fever is often present

Injection Anthrax

• A fever is often present

Pulse

Cutaneous Anthrax

• Tachycardia is often present

Gastrointestinal Anthrax

• Tachycardia is often present

Inhalation or Pulmonary Anthrax

• Tachycardia is often present

Injection Anthrax

• Tachycardia is often present

Blood Pressure

Cutaneous Anthrax

• Hypotension may be present in severe systemic cases

Gastrointestinal Anthrax

• Hypotension may be present in severe systemic cases

Inhalation Anthrax

• Hypotension may be present in severe systemic cases

Respiratory Rate

Gastrointestinal Anthrax

• Bradypnea may be present in more severe cases

Inhalation Anthrax

• Bradypnea is often present

Skin

Cutaneous Anthrax

• A rash is often present. Initially appearing as a small papule, which will then develop a ring of vesicles around the papule, possibly with exudate. Between days 5 - 7, initial papule will ulcerate to form a typical scar.
• Edema may be present
• Regional lymphadenitis may be present

Gastrointestinal Anthrax

• Edema may be present, particularly in the neck region
• Pallor may be present in cases of systemic anthrax with shock

Inhalation Anthrax

• Cyanosis may be present
• Pallor may be present

Throat

Gastrointestinal Anthrax

• The throat may be erythematous if lesion located on oropharyngeal mucosa
• Exudate may be present if lesion located on oropharyngeal mucosa
• Tonsillar inflammation may be present if lesion located on oropharyngeal mucosa

Inhalation Anthrax

• Edema may be present

Neck

Cutaneous Anthrax

• Lymph nodes may be present, particularly if initial lesion is located in that region

Gastrointestinal Anthrax

• Painful lymph nodes may be present
• Edema may be present in oropharyngeal anthrax

Inhalation Anthrax

• Edema may be present
• Lymph nodes may be present

Auscultation

Inhalation Anthrax

• Heart and lung sounds may be decreased in the presence of pleural effusion

Abdomen

Cutaneous Anthrax

• Abdominal tenderness may be present, particularly if exuberant vomiting

Gastrointestinal Anthrax

• Abdominal distention may be present
• Abdominal tenderness may be present

Extremities

Cutaneous Anthrax

• Edema may be present, particularly around the initial lesion

Gastrointestinal Anthrax

• Edema may be present

Inhalation Anthrax

• Cyanosis may be present
• Edema may be present

Neurologic

Cutaneous Anthrax

• Mental status may be altered in case of severe systemic anthrax

Gastrointestinal Anthrax

• Mental status may be altered in case of severe systemic anthrax
• Coma may be present

Inhalation Anthrax

• Mental status may be altered in case of severe systemic anthrax
• Coma may be present