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 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

• 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 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

Shown below are images of the development and resolution of uncomplicated cutaneous anthrax lesion.

• 

  Day 1 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)

• 

  Day 2 - 3 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)

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  Day 4 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)

• 

  Day 6 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)

• 

  Day 11 of development and resolution of uncomplicated cutaneous anthrax lesion.”Adapted from World Health Organization (WHO)

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

• Cyanosis may be present
• Edema may be present

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