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 which then develops a ring of vesicles around the papule, possibly with exudate. Between days 5 - 7, the initial papule ulcerates to form a typical scar.
- Edema may be present
- Regional lymphadenitis may be present
Neck
- Lymph nodes may be present, particularly if 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
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 more 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
Neck
- Edema may be present
- Lymph nodes 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
- Tachycardia is often present