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.[1][2]
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
Rate
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
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
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