Anthrax Clinical Forms: Cutaneous, Inhalation, and Gastrointestinal

1. Cutaneous Anthrax (95% of Natural Cases)

• Painless papule → vesicle → black eschar with non-pitting edema.
• Regional lymphadenopathy, low-grade fever.
• Mortality <1% with antibiotics; 20% untreated.

2. Inhalation Anthrax (Woolsorter's Disease)

• Incubation 1–6 weeks. Prodrome: flu-like (fever, cough, myalgia).
• Fulminant phase: Mediastinal widening on CXR, hemorrhagic mediastinitis, septic shock, meningitis.
• Mortality >80% even with aggressive ICU care if treatment is delayed.

3. Gastrointestinal Anthrax

• Oropharyngeal or intestinal. Severe odynophagia, ulceration, ascites, bloody diarrhea.
• Mortality 25–60%.

Systemic Spread

All forms can progress to bacteremia → sepsis → meningitis. B. anthracis toxins (lethal factor, edema factor) impair immune clearance.

Key Management Points

Early antibiotics (ciprofloxacin, doxycycline) plus antitoxin (raxibacumab, obiltoxaximab) for systemic disease. Post-exposure prophylaxis: 60 days of antibiotics + vaccine.