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Emergency: requires immediate attention
Cutaneous anthrax
See also in: Cellulitis DDx,External and Internal Eye
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Other Resources UpToDate PubMed
Emergency: requires immediate attention

Cutaneous anthrax

See also in: Cellulitis DDx,External and Internal Eye
Print Images (20)
Contributors: Lewis Rubinson MD, PhD, Art Papier MD
Other Resources UpToDate PubMed

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Synopsis

Cutaneous anthrax : Fever, Eschar, Plaque with ulcer, Regional lymphadenopathy, Tense vesicle
Cutaneous anthrax is one of 4 major syndromes caused by Bacillus anthracis, an encapsulated, gram-positive, spore-forming bacillus. The other "forms" are inhalational, gastrointestinal, and injection anthrax. Bacillus anthracis has been classified by the US Centers for Disease Control and Prevention (CDC) as a Category A bioterrorism agent. If anthrax were to be intentionally dispersed, the most likely syndromes will be inhalational and cutaneous. Cutaneous anthrax occurs in endemic areas (eg, Turkey) due to exposure to infected animals. Cases of cutaneous anthrax also occurred during the intentional exposures in the United States in 2001.

Bacillus anthracis is present in both domestic and wild animals throughout the world (mainly in agricultural regions of South and Central America, Southern and Eastern Europe, Asia, Africa, the Caribbean, and the Middle East) and can be transmitted by these animals' meat, wool, or hides. Therefore, veterinarians and those in the meat-, wool-, or hide-processing industries, as well as those who have butchered meat or touched raw meat, may develop cutaneous lesions.

Bacillus anthracis is not routinely found in all US soil, although it can be found in soil where previously infected animals have died. Major epizootics in the past have occurred in North Dakota, South Dakota, Minnesota, and Texas. Hence, international travel should be elicited when evaluating a suspect lesion.

Cutaneous anthrax lesions evolve from nonpainful, pruritic papules to clusters of vesicles to ulcers within 1-2 days following exposure of abraded skin or wounds to the spores. The ulcers then develop into depressed, black eschars over the next 2-5 days. The most common areas affected are the arms, face, and neck. Some lesions may have extensive edema formation. The incubation period is 1-12 days.

With antibiotic treatment, the mortality rate for cutaneous anthrax is approximately 1%. However, without treatment, it may progress to a systemic form of anthrax with a mortality rate of approximately 20%. In these cases, the spores introduced into the body are eaten by macrophages and taken to regional lymph nodes, where they germinate into bacteria. Released into the lymph system, they enter the blood stream, causing septicemia-releasing toxins that result in a fatal toxemia.

Codes

ICD10CM:
A22.0 – Cutaneous anthrax

SNOMEDCT:
84980006 – Cutaneous anthrax

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated:01/23/2017
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Emergency: requires immediate attention
Cutaneous anthrax
See also in: Cellulitis DDx,External and Internal Eye
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A medical illustration showing key findings of Cutaneous anthrax : Fever, Eschar, Plaque with ulcer, Regional lymphadenopathy, Tense vesicle
Clinical image of Cutaneous anthrax - imageId=765248. Click to open in gallery. caption: 'Numerous bullae with central umbilication, some with early eschar formation, on the arm.'
Numerous bullae with central umbilication, some with early eschar formation, on the arm.

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