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.
A22.0 – Cutaneous anthrax
84980006 – Cutaneous anthrax
Differential Diagnosis & Pitfalls
- Tularemia, ulceroglandular
- Rat-bite fever
- Coumadin necrosis (warfarin necrosis)
- Ecthyma gangrenosum
- Herpes simplex virus (HSV)
- Cutaneous leishmaniasis
- Antiphospholipid antibody syndrome ulcers
- Brown recluse spider bite
- Cat-scratch disease
- Heparin necrosis
- Staphylococcal lymphadenitis / lymphangitis
- Streptococcal adenitis
- Staphylococcal / streptococcal ecthyma
- Tropical ulcer
- Cutaneous tuberculosis
- Scrub typhus
- Milker's nodules
- Bacillus pumilus infection
Drug Reaction Data