Anthrax laboratory findings: Difference between revisions

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| style="background: #DCDCDC; padding: 5px; text-align: center;" colspan=2| Characterization of inflammatory response<br>Typically low [[CRP]] in injection [[anthrax]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" colspan=2| Characterization of inflammatory response<br>Typically low [[CRP]] in injection [[anthrax]]
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| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Gram stain]]<br>Cultures<br>Toxic Assays'''
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Gram stain]]<br>Cultures<br>Toxic Assays'''<br>([[Blood]], [[serum]], [[CSF]], [[pleural fluid]], [[ascites]], wound [[exudate]], bronchial [[exudate]])
| style="background: #DCDCDC; padding: 5px;"| [[Blood]]<br>[[Serum]]<br>[[CSF]]<br>[[Pleural fluid]]<br>[[Ascites]]<br>Wound [[exudate]]<br>[[Bronchial]] [[exudate]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" colspan=2| Cultures usually negative after [[antibiotics]]<br>[[Toxins]] may be detected
| style="background: #DCDCDC; padding: 5px;"| Cultures usually negative after [[antibiotics]]<br>[[Toxins]] may be detected
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| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Cardiac]] Enzymes<br>[[BNP]]'''
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Cardiac]] Enzymes<br>[[BNP]]'''

Revision as of 20:09, 17 July 2014

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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

When systemic anthrax is present, abnormalities in laboratory tests include anemia, thrombocytopenia, and leukocytosis particularly in latter stages of the disease. Other laboratory findings are hyponatremia, increased BUN, elevated transaminase levels, hypoalbuminemia, and elevated troponin. Cell cultures from blood, CSF, or pleural fluid can identify the organism and possibly the toxins. In injection anthrax, the typical labortatory finding is an inflammatory pattern with a low CRP. A normal PT/PTT at admission does not exclude coagulopathy nor DIC.

Laboratory Findings

The following tests are used in the diagnosis and monitoring of systemic anthrax:[1]

Laboratory findings
Test Initial Findings Serial Monitoring
CBC Hemoconcentration
Possible thrombocytopenia
Leukocyte count commonly normal
Anemia
Thrombocytopenia
Leukocytosis (late in disease)
Electrolyte
Renal Panel
Decreased sodium level
Increased BUN
Liver Enzymes
Serum Albumin
Elevated transaminase levels
Hypoalbuminemia
PT
PTT
D-dimer
Fibrinogen
Normal PT/PTT does not exclude DIC or coagulopathy Low threshold for hypercoagulability workup:
Haptoglobin
LDH
Fibrin split products
ADAMTS 13 if hemolytic anemia
C-Reactive Protein Characterization of inflammatory response
Typically low CRP in injection anthrax
Gram stain
Cultures
Toxic Assays

(Blood, serum, CSF, pleural fluid, ascites, wound exudate, bronchial exudate)
Cultures usually negative after antibiotics
Toxins may be detected
Cardiac Enzymes
BNP
Troponin leak caused by increased cardiac demand from infection
(particularly if atrial fibrillation with rapid ventricular response)

References

  1. Hendricks, Katherine A.; Wright, Mary E.; Shadomy, Sean V.; Bradley, John S.; Morrow, Meredith G.; Pavia, Andy T.; Rubinstein, Ethan; Holty, Jon-Erik C.; Messonnier, Nancy E.; Smith, Theresa L.; Pesik, Nicki; Treadwell, Tracee A.; Bower, William A. (2014). "Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults". Emerging Infectious Diseases. 20 (2). doi:10.3201/eid2002.130687. ISSN 1080-6040.