Anthrax physical examination: Difference between revisions

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==Overview==
==Overview==
The physical findings of [[anthrax]] infection depend on the mode of anthrax exposure in the patient (cutaneous, ingestion, inhalation, injection). Common findings associated with [[cutaneous]] anthrax infection include [[fever]], [[tachycardia]], [[skin rash]] with formation of a typical [[scar]], [[edema]], and [[lymphadenopathy]].  Signs of [[gastrointestinal]] anthrax infection include [[fever]], [[tachycardia]], [[mucosal]] [[ulcer]], [[edema]] in case of [[oropharyngeal]] lesion, and [[edema]] and [[pallor]] in more severe cases.  [[Inhalation]] anthrax is associated with [[fever]], [[tachycardia]], [[bradypnea]] in severe cases, [[pallor]], [[cyanosis]], and decreased [[heart]] and [[lung]] sounds in the presence of [[pleural effusion]].  Findings in anthrax infection due to injection include [[fever]], typical skin [[scar]] at the site of injection, [[edema]], and [[subcutaneous]] and/or muscular [[abscess]].
The physical findings of [[anthrax]] infection depend on the mode of anthrax exposure in the patient (cutaneous, ingestion, inhalation, injection). Common findings associated with [[cutaneous]] anthrax infection include [[fever]], [[tachycardia]], [[skin rash]] with formation of a typical [[scar]], [[edema]] and [[lymphadenopathy]]; with [[gastrointestinal]] anthrax infection include [[fever]], [[tachycardia]], [[mucosal]] [[ulcer]] and [[edema]] in case of [[oropharyngeal]] lesion and [[edema]] and [[pallor]] in more severe cases; with [[inhalation]] anthrax infection includes: [[fever]], [[tachycardia]], [[bradypnea]] in severe cases, [[pallor]], [[cyanosis]] and decreased [[heart]] and [[lung]] sounds in the presence of [[pleural effusion]]; and with anthrax infection due to injection include [[fever]], typical skin [[scar]] at the site of injection, [[edema]] and [[subcutaneous]] and/or muscular [[abscess]].


==Cutaneous Anthrax==
==Cutaneous Anthrax==
===Vitals===
===Vitals===
====Temperature====
====Temperature====
* A [[fever]] is often present
* A [[fever]] is rarely present<ref name="pmid12610093">{{cite journal| author=Spencer RC| title=Bacillus anthracis. | journal=J Clin Pathol | year= 2003 | volume= 56 | issue= 3 | pages= 182-7 | pmid=12610093 | doi= | pmc=PMC1769905 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12610093  }} </ref>
 
====Pulse====
====Pulse====
* [[Tachycardia]] is often present
* [[Tachycardia]] is often present
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* [[Hypotension]] may be present in severe systemic cases
* [[Hypotension]] may be present in severe systemic cases
===Skin===
===Skin===
* A [[rash]] is often present. The rash initially appears as a small [[papule]] which then develops a ring of [[vesicles]] around the [[papule]], possibly with [[exudate]]. Between days 5 - 7, the initial [[papule]] ulcerates to form a typical [[scar]].
* A [[rash]] is often present.
** The [[rash]] initially appears as a small [[papule]]. A ring of [[vesicles]] develops around the [[papule]], often with [[exudate]]. Between days 5 - 7, the initial [[papule]] ulcerates to form a typical [[scar]].
** Cutaneous lesions are single, but sometimes two or more lesions are present.
** Cutaneous lesions are seen on exposed unprotected regions of the body, mostly on the [[face]], [[neck]], [[hand]]s and [[wrist]]s.
* [[Edema]] may be present
* [[Edema]] may be present
* Regional [[lymphadenitis]] may be present
* Regional [[lymphadenitis]] may be present


===Neck===
===Neck===
*[[Lymph nodes]] may be present, particularly if initial lesion is located in that region
*[[Lymphadenopathy]] may be present, particularly if initial lesion is located near the neck
===Abdomen===
===Abdomen===
*[[Abdominal tenderness]] may be present, particularly if there is exuberant vomiting
*[[Abdominal tenderness]] may be present, particularly if there is exuberant vomiting
===Extremities===
===Extremities===
*[[Edema]] may be present, particularly around the initial lesion
*[[Edema]] may be present, particularly around the site of the initial lesion
===Neurologic===
===Neurologic===
* The [[mental status]] may be altered in case of severe systemic anthrax
* The [[mental status]] may be altered in case of severe systemic anthrax
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* [[Hypotension]] may be present in severe systemic cases
* [[Hypotension]] may be present in severe systemic cases
====Respiratory Rate====
====Respiratory Rate====
* [[Bradypnea]] may be present in more severe cases
* [[Bradypnea]] may be present in severe cases
 
===Skin===
===Skin===
* [[Edema]] may be present, particularly in the [[neck]] region
* [[Edema]] may be present, particularly in the [[neck]] region
Line 42: Line 47:
===Throat===
===Throat===
* The [[throat]] may be [[erythematous]] if the lesion is located on the [[oropharyngeal]] mucosa
* The [[throat]] may be [[erythematous]] if the lesion is located on the [[oropharyngeal]] mucosa
* [[Exudate]] may be present if the lesion is located on oropharyngeal mucosa
* [[Exudate]] may be present if the lesion is located on [[oropharyngeal]] mucosa
* Tonsillar [[inflammation]] may be present if the lesion is located on [[oropharyngeal]] mucosa
* Tonsillar [[inflammation]] may be present if the lesion is located on [[oropharyngeal]] mucosa
===Neck===
===Neck===
* Painful [[lymph nodes]] may be present
* Painful [[lymph nodes]] may be present
Line 71: Line 77:
===Neck===
===Neck===
* [[Edema]] may be present
* [[Edema]] may be present
* [[Lymph nodes]] may be present
* Regional [[lymphadenopathy]] may be present


===Auscultation===
===Auscultation===
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====Temperature====
====Temperature====
* A [[fever]] is often present
* A [[fever]] is often present
====Pulse====
* [[Tachycardia]] is often present
====Blood Pressure====
* [[Hypotension]] may be present in severe systemic cases
===Skin===
* A [[rash]] is often present. The [[rash]] initially appears as a group of small [[blisters]] located on the site of injection. Afterwards, a skin sore with black center replaces the [[blister]]s, surrounded by an area of [[edema]]
* Regional [[lymphadenitis]] may be present
* A nodular [[abscess]] is often palpated on the site where the drug was injected
===Neck===
*[[Lymphadenopathy]] may be present, particularly if the initial lesion is located in that region


====Respiratory Rate====
===Abdomen===
* [[Tachycardia]] is often present
*[[Abdominal tenderness]] may be present, particularly if there is exuberant vomiting
===Extremities===
*[[Edema]] may be present, particularly around the initial lesion
===Neurologic===
* The [[mental status]] may be altered in case of severe systemic anthrax
 
==Gallery==
<gallery>
Image:Cutaneous A1.png| Day 1 of development and resolution of uncomplicated cutaneous anthrax lesion.”<SMALL><SMALL>''[http://www.who.int/en//  Adapted from World Health Organization (WHO)]''<ref name="WHO">{{Cite web | title = World Health Organization | url = http://www.who.int/en/}}</ref></SMALL></SMALL>
 
Image:CutaneousA2.png| Day 2 - 3 of development and resolution of uncomplicated cutaneous anthrax lesion.”<SMALL><SMALL>''[http://www.who.int/en//  Adapted from World Health Organization (WHO)]''<ref name="WHO">{{Cite web | title = World Health Organization | url = http://www.who.int/en/}}</ref></SMALL></SMALL>
 
Image:CutaneousA3.png| Day 4 of development and resolution of uncomplicated cutaneous anthrax lesion.”<SMALL><SMALL>''[http://www.who.int/en//  Adapted from World Health Organization (WHO)]''<ref name="WHO">{{Cite web | title = World Health Organization | url = http://www.who.int/en/}}</ref></SMALL></SMALL>
 
Image:CutaneousA4.png| Day 6 of development and resolution of uncomplicated cutaneous anthrax lesion.”<SMALL><SMALL>''[http://www.who.int/en//  Adapted from World Health Organization (WHO)]''<ref name="WHO">{{Cite web | title = World Health Organization | url = http://www.who.int/en/}}</ref></SMALL></SMALL>
 
Image:CutaneousA5.png| Day 11 of development and resolution of uncomplicated cutaneous anthrax lesion.”<SMALL><SMALL>''[http://www.who.int/en//  Adapted from World Health Organization (WHO)]''<ref name="WHO">{{Cite web | title = World Health Organization | url = http://www.who.int/en/}}</ref></SMALL></SMALL>
 
Image:CutaenousA58.jpg| "Female patient shown here on the 24th day of a Bacillus anthracis infection involving her left eye.”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA59.jpg| Female patient shown here on the 5th day of a Bacillus anthracis infection involving her left eye.” <SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA60.jpg| "Female patient shown here on the 5th day of a Bacillus anthracis infection involving her left eye.”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA61.jpg| Symptoms of cutaneous anthrax due to B. anthracis.” <SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA62.jpg| "Symptoms of cutaneous anthrax due to B. anthracis.”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA69.jpg| High magnification of 12,483X, this scanning electron micrograph (SEM) depicted spores from the Sterne strain of Bacillus anthracis bacteria.”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:Milzbrand.jpg| "Anthrax lesion on the skin of the forearm caused by the bacterium Bacillus anthracis”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA79.jpg| "Anthrax lesion on the neck”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:Anthrax-6.jpg| "Anthrax lesion on volar surface of right forearm”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA106.jpg| "Anthrax, skin of left forearm”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA107.jpg| "Anthrax, skin of right forearm, 4th day”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA109.jpg| "Anthrax, skin of face, 13th day”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA110.jpg| "Anthrax, skin of face, 11th day”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA111.jpg| "Anthrax, skin of face, 8th day”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA112.jpg| "Anthrax, skin of face, 6th day”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA113.jpg| "Anthrax, skin of face, 4th day”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA114.jpg| "Anthrax, skin of right forearm, 7th day.”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA115.jpg| "Anthrax, skin of right forearm, 5th day”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA116.jpg| "Anthrax, skin of right forearm, 12th day.”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA118.jpg| "Cutaneous anthrax lesion on neck of man”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA119.jpg| "Cutaneous anthrax, lesion on the left forearm”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA133.jpg| "Anthrax skin lesion on face of man. Cutaneous”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
 
Image:CutaneousA134.jpg| "Anthrax skin lesion on neck of man. Cutaneous”<SMALL><SMALL>''[http://phil.cdc.gov/phil/  Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
</gallery>


==References==
==References==
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[[Category:Zoonoses]]
[[Category:Zoonoses]]
[[Category:Medical disasters]]
[[Category:Medical disasters]]
[[Category:Emergency mdicine]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Dermatology]]
[[Category:Pulmonology]]
[[Category:Gastroenterology]]

Latest revision as of 20:26, 29 July 2020

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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 mode of anthrax exposure in the patient (cutaneous, ingestion, inhalation, injection). Common findings associated with cutaneous anthrax infection include fever, tachycardia, skin rash with formation of a typical scar, edema and lymphadenopathy; with gastrointestinal anthrax infection include fever, tachycardia, mucosal ulcer and edema in case of oropharyngeal lesion and edema and pallor in more severe cases; with inhalation anthrax infection includes: fever, tachycardia, bradypnea in severe cases, pallor, cyanosis and decreased heart and lung sounds in the presence of pleural effusion; and with anthrax infection due to injection include fever, typical skin scar at the site of injection, edema and subcutaneous and/or muscular abscess.

Cutaneous Anthrax

Vitals

Temperature

Pulse

Blood Pressure

Skin

  • A rash is often present.
    • The rash initially appears as a small papule. A ring of vesicles develops around the papule, often with exudate. Between days 5 - 7, the initial papule ulcerates to form a typical scar.
    • Cutaneous lesions are single, but sometimes two or more lesions are present.
    • Cutaneous lesions are seen on exposed unprotected regions of the body, mostly on the face, neck, hands and wrists.
  • Edema may be present
  • Regional lymphadenitis may be present

Neck

  • Lymphadenopathy may be present, particularly if initial lesion is located near the neck

Abdomen

Extremities

  • Edema may be present, particularly around the site of the initial lesion

Neurologic

  • The mental status may be altered in case of severe systemic anthrax

Gastrointestinal Anthrax

Vitals

Temperature

Blood Pressure

Respiratory Rate

Skin

  • Edema may be present, particularly in the neck region
  • Pallor may be present in cases of systemic anthrax with shock

Throat

Neck

Abdomen

Extremities

Neurologic

  • The mental status may be altered in case of severe systemic anthrax
  • Coma may be present

Inhalation Anthrax

Vitals

Temperature

Blood Pressure

Respiratory Rate

  • Bradypnea may be present in more severe cases

Skin

Neck

Auscultation

Extremities

Neurologic

  • The mental status may be altered in case of severe systemic anthrax
  • Coma may be present

Injection Anthrax

Vitals

Temperature

Pulse

Blood Pressure

Skin

  • A rash is often present. The rash initially appears as a group of small blisters located on the site of injection. Afterwards, a skin sore with black center replaces the blisters, surrounded by an area of edema
  • Regional lymphadenitis may be present
  • A nodular abscess is often palpated on the site where the drug was injected

Neck

  • Lymphadenopathy may be present, particularly if the initial lesion is located in that region

Abdomen

Extremities

  • Edema may be present, particularly around the initial lesion

Neurologic

  • The mental status may be altered in case of severe systemic anthrax

Gallery

References

  1. ↑ Spencer RC (2003). "Bacillus anthracis". J Clin Pathol. 56 (3): 182–7. PMC 1769905. PMID 12610093.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 "World Health Organization".
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 "Public Health Image Library (PHIL), Centers for Disease Control and Prevention".
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