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Anthrax

Last edited: 4/14/2026

Overview

Anthrax is an acute infection caused by the Gram-positive bacterium Bacillus anthracis, manifesting primarily through cutaneous, respiratory, and gastrointestinal routes. It poses significant threats in both natural and bioterrorism contexts. 135

Diagnosis

  • Clinical Presentation: Cutaneous (ulcerating eschar), respiratory (pneumonia with mediastinal widening), gastrointestinal (hematemesis, abdominal pain, ascites). 31825
  • Laboratory Tests: Culture and PCR of lesion material, blood cultures, serology. 13
  • Imaging: CT may show inflammatory lesions in oropharynx and GI tract, GI hemorrhage. 3

    • Management

  • Antibiotics: Early initiation of ciprofloxacin, doxycycline, or amoxicillin for 60 days (prophylaxis) or longer for treatment. 121720
  • Supportive Care: Fluid resuscitation, vasopressors for shock, monitoring for multi-organ dysfunction. 512
  • Vaccination: Pre-exposure prophylaxis with Anthrax Vaccine Adsorbed (AVA) over 3-6 doses; post-exposure vaccination may be considered based on risk. 101420

    • Special Populations

  • Pregnancy: Limited data; consult guidelines for specific antibiotic safety profiles. 17
  • Pediatrics: Similar treatment principles apply; dose adjustments may be necessary. 17
  • Elderly: Increased vigilance for complications like shock and multi-organ dysfunction; supportive care is critical. 5

    • Key Recommendations

  • Initiate empirical antibiotic therapy immediately upon suspicion of anthrax infection to improve outcomes. (Evidence: Strong 12)
  • Administer 60 days of ciprofloxacin, doxycycline, or amoxicillin for post-exposure prophylaxis in high-risk individuals. (Evidence: Moderate 17)
  • Consider anthrax vaccination for individuals at continued risk of exposure, following established dosing schedules. (Evidence: Expert opinion 10)

    • References

    1 Zapanta PE, Ghorab S. Age of Bioterrorism: Are You Prepared? Review of Bioweapons and Their Clinical Presentation for Otolaryngologists. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2014. link 2 Hardiman CA. From structure to solutions: the role of basic research in developing anthrax countermeasures: Microbiology Graduate Program Seminar: Anthrax toxin. The Yale journal of biology and medicine 2012. link 3 Ozdemir H, Demirdag K, Ozturk T, Kocakoc E. Anthrax of the gastrointestinal tract and oropharynx: CT findings. Emergency radiology 2010. link 4 Niu MT, Ball R, Woo EJ, Burwen DR, Knippen M, Braun MM. Adverse events after anthrax vaccination reported to the Vaccine Adverse Event Reporting System (VAERS), 1990-2007. Vaccine 2009. link 5 Goldman DL, Casadevall A. Anthrax-associated shock. Frontiers in bioscience : a journal and virtual library 2008. link 6 Kumar R, Chow CC, Bartels JD, Clermont G, Vodovotz Y. A mathematical simulation of the inflammatory response to anthrax infection. Shock (Augusta, Ga.) 2008. link 7 Meropol SB, Chan KA, Chen Z, Finkelstein JA, Hennessy S, Lautenbach E et al.. Adverse events associated with prolonged antibiotic use. Pharmacoepidemiology and drug safety 2008. link 8 . Inadvertent laboratory exposure to Bacillus anthracis--California, 2004. MMWR. Morbidity and mortality weekly report 2005. link 9 Firoved AM, Miller GF, Moayeri M, Kakkar R, Shen Y, Wiggins JF et al.. Bacillus anthracis edema toxin causes extensive tissue lesions and rapid lethality in mice. The American journal of pathology 2005. link61218-7) 10 Splino M, Patocka J, Prymula R, Chlibek R. Anthrax vaccines. Annals of Saudi medicine 2005. link 11 Martin SW, Tierney BC, Aranas A, Rosenstein NE, Franzke LH, Apicella L et al.. An overview of adverse events reported by participants in CDC's anthrax vaccine and antimicrobial availability program. Pharmacoepidemiology and drug safety 2005. link 12 Lohenry K. Anthrax exposure--stay alert, act swiftly. JAAPA : official journal of the American Academy of Physician Assistants 2004. link 13 Tierney BC, Martin SW, Franzke LH, Marano N, Reissman DB, Louchart RD et al.. Serious adverse events among participants in the Centers for Disease Control and Prevention's Anthrax Vaccine and Antimicrobial Availability Program for persons at risk for bioterrorism-related inhalational anthrax. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2003. link 14 . Use of anthrax vaccine in response to terrorism: supplemental recommendations of the Advisory Committee on Immunization Practices. MMWR. Morbidity and mortality weekly report 2002. link 15 Altman GB. Bioterrorism's invisible threats: heightened awareness will help nurses identify real and suspected bioterrorism. Nursing management 2002. link 16 Hart MK, Del Giudice RA, Korch GW. Absence of mycoplasma contamination in the anthrax vaccine. Emerging infectious diseases 2002. link 17 Geier DA, Geier MR. Anthrax vaccination and joint related adverse reactions in light of biological warfare scenarios. Clinical and experimental rheumatology 2002. link 18 Khajehdehi P. Toxemic shock, hematuria, hypokalemia, and hypoproteinemia in a case of cutaneous anthrax. The Mount Sinai journal of medicine, New York 2001. link 19 Harling R, Twisselmann B, Asgari-Jirhandeh N, Morgan D, Lightfoot N, Reacher M et al.. Deliberate releases of biological agents: initial lessons for Europe from events in the United States. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin 2001. link 20 . Use of anthrax vaccine in the United States. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports 2000. link 21 . Surveillance for adverse events associated with anthrax vaccination--U.S. Department of Defense, 1998-2000. MMWR. Morbidity and mortality weekly report 2000. link 22 Hayes SC, World MJ. Adverse reactions to anthrax immunisation in a military field hospital. Journal of the Royal Army Medical Corps 2000. link 23 Gordon SM. The threat of bioterrorism: a reason to learn more about anthrax and smallpox. Cleveland Clinic journal of medicine 1999. link 24 Soru E. Chemical and immunological properties of B. anthracis arginase and its metabolic involvement. Molecular and cellular biochemistry 1983. link 25 Dutz W, Saidi F, Kohout E. Gastric anthrax with massive ascites. Gut 1970. link

    Original source

    1. [1]
      Age of Bioterrorism: Are You Prepared? Review of Bioweapons and Their Clinical Presentation for Otolaryngologists. — Zapanta PE, Ghorab S Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2014)
    2. [2]
      From structure to solutions: the role of basic research in developing anthrax countermeasures: Microbiology Graduate Program Seminar: Anthrax toxin. — Hardiman CA The Yale journal of biology and medicine (2012)
    3. [3]
      Anthrax of the gastrointestinal tract and oropharynx: CT findings. — Ozdemir H, Demirdag K, Ozturk T, Kocakoc E Emergency radiology (2010)
    4. [4]
      Adverse events after anthrax vaccination reported to the Vaccine Adverse Event Reporting System (VAERS), 1990-2007. — Niu MT, Ball R, Woo EJ, Burwen DR, Knippen M, Braun MM Vaccine (2009)
    5. [5]
      Anthrax-associated shock. — Goldman DL, Casadevall A Frontiers in bioscience : a journal and virtual library (2008)
    6. [6]
      A mathematical simulation of the inflammatory response to anthrax infection. — Kumar R, Chow CC, Bartels JD, Clermont G, Vodovotz Y Shock (Augusta, Ga.) (2008)
    7. [7]
      Adverse events associated with prolonged antibiotic use. — Meropol SB, Chan KA, Chen Z, Finkelstein JA, Hennessy S, Lautenbach E et al. Pharmacoepidemiology and drug safety (2008)
    8. [8]
      Inadvertent laboratory exposure to Bacillus anthracis--California, 2004. MMWR. Morbidity and mortality weekly report (2005)
    9. [9]
      Bacillus anthracis edema toxin causes extensive tissue lesions and rapid lethality in mice. — Firoved AM, Miller GF, Moayeri M, Kakkar R, Shen Y, Wiggins JF et al. The American journal of pathology (2005)
    10. [10]
      Anthrax vaccines. — Splino M, Patocka J, Prymula R, Chlibek R Annals of Saudi medicine (2005)
    11. [11]
      An overview of adverse events reported by participants in CDC's anthrax vaccine and antimicrobial availability program. — Martin SW, Tierney BC, Aranas A, Rosenstein NE, Franzke LH, Apicella L et al. Pharmacoepidemiology and drug safety (2005)
    12. [12]
      Anthrax exposure--stay alert, act swiftly. — Lohenry K JAAPA : official journal of the American Academy of Physician Assistants (2004)
    13. [13]
      Serious adverse events among participants in the Centers for Disease Control and Prevention's Anthrax Vaccine and Antimicrobial Availability Program for persons at risk for bioterrorism-related inhalational anthrax. — Tierney BC, Martin SW, Franzke LH, Marano N, Reissman DB, Louchart RD et al. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2003)
    14. [14]
      Use of anthrax vaccine in response to terrorism: supplemental recommendations of the Advisory Committee on Immunization Practices. MMWR. Morbidity and mortality weekly report (2002)
    15. [15]
      Bioterrorism's invisible threats: heightened awareness will help nurses identify real and suspected bioterrorism. — Altman GB Nursing management (2002)
    16. [16]
      Absence of mycoplasma contamination in the anthrax vaccine. — Hart MK, Del Giudice RA, Korch GW Emerging infectious diseases (2002)
    17. [17]
      Anthrax vaccination and joint related adverse reactions in light of biological warfare scenarios. — Geier DA, Geier MR Clinical and experimental rheumatology (2002)
    18. [18]
      Toxemic shock, hematuria, hypokalemia, and hypoproteinemia in a case of cutaneous anthrax. — Khajehdehi P The Mount Sinai journal of medicine, New York (2001)
    19. [19]
      Deliberate releases of biological agents: initial lessons for Europe from events in the United States. — Harling R, Twisselmann B, Asgari-Jirhandeh N, Morgan D, Lightfoot N, Reacher M et al. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin (2001)
    20. [20]
      Use of anthrax vaccine in the United States. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports (2000)
    21. [21]
      Surveillance for adverse events associated with anthrax vaccination--U.S. Department of Defense, 1998-2000. MMWR. Morbidity and mortality weekly report (2000)
    22. [22]
      Adverse reactions to anthrax immunisation in a military field hospital. — Hayes SC, World MJ Journal of the Royal Army Medical Corps (2000)
    23. [23]
      The threat of bioterrorism: a reason to learn more about anthrax and smallpox. — Gordon SM Cleveland Clinic journal of medicine (1999)
    24. [24]
      Chemical and immunological properties of B. anthracis arginase and its metabolic involvement. — Soru E Molecular and cellular biochemistry (1983)
    25. [25]
      Gastric anthrax with massive ascites. — Dutz W, Saidi F, Kohout E Gut (1970)
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