Management of Cutaneous Anthrax

6 Jan

*Most commonly from contact with infected animals or animal products. Keep bioterrorism in mind and look for evidence of inhalation or GI tract exposure.  

*Incubation period of 1-12 days

***Call the State Department of Health. This is a reportable disease.***


Physical exam: Small, painless, pruritic papules -> central vesicle/bulla -> erosion with painless necrotic ulcer/black eschar

 anthrax1 anthrax2

*Oftentimes there is extensive surrounding edema and lymphadenopathy (from toxin release).

*May see systemic signs of fever, malaise, HA. If there are any systemic signs or if the lesions involve the head or neck, treatment must be inpatient. These patients need antitoxin, IV antibiotics, usually an LP, infection control (drainage of effusions…)



-For vesicular lesions- 2 swabs of fluid from an unopened vesicle. Send 1 for Gram stain/culture and the other for PCR.

-For eschars, the edge should be lifted and 2 swabs rotated underneath. Send 1 for Gram stain/culture and the other for PCR.

-For ulcers, the base of the lesion should be sampled with 2 saline moistened swabs. Send 1 for Gram stain/culture and the other for PCR.

-For all lesions, send a full thickness punch biopsy of the lesion in 10% formalin for histopathology and immunohistochemistry. If the patient is not on antibiotics or has been on antibiotics <24 hours, take a second biopsy for Gram stain, culture, and PCR testing.


Isolation: Standard precautions (unless there is continued drainage from wound- then contact precautions).

Treatment: (of cutaneous anthrax without systemic s/sx that does not involve the head or neck)=Generally outpatient.  

7-10 days of ciprofloxacin 500 mg q12 hours

OR doxycycline 100 mg q12 hours OR

clindamycin 600 mg q12.

Follow-up in 1-2 days.


Submitted by Heather Groth. 


Sources: CDC website, Up-To-Date, Vanderbilt Department of Infectious Disease website


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