The main clinical finding is the typical appearance and progression of the skin lesion:
(1) painless or pruritic papule or pustule
(2) vesicular or ulcerative lesion
(3) black eschar
where:
• While epidemiologic factors are listed for inhalation anthrax, these are not listed in the CDC guidelines. I have added this to the implementation.
If a person has a lesion suspected of being cutaneous anthrax, collect diagnostic materials:
(1) Gram stain and culture the skin lesion (use dry swab to collect vesicle fluid; use wet swab for ulcerated lesions or eschar)
(2) Draw blood cultures.
(3) Consider punch biopsy of skin if (a) the patient has been started on antibiotics OR (b) Gram stain and culture are negative but clinical suspicion is high.
After collection of diagnostic materials:
(1) Start empiric antibiotic therapy.
(2) Notify public health officials.
|
Culture
|
Progression to Black Eschar
|
Management
|
|
negative
|
negative
|
anthrax unlikely; discontinue therapy
|
|
positive
|
negative
|
continue antibiotic therapy
|
|
negative
|
positive
|
continue antibiotic therapy
|
|
positive
|
positive
|
continue antibiotic therapy
|
