Patient selection: exposure to anthrax during a mass exposure, with certain signs and symptoms and/or with a skin lesion
Parameters:
(1) skin lesion that is papular, vesicular or a depressed black scab (eschar)
(2) skin lesion on head, neck or upper torso
(3) skin lesion > 4 cm, bullous, edematous or multiple
(4) chest auscultation (abnormal if rhonchi, wheezing or muffled heart sounds)
(5) new onset of ascites since exposure date
|
Parameter
|
Finding
|
Points
|
|
skin lesion that is papular, vesicular or depressed
|
no
|
0
|
|
|
yes
|
1
|
|
skin lesion on head, neck or upper torso
|
no
|
0
|
|
|
yes
|
1
|
|
skin lesion > 4 cm, bullous, etc
|
no
|
0
|
|
|
yes
|
1
|
|
chest auscultation
|
normal
|
0
|
|
|
abnormal
|
1
|
|
new onset of ascites
|
no
|
0
|
|
|
yes
|
1
|
score for starting IV therapy if evaluation for signs and symptoms =
= SUM(points for all 5 findings)
score for diagnostic testing if evaluation for signs and symptoms =
= SUM(points for all 5 findings)
score for starting IV therapy if evaluation for skin lesion only =
= SUM(points for findings 2 through 5)
score for oral therapy if evaluation for skin lesion only =
= SUM(points for findings 2 through 5)
Interpretation:
• Intravenous antibiotic therapy is started if the score for starting IV therapy by either score is >= 1.
• Diagnostic testing is performed if the score for diagnostic testing is 0.
• PO therapy or post-exposure prophylaxis is provided if the score for oral therapy is >=1.
Diagnostic testing may involve:
(1) imaging studies (ultrasound, X-rays, etc)
(2) Gram stain or culture of pleural fluid, ascites fluid, wound or CSF.
(3) blood cultures
(4) PCR on specimens from a normally sterile site
(5) serology
(6) other approved test for Bacillus anthracis
