Diagnosis and clinical manifestations
Before starting treatment, it is necessary to confirm the presence of the disease. Diagnosis is based on identifying typical clinical symptoms, taking an epidemiological history, and evaluating laboratory data.
Infection is often associated with occupational risk factors: processing sheep hides, contact with dead animals, or excavation work (digging foundation pits) where bone remains are encountered.
Depending on the form of the disease, the clinical picture has its own specific features:
- Cutaneous form. It begins with the appearance of a pink spot, which rapidly transforms into a vesicle with serous-hemorrhagic contents (pustula maligna). Later, an ulcer forms with a dense black eschar at the base. Secondary daughter vesicles form around the eschar — the “necklace” sign. The most important local symptom is pronounced gelatinous edema (Stephansky's sign, in which tissues "tremble" upon percussion) and characteristic loss of pain sensitivity in the affected area. Regional lymph nodes enlarge but remain painless.
- Generalized (pulmonary) form. It mimics acute respiratory viral infection or influenza: high fever, cough, hoarseness. By the end of the second day, the condition deteriorates sharply: fever rises up to 40°C, cyanosis, dyspnea, tachycardia, and hypotension develop. A characteristic sign is the expectoration of blood-tinged sputum, which acquires a jelly-like consistency upon standing.
Assessment of severity and complications
The severity of anthrax is determined by several criteria:
- Localization of the carbuncle. The location of the lesion on the head, face, or neck (for example, in the angle of the mandible) is considered the most dangerous.
- Severity of edema. The extent and magnitude of the gelatinous subcutaneous edema are assessed, which can spread from the face to the neck, chest, and even down to the inguinal region.
- Infectious-toxic syndrome. The degree of its manifestation directly correlates with the severity of the disease.
Severe cases may be accompanied by complications. One of the most formidable is meningitis. When it develops, the patient becomes agitated, consciousness is clouded, and nuchal rigidity is detected. Blood pressure drops sharply (e.g., to 80/60 mm Hg), the pulse becomes thready, and hepatosplenomegaly (enlargement of the liver and spleen) is revealed.
Important: It is strictly forbidden to independently "squeeze" the primary vesicles, as this is a risk factor for an unfavorable course and generalization of the infection.
Laboratory confirmation
The final clinical diagnosis is formulated only taking into account the results of specific tests:
- Bacteriological method. Includes culturing the vesicle contents or cerebrospinal fluid on nutrient media to isolate a pure culture of B. anthracis, bacterioscopy of smears, and biological testing.
- Serological method. Aims to detect specific antibodies to the pathogen's antigens. Indirect hemagglutination assay (IHA), enzyme-linked immunosorbent assay (ELISA), and fluorescent antibody test are used.
Treatment tactics and anti-epidemic measures
At the slightest suspicion of anthrax, the physician is obliged to immediately report it to the chief medical officer of the healthcare facility. The chief medical officer, in turn, informs the health department and the Center for State Sanitary and Epidemiological Surveillance of the administrative district.
The patient is strictly hospitalized in an isolated box ward of an infectious diseases hospital. Therapy is prescribed empirically, without waiting for laboratory results.
Complex treatment includes:
- Etiotropic therapy. The drug of choice is Ciprofloxacinum (Ciprofloxacin). It is prescribed orally at 500 mg twice daily. The standard course lasts 7–10 days.
- Specific therapy. Administration of anthrax immunoglobulin to neutralize the pathogen's toxins.
- Pathogenetic therapy. Administration of massive detoxification therapy to combat infectious-toxic syndrome.
Discharge criteria from the hospital:
- In the cutaneous form, the patient is discharged only after complete epithelialization of the affected area and scarring of the ulcers at the site of the sloughed eschar.
- In the generalized form, a mandatory condition for discharge is the complete clinical recovery of the patient.
Briefly: answers to topical questions
In what doses and according to what regimen is anthrax immunoglobulin administered?
Anthrax immunoglobulin is administered intramuscularly simultaneously with antibacterial therapy. The dosage of the drug strictly depends on the severity of the disease:
- Mild form — prescribed at a dose of 20 ml/day.
- Moderate form — prescribed at a dose of 40–80 ml/day.
- Severe form — prescribed at a dose of 40–80 ml/day.
As part of emergency post-exposure prophylaxis, anthrax immunoglobulin is administered within the first 5 days after likely contact with the source of infection.
What incubation period is characteristic of various forms of anthrax?
The cited sources explicitly indicate the following information:
| Clinical form / route of infection | Incubation period |
|---|---|
| Cutaneous form | 3–10 days |
| Aerogenic route of infection / pulmonary form | The incubation period is significantly prolonged; spore germination can proceed slowly — up to several weeks |
The cutaneous form is described as the most common form of anthrax. For the aerogenic route of infection, it is noted that slow spore germination significantly lengthens the incubation period.
To memorize the classic anthrax carbuncle, use the formula "Black eschar + Necklace + Anesthesia": a central black ulcer forms, peripheral daughter vesicles (necklace) surround it, and complete absence of pain is observed directly in the lesion and enlarged lymph nodes.
Class and exam questions
Why is the localization of the ulcer on the neck considered dangerous?
Localization of the carbuncle on the head or neck is a criterion of severe course, as massive gelatinous edema can rapidly spread to the respiratory tract and chest.
Should one wait for culture results before initiating treatment?
No, etiotropic therapy (ciprofloxacin) and the administration of specific immunoglobulin are prescribed empirically immediately after making a presumptive diagnosis.
When can a patient with cutaneous anthrax be discharged?
Discharge is carried out exclusively after the black eschar sloughs off and the ulcer is completely epithelialized and scarred.
What else to study on this topic
- Mechanism of gelatinous edema formation (Stephansky's sign)
- Differential diagnosis of anthrax versus ordinary carbuncles and furuncles
- Features of bacteriological examination: methods for isolating pure cultures of B. anthracis
- Clinical picture of anthrax meningitis and cerebrospinal fluid changes
- Sanitary and epidemiological rules upon identifying an infection focus
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