Anthrax infections occur as cutaneous, inhaled, and gastrointestinal.
All forms can progress to sepsis and meningitis. Cutaneous
anthrax appears when B anthracis spores
enter through a cutaneous abrasion.4 A small erythematous papule
vesiculates to form a painless eschar with marked edema. Lymphadenopathy
or lymphangitis may occur. Untreated, mortality is as high as 20%.
Inhalation anthrax occurs after respiratory
exposure to B anthracis spores.5 Initial symptoms
are nonspecific, mimicking influenza. Symptoms become fulminant
over a few days, often leading to death. Mediastinal widening on
chest radiograph is pathognomonic. Hemorrhagic meningitis and bacteremia
are common.
Gastrointestinal anthrax follows ingestion of
contaminated, undercooked meat,6 presenting with
nausea, vomiting, and malaise, progressing to bloody diarrhea, gross ascites,
hemorrhagic lymphadenitis, and sepsis. A pharyngeal form of anthrax
occurs with profound submental swelling, adenopathy, and systemic
symptoms.7 Multiple forms of anthrax have been
described in children.8-15