Anthrax differential diagnosis: Difference between revisions
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==Overview== | ==Overview== | ||
The differential diagnosis of anthrax includes a wide range of infectious and non-infectious conditions depending on the mode of anthrax exposure in the patient (cutaneous, ingestion, inhalation, injection).<ref>{{cite book | last = Turnbull | first = Peter | title = Anthrax in humans and animals | publisher = World Health Organization | location = Geneva, Switzerland | year = 2008 | isbn = 9789241547536 }}</ref> A history of exposure to contaminated animal materials, occupational exposure, and living in an endemic area is crucial when considering a diagnosis of anthrax. Additional tests that isolate ''[[Bacillus anthracis]]'' are needed to differentiate anthrax from other conditions and confirm the diagnosis. | The differential diagnosis of anthrax includes a wide range of infectious and non-infectious conditions depending on the mode of anthrax exposure in the patient (cutaneous, ingestion, inhalation, injection).<ref name=WHO>{{cite book | last = Turnbull | first = Peter | title = Anthrax in humans and animals | publisher = World Health Organization | location = Geneva, Switzerland | year = 2008 | isbn = 9789241547536 }}</ref> A history of exposure to contaminated animal materials, occupational exposure, and living in an endemic area is crucial when considering a diagnosis of anthrax. Additional tests that isolate ''[[Bacillus anthracis]]'' are needed to differentiate anthrax from other conditions and confirm the diagnosis. | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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* A history of exposure to contaminated animal materials, occupational exposure, and living in an endemic area is crucial when considering a diagnosis of anthrax. A painless, [[pruritus|pruritic]] [[papule]], surrounding [[vesicle]]s and [[edema]], usually on an exposed region of the body should raise a concern of [[cutaneous anthrax]], which is confirmed by the demonstration of [[Gram-positive]] encapsulated [[bacilli]] from the lesion and/or positive culture for ''[[Bacillus anthracis]]'' from the lesion and/or positive specialized tests. | * A history of exposure to contaminated animal materials, occupational exposure, and living in an endemic area is crucial when considering a diagnosis of anthrax. A painless, [[pruritus|pruritic]] [[papule]], surrounding [[vesicle]]s and [[edema]], usually on an exposed region of the body should raise a concern of [[cutaneous anthrax]], which is confirmed by the demonstration of [[Gram-positive]] encapsulated [[bacilli]] from the lesion and/or positive culture for ''[[Bacillus anthracis]]'' from the lesion and/or positive specialized tests. | ||
* The differential diagnosis of the anthrax [[eschar]] includes a wide range of infectious and non-infectious conditions including:<ref>{{cite book | last = Turnbull | first = Peter | title = Anthrax in humans and animals | publisher = World Health Organization | location = Geneva, Switzerland | year = 2008 | isbn = 9789241547536 }}</ref> | * The differential diagnosis of the anthrax [[eschar]] includes a wide range of infectious and non-infectious conditions including:<ref name=WHO>{{cite book | last = Turnbull | first = Peter | title = Anthrax in humans and animals | publisher = World Health Organization | location = Geneva, Switzerland | year = 2008 | isbn = 9789241547536 }}</ref> | ||
:* [[Boil]] (early lesion) | :* [[Boil]] (early lesion) | ||
:* [[Spider bite|Arachnid bites]] | :* [[Spider bite|Arachnid bites]] | ||
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** Hemorrhagic [[gastroenteritis]] | ** Hemorrhagic [[gastroenteritis]] | ||
*** Necrotizing [[enteritis]] caused by ''[[Clostridium perfringens]]'' | *** Necrotizing [[enteritis]] caused by ''[[Clostridium perfringens]]'' | ||
*** [[Dysentery]] (amebic or bacterial)<ref>{{cite book | last = Turnbull | first = Peter | title = Anthrax in humans and animals | publisher = World Health Organization | location = Geneva, Switzerland | year = 2008 | isbn = 9789241547536 }}</ref> | *** [[Dysentery]] (amebic or bacterial)<ref name=WHO>{{cite book | last = Turnbull | first = Peter | title = Anthrax in humans and animals | publisher = World Health Organization | location = Geneva, Switzerland | year = 2008 | isbn = 9789241547536 }}</ref> | ||
===Inhalational Anthrax (Pulmonary, Mediastinal, and Respiratory Anthrax)=== | ===Inhalational Anthrax (Pulmonary, Mediastinal, and Respiratory Anthrax)=== | ||
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** [[Histoplasmosis]] | ** [[Histoplasmosis]] | ||
** [[Coccidiomycosis]] | ** [[Coccidiomycosis]] | ||
** [[Malignancy]]<ref>{{cite book | last = Turnbull | first = Peter | title = Anthrax in humans and animals | publisher = World Health Organization | location = Geneva, Switzerland | year = 2008 | isbn = 9789241547536 }}</ref> | ** [[Malignancy]]<ref name=WHO>{{cite book | last = Turnbull | first = Peter | title = Anthrax in humans and animals | publisher = World Health Organization | location = Geneva, Switzerland | year = 2008 | isbn = 9789241547536 }}</ref> | ||
===Anthrax Meningitis=== | ===Anthrax Meningitis=== | ||
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** [[Subarachnoid hemorrhage]] | ** [[Subarachnoid hemorrhage]] | ||
* The definitive diagnosis is obtained by visualization of the capsulated [[bacilli]] in the [[cerebrospinal fluid]] and/or by culture.<ref>{{cite book | last = Turnbull | first = Peter | title = Anthrax in humans and animals | publisher = World Health Organization | location = Geneva, Switzerland | year = 2008 | isbn = 9789241547536 }}</ref> | * The definitive diagnosis is obtained by visualization of the capsulated [[bacilli]] in the [[cerebrospinal fluid]] and/or by culture.<ref name=WHO>{{cite book | last = Turnbull | first = Peter | title = Anthrax in humans and animals | publisher = World Health Organization | location = Geneva, Switzerland | year = 2008 | isbn = 9789241547536 }}</ref> | ||
===Anthrax Sepsis=== | ===Anthrax Sepsis=== | ||
* [[Sepsis]] due to other bacteria should be considered. | * [[Sepsis]] due to other bacteria should be considered. | ||
* The definitive diagnosis of anthrax is made by the isolation of ''[[Bacillus anthracis]]'' from the primary lesion and from blood cultures or by detection of the toxin or DNA (deoxyribonucleic acid) of ''[[Bacillus anthracis|B. anthracis]]'' in these specimens.<ref>{{cite book | last = Turnbull | first = Peter | title = Anthrax in humans and animals | publisher = World Health Organization | location = Geneva, Switzerland | year = 2008 | isbn = 9789241547536 }}</ref> | * The definitive diagnosis of anthrax is made by the isolation of ''[[Bacillus anthracis]]'' from the primary lesion and from blood cultures or by detection of the toxin or DNA (deoxyribonucleic acid) of ''[[Bacillus anthracis|B. anthracis]]'' in these specimens.<ref name=WHO>{{cite book | last = Turnbull | first = Peter | title = Anthrax in humans and animals | publisher = World Health Organization | location = Geneva, Switzerland | year = 2008 | isbn = 9789241547536 }}</ref> | ||
==References== | ==References== | ||
Revision as of 11:18, 18 July 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The differential diagnosis of anthrax includes a wide range of infectious and non-infectious conditions depending on the mode of anthrax exposure in the patient (cutaneous, ingestion, inhalation, injection).[1] A history of exposure to contaminated animal materials, occupational exposure, and living in an endemic area is crucial when considering a diagnosis of anthrax. Additional tests that isolate Bacillus anthracis are needed to differentiate anthrax from other conditions and confirm the diagnosis.
Differential Diagnosis
Cutaneous Anthrax
- A history of exposure to contaminated animal materials, occupational exposure, and living in an endemic area is crucial when considering a diagnosis of anthrax. A painless, pruritic papule, surrounding vesicles and edema, usually on an exposed region of the body should raise a concern of cutaneous anthrax, which is confirmed by the demonstration of Gram-positive encapsulated bacilli from the lesion and/or positive culture for Bacillus anthracis from the lesion and/or positive specialized tests.
- The differential diagnosis of the anthrax eschar includes a wide range of infectious and non-infectious conditions including:[1]
- Generally these other diseases and conditions lack the characteristic edema of anthrax. The absence of pus, the lack of pain, and the patient’s occupation may provide further diagnostic clues. The outbreak of Rift Valley fever, initially thought to be anthrax in livestock, also affected numerous humans.
- In the differential diagnosis of the severe forms, orbital cellulitis, dacryocystitis and deep tissue infection of the neck should be considered in the case of severe anthrax lesions involving the face, neck and anterior chest wall. Necrotizing soft tissue infections, particularly group A streptococcal infections and gas gangrene, and severe cellulitis due to staphylococci, should also be considered in the differential diagnosis of severe forms of cutaneous anthrax. Gas and abscess formation are not observed in patients with cutaneous anthrax. Abscess formation is only seen when the lesion is infected with other bacteria such as streptococci or staphylococci.
Ingestional Anthrax (Oropharyngeal and Gastrointestinal Anthrax)
Oropharyngeal Anthrax
- The list of differential diagnosis of oropharyngeal anthrax include:
- Diphtheria
- Complicated tonsillitis
- streptococcal pharyngitis
- Vincent's angina
- Ludwig's angina
- Parapharyngeal abscess
- Deep-tissue infection of the neck
Gastrointestinal Anthrax
- The list of differential diagnosis of gastrointestinal anthrax include:
- Food poisoning (in the early stages of intestinal anthrax)
- Acute abdomen
- Hemorrhagic gastroenteritis
- Necrotizing enteritis caused by Clostridium perfringens
- Dysentery (amebic or bacterial)[1]
Inhalational Anthrax (Pulmonary, Mediastinal, and Respiratory Anthrax)
- The list of differential diagnosis of inhalation anthrax include:
Anthrax Meningitis
- The list of differential diagnosis of anthrax meningitis include:
- Acute meningitis
- Cerebral malaria
- Subarachnoid hemorrhage
- The definitive diagnosis is obtained by visualization of the capsulated bacilli in the cerebrospinal fluid and/or by culture.[1]
Anthrax Sepsis
- Sepsis due to other bacteria should be considered.
- The definitive diagnosis of anthrax is made by the isolation of Bacillus anthracis from the primary lesion and from blood cultures or by detection of the toxin or DNA (deoxyribonucleic acid) of B. anthracis in these specimens.[1]