Signs and Symptoms of Inhalational Anthrax (IA): Incubation period is generally 1-6 days, although longer periods have been noted. Fever, malaise, fatigue, dry cough, and mild chest discomfort progresses to severe respiratory distress with dyspnea, diaphoresis, stridor, cyanosis, and shock. Death typically occurs within 24-36 hr after onset of severe symptoms.
Diagnosis: Physical findings are non-specific. A widened mediastinum and pleural effusions may be seen on CXR or CT scan in later stages of illness. The organism is detectable by Gram stain of the blood and by blood culture late in the course of illness.
Treatment: Although effectiveness may be limited after symptoms are present, high dose intravenous antibiotic treatment with ciprofloxacin or doxycycline combined with one or two additional antibiotics should be considered. Intensive supportive therapy may be necessary.
Prophylaxis: Oral ciprofloxacin or doxycycline for known or imminent exposure.
An FDA-licensed vaccine is available. Vaccine schedule is 0.5 ml subcutaneously at 0, 2, 4 weeks, then 6, 12, and 18 months (primary series), followed by annual boosters.
Isolation and Decontamination: Standard precautions for healthcare workers. Avoid invasive procedures or autopsy; but if performed, all instruments and proximate environment should be thoroughly disinfected with a sporicidal agent (e.g., hypochlorite).
USAMRIID's Medical Management of Biological Casualities Handbook. Sixth ed. Fort Dietrich, Maryland: U.S. Army Medical Research Institute of Infectious Diseases, 2005. 17.
