Rationale:

• Infectious diseases specialists can help provide expertise in the diagnosis of cutaneous, inhalational, and gastrointestinal anthrax.
• Rapid diagnosis is essential for cutaneous anthrax as it can become disseminated; early diagnosis of anthrax disease is essential to saving lives.
• Gram stain and culture results of vesicles or specimen biopsy of a lesion with immunohistochemical staining or PCR increase diagnostic yield.
• Because systemic disease with anthrax can affect the GI tract, early involvement of a GI specialist may help to facilitate the diagnosis of GI anthrax.
• Colonoscopy with biopsy may help with diagnosis.

Evidence:

• In 2001, rapid diagnosis helped to decrease the mortality rate to 50% versus 80% to 90% in previous studies (28).
• Delay in diagnosis of cutaneous anthrax in the 2001 anthrax attacks resulted in severe systemic disease, including microangiopathic hemolytic anemia in a 7-month-old infant (27).
• Early treatment of cutaneous anthrax has a <1% mortality rate, whereas untreated disease has a mortality rate of 20% (48).
• Gram stain, culture, or biopsy with special stains improves diagnostic yield for cutaneous anthrax (45).
• In the Sverdlovsk outbreak of inhalational anthrax, 39 of 42 patients had evidence of GI disease (33).
• Colonoscopy with biopsy may help with diagnosis of GI anthrax (32).
• The mortality of GI anthrax is high given the difficulty in early diagnosis (24).
• Clinicians and public health agencies are important partners in the diagnosis of anthrax (49).

Comments:

• None.