Diagnosis

Seek specialist advice.

Specimens required to confirm the diagnosis:

• swab of exudate -
• for gram staining and culture
• standard universal precautions (gloves, gowns, masks and hand washing) should be adopted to take the samples
• note that lesions become sterile within 24-48 hours of starting effective antibiotic treatment
• skin biopsy - two samples - one for histology, immunocytochemistry and polymerase chain reaction; one for gram staining and culture
• blood - serology, PCR, culture
• respiratory samples including lung aspirates, pleural fluids, or sputum samples (2)

In addition for inhalation anthrax

• chest X-ray: Mediastinal Widening, Pleural Effusion, Pulmonary Infiltrate
• CT Chest if high suspicion and normal Chest X-ray (3)

Reference:

• (1) Dermatology in Practice 2004; 12(3): 10-11.
• (2) Health Protection Agency (HPA) 2010. Anthrax: Guidelines for action in the event of a deliberate release
• (3) Health Protection Agency (HPA).Clinical evaluation and management of persons with possible inhalation anthrax