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Anthrax (Bacillus anthracis)
2010 Case Definition
CSTE Position Statement Number: 09-ID-10
Clinical description
Cutaneous Anthrax: An acute illness, or post-mortem examination revealing a painless skin lesion developing over 2 to 6 days from a papular through a vesicular stage into a depressed black eschar with surrounding edema. Fever, malaise and lymphadenopathy may accompany the lesion.
Inhalation Anthrax: An acute illness, or post-mortem examination revealing a prodrome resembling a viral respiratory illness, followed by hypoxia, dyspnea or acute respiratory distress with resulting cyanosis and shock. Radiological evidence of mediastinal widening or pleural effusion is common.
Gastrointestinal Anthrax: An acute illness, or post-mortem examination revealing severe abdominal pain and tenderness, nausea, vomiting, hematemesis, bloody diarrhea, anorexia, fever, abdominal swelling and septicemia.
Oropharyngeal Anthrax: An acute illness, or post-mortem examination revealing a painless mucosal lesion in the oral cavity or oropharynx, with cervical adenopathy, edema, pharyngitis, fever, and possibly septicemia.
Meningeal Anthrax: An acute illness, or post-mortem examination revealing fever, convulsions, coma, or meningeal signs. Signs of another form will likely be evident as this syndrome is usually secondary to the above syndromes.
Case classification
Suspected: An illness suggestive of one of the known anthrax clinical forms. No definitive, presumptive, or suggestive laboratory evidence of B. anthracis, or epidemiologic evidence relating it to anthrax.
Probable:
A clinically compatible illness that does not meet the confirmed case definition, but with one of the following:
- Epidemiological link to a documented anthrax environmental exposure;
- Evidence of B. anthracis DNA (for example, by LRN-validated polymerase chain reaction) in clinical specimens collected from a normally sterile site (such as blood or CSF) or lesion of other affected tissue (skin, pulmonary, reticuloendothelial, or gastrointestinal);
- Positive result on testing of clinical serum specimens using the Quick ELISA Anthrax-PA kit;
- Detection of Lethal Factor (LF) in clinical serum specimens by LF mass spectrometry
- Positive result on testing of culture from clinical specimens with the RedLine Alert test.
Confirmed:
A clinically compatible illness with one of the following:
- Culture and identification of B. anthracis from clinical specimens by the Laboratory Response Network (LRN);
- Demonstration of B. anthracis antigens in tissues by immunohistochemical staining using both B. anthracis cell wall and capsule monoclonal antibodies;
- Evidence of a four-fold rise in antibodies to protective antigen between acute and convalescent sera or a fourfold change in antibodies to protective antigen in paired convalescent sera using Centers for Disease Control and Prevention (CDC) quantitative anti-PA IgG ELISA testing;
- Documented anthrax environmental exposure AND evidence of B. anthracis DNA (for example, by LRN-validated polymerase chain reaction) in clinical specimens collected from a normally sterile site (such as blood or CSF) or lesion of other affected tissue (skin, pulmonary, reticuloendothelial, or gastrointestinal).
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