DIAGNOSIS FOR ANTHRAX

Clinical diagnosis of anthrax requires a high index of suspicion. During the recent postal-related outbreak of anthrax in the United States, the CDC used surveillance case definitions, which established a confirmed case of anthrax as a patient with a compatible clinical illness combined with either isolation of B. anthracis from a culture or laboratory evidence of infection based on at least two supportive tests (polymerase chain reaction [PCR], immunohistochemistry, or serology). A suspected case was defined as a patient with a compatible clinical illness combined with either a single non-culture laboratory test or epidemiologic linkage to a source.
Gram stain and culture of B. anthracis can be obtained from blood, cerebrospinal fluid, vesicular fluid, and biopsy material from a cutaneous specimen. Growth of the bacillus is usually noted within 6 to 24 hours, and it is non-motile and non-hemolytic and demonstrates spores in nutritionally deficient media. Serologic testing requires the acquisition of acute and convalescent specimens and is not commercially available. Confirmation of identification can also occur with PCR, direct fluorescent antibody analysis, or immunohistochemical testing, which are generally available only through public health laboratories. Nasal swabs have been used in epidemiologic outbreak investigations but have no clinical utility in making treatment decisions. Although community laboratories can provide presumptive identification, confirmatory testing is available only through state health department laboratories.
*208/348/5*

DIAGNOSIS FOR ANTHRAXClinical diagnosis of anthrax requires a high index of suspicion. During the recent postal-related outbreak of anthrax in the United States, the CDC used surveillance case definitions, which established a confirmed case of anthrax as a patient with a compatible clinical illness combined with either isolation of B. anthracis from a culture or laboratory evidence of infection based on at least two supportive tests (polymerase chain reaction [PCR], immunohistochemistry, or serology). A suspected case was defined as a patient with a compatible clinical illness combined with either a single non-culture laboratory test or epidemiologic linkage to a source.Gram stain and culture of B. anthracis can be obtained from blood, cerebrospinal fluid, vesicular fluid, and biopsy material from a cutaneous specimen. Growth of the bacillus is usually noted within 6 to 24 hours, and it is non-motile and non-hemolytic and demonstrates spores in nutritionally deficient media. Serologic testing requires the acquisition of acute and convalescent specimens and is not commercially available. Confirmation of identification can also occur with PCR, direct fluorescent antibody analysis, or immunohistochemical testing, which are generally available only through public health laboratories. Nasal swabs have been used in epidemiologic outbreak investigations but have no clinical utility in making treatment decisions. Although community laboratories can provide presumptive identification, confirmatory testing is available only through state health department laboratories.*208/348/5*

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