IMMEDIATELY REPORTABLE DISEASE: Any suspected case should be reported immediately by telephone to the Local Health Officer and by the Health Officer to the State Department of Health and Senior Services; include clinical and laboratory information supporting the diagnosis for appropriate investigation and control recommendations.

CLINICAL DESCRIPTION

An illness caused by Bacillus anthracis with acute onset characterized by several distinct clinical forms:

1. Cutaneous: a skin lesion that evolves over 2 to 6 days from a papule to a vesicle, to a depressed black eschar;
   
   
2. Inhalation: a brief prodrome resembling a viral respiratory illness, followed by hypoxia and dyspnea with radiographic evidence of mediastinal widening;
   
   
3. Intestinal: severe abdominal distress followed by fever and signs of septicemia; OR
   
   
4. Oropharyngeal: mucosal lesion in the oral cavity or oropharynx, cervical adenopathy and edema, and fever.

Cutaneous infection is transmitted by contact with tissues of animals dying of the disease, inhalation anthrax is acquired through inhalation of spores, and intestinal and oropharyngeal anthrax is contracted from ingestion of contaminated undercooked meat. Transmission from person to person is very rare. The incubation period is from 1 to 7 days, although an incubation period up to 60 days is possible.

1. CONFIRMED
   Clinical diagnosis (see above) AND one or more of the following:
   
   

   • Isolation of B. anthracis from a clinical specimen, OR

   • Anthrax electrophoretic immunotransblot (EITB) reaction to the protective antigen, OR

   • Lethal factor bands obtained after onset of symptoms, OR

   • Demonstration of B. anthracis in a clinical specimen by immunofluorescence.
     
     
2. PROBABLE
   
   • A clinically compatible case that is epidemiologically linked to a confirmed case as determined by the DHSS.
     
     
3. POSSIBLE
   
   

   • Initially reported case on the basis of clinical diagnosis until confirmation is obtained. All cases require confirmation; no possible case classifications are retained within the database of the DHSS.

What you should know about Anthrax?