Anthrax is caused by Bacillus anthracis, a Gram positive rod with poly-D glutamate capsule, (vs regular polysaccharide capsule to others) that antiphagocytic property

It is spread by infected carcasses.

Pulmonary anthrax is also known as Woolsorters' disease. Bacillus anthracis produces a tripartite protein toxin

• protective antigen
• oedema factor: a bacterial adenylate cyclase which increases cAMP
• lethal factor: toxic to macrophages

Features

• causes painless black eschar (cutaneous 'malignant pustule', but no pus) = cutaneous anthrax
• typically painless and non-tender
• may cause marked oedema
• anthrax can cause gastrointestinal bleeding

Dx

Pulmonary anthrax --> hemorrhagic mediastinitis can be seen as mediastinal widening on CXR

On microscopy, it forms long chains that are described as being "serpentine" or "medusa head" on appearance.

Management

• the current Health Protection Agency advice for the initial management of cutaneous anthrax is ciprofloxacin
• further treatment is based on microbiological investigations and expert advice