ANTHRAX Anthrax can occur in 4 forms, depending on the route of infection: cutaneous, inhalational, gastrointestinal, and injection. Cutaneous anthrax begins as a pruritic papule or vesicle and progresses over 2 to 6 days to an ulcerated lesion with subsequent formation of a central black eschar. The lesion itself is characteristically painless, with surrounding oedema, hyperaemia, and painful regional lymphadenopathy. Patients may have associated fever, lymphangitis, and extensive oedema. Inhalational anthrax is a frequently lethal form of the disease and constitutes a medical emergency. The initial presentation is nonspecific with fever, sweats, non-productive cough, chest pain, headache, myalgia, malaise, nausea, and vomiting, but progresses to the fulminant phase 2 to 5 days later. In some cases, the illness is biphasic with a period of improvement between prodromal symptoms and overwhelming illness. Fulminant manifestations include hypotension, dyspnoea, hypoxia, cyanosis, and shock occurring as a result of haemorrhagic mediastinal lymphadenitis, haemorrhagic pneumonia, haemorrhagic pleural effusions, and toxaemia. A widened mediastinum is the classic finding on imaging of the chest. Chest radiography may also show pleural effusions or infiltrates, both of which may be haemorrhagic in nature. Gastrointestinal tract disease can present as one of 2 distinct clinical syndromes — intestinal or oropharyngeal. Patients with the intestinal form have nausea, anorexia, vomiting, and fever progressing to severe abdominal pain, massive ascites, hematemesis, and bloody diarrhea, related to development of oedema and ulceration of the bowel, primarily the ileum and cecum. Patients with oropharyngeal anthrax may also have dysphagia with posterior oropharyngeal necrotic ulcers, which can be associated with marked, often unilateral neck swelling, regional adenopathy, fever, and sepsis. Injection anthrax has not been reported to date in children. Its primary occurrence has been reported among injecting heroin users; however, smoking and snorting of heroin also have been identified as exposure routes. Systemic illness can result from hematogenous and lymphatic dissemination and can occur with any form of anthrax. Most patients with inhalational, gastrointestinal, and injection anthrax have systemic illness. Anthrax meningitis can occur in any patient with systemic illness regardless of origin; it can also occur in patients lacking any other apparent clinical presentation. The case-fatality rate for patients with appropriately treated cutaneous anthrax is usually less than 1%. Even with antimicrobial treatment and supportive care, the mortality rate for inhalational or gastrointestinal tract disease is between 40% and 45% and approaches 100% for meningitis. Choose the correct statement.

Питання КРОК 1 (медицина) · тест з варіантами та поясненням · Medus

EN: Choose the correct statement.

Варіанти відповідей

1. Patients with the cutaneous form of anthrax always have associated fever
2. Cutaneous form presents only with the formation of papule or vesicle
3. lymphangitis
4. Cutaneous form presents with the formation of black eschar
5. and extensive oedema.
6. Cutaneous form is painless

Answer options (EN)

1. Patients with the cutaneous form of anthrax always have associated fever
2. Cutaneous form presents only with the formation of papule or vesicle
3. Lymphangitis is the primary clinical finding in cutaneous anthrax
4. Cutaneous form presents with the formation of black eschar
5. Extensive oedema without eschar is the characteristic finding
6. Cutaneous form is painless

Правильна відповідь

Cutaneous form presents with the formation of black eschar

Пояснення

Шкірна форма сибірки (вугля) характеризується утворенням карбункула з чорним струпом (есхаром) та навколишнім набряком; ділянка часто безболісна через нейротоксин. Ліхоманка може бути, але не завжди; лімфангіт не є обов’язковим. Правильне твердження - саме про чорний струп.

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