Table 8.
Syndrome (Route) | Typical Time Course | Symptoms | Physical Findings | Laboratory Findingsa | Radiographic Findings |
---|---|---|---|---|---|
Cutaneous (transdermal) | Incubation period range 1–12 d Lesion usually begins 3–5 d after infection Edema rapidly develops over 12–24 h Eschar sloughs within 1–2 wk Resolution may take months without treatment |
Painless lesion, which may be pruritic Dysphagia or dyspnea if face involved and major edema |
Lesion beginning as a pustule, develops significant surrounding edema rapidly, evolves into a necrotic center Respiratory distress (if head/neck involved) Regional lymphadenopathy Septic shock (infrequent) Meningitis (rare) |
Histology: lymphocytic infiltrate with edema and necrosis General laboratory results may show only leukocytosis unless patient progresses to a systemic illness |
CT or MRI shows extensive soft tissue edema in the immediate area of the lesion and may show regional lymphadenopathy |
GI (ingestion) |
Oropharyngeal:
|
Oropharyngeal:
|
Oropharyngeal:
|
|
CT: ascites, thickening of bowel wall, lymphadenopathy |
Thoracic (inhalation) |
|
|
|
Hypocalcemia Hypoglycemia Hyperkalemia Lactic acidosis Elevated hematocrit |
CXR: hilar prominence often greater on the right, pleural effusions and widened mediastinum (common) [note: lung consolidation is not a feature) CT: mediastinal adenopathy with changes suggesting intermodal hemorrhage, peribronchial parenchymal opacification (suggests lymphatic involvement) |