Table 1.

Comparison of cutaneous, gastrointestinal, inhalational and intravenous/injectional anthrax.

	Cutaneous Anthrax	Gastrointestinal Anthrax	Inhalational Anthrax	Intravenous/Injectional Anthrax *
References	[32]	[6,33]	[27,34,35]	[30,36]
Occurrence	Endemic areas and middle-income countries	Consumption of undercooked meat in endemic areas	Bioterrorism, bioweapon, sporadic cases in wool handlers, drummers, drum-makers and persons exposed to infected animals	Drug users, industrial countries
Incubation period	1–17 days	2–5 days	1–6 days; periods up to 43 days have been observed	1–10 days
Lesion site	Exposure site, mostly superficial	Abdominal pain, vomiting (including hematemesis), hematochezia, and occasional watery diarrhea	Hemorrhagic lymphadenitis, widened mediastinum, meningeal edema and hemorrhage, pleural effusions, pulmonary edema, and hemorrhagic meningitis	Injection site, soft tissue infection with necrosis
Severity of infection	Mild to severe, rarely complicated, up to 20% die if not treated	Early diagnosis is difficult, resulting in high mortality	Severe	Severe
Diagnosis	Patient history, patient examination, laboratory results	Patient history, patient examination, laboratory results	Early diagnosis is difficult. Patient history, examination, microhemagglutination test specific for PA, X-ray, microbiology (blood, sputum)	Patient history, patient examination, laboratory results
Treatment	Antibiotics, supportive care in severe cases	Antibiotics, supportive care	Antibiotics and supportive care, immunoglobulins	Supportive care, of antibiotic combination treatment
Duration of antibiotic treatment	3–5 days	3–5 days	≥2–3 weeks, then 60 days from onset of illness	10–14 days, with up to 60 days for intranasal drug users
Surgical intervention	Rarely	Often due to ascites and/or peritonitis	Rarely	Debridement, reconstructive surgery may be required
Mortality	<1%	4–50%	85–90%. With aggressive treatment, mortality can be reduced to 45%	>30%

* Includes IV and injectional drug misuse.