Anthraxs

Surgical treatment is unnecessary until after the patient has been adequately treated with antibiotics because of the risk of systemic dissemination of the bacillus. (2) Vesicular fluid becomes sterile 5 to 24 hours after treatment with antibiotics. (2) After adequate medical treatment, excision of the .
             eschar with skin grafting may be carried out, although smaller lesions typically heal without scarring. (2) Because of the massive tissue edema associated with anthrax, large and circumferential lesions on the extremities could lead to compartment syndrome and vascular compromise. (2) Any invasive measurement of compartment pressures or fasciotomy, if indicated, should avoid the primary lesion until adequate antibiotic treatment has been administered. .
             Gastrointestinal Anthrax.
             Gastrointestinal anthrax accounts for approximately 2.5% to 5% of naturally occurring cases worldwide and is associated with a death rate ranging from 25% to 60%.(2) The gastrointestinal tract can be affected directly by the consumption of food contaminated with anthrax bacilli or by hematogenous spread from systemic disease, usually originating in the respiratory tract, as confirmed by autopsies performed on patients after accidental exposure at Sverdlovsk in 1979. In this series, 39 of the 42 patients had multiple submucosal hemorrhagic lesions in the gastrointestinal tract, particularly the small bowel, stomach, and colon. Mesenteric lymphadenitis was found in 9 of the 42. (1) It is unknown how many other patients not included in the series had either primary or secondary gastrointestinal involvement, how many underwent surgery on the affected gastrointestinal tract, and what the overall death rate associated with gastrointestinal anthrax was in the Sverdlovsk incident. .
             In cases of direct exposure, spores can germinate in the oropharynx or the lower tract, with clinical manifestations occurring 2 to 5 days after ingestion.