Pediatric emergency medicine trisk 4547 4547
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finally to a depressed, black eschar. The surrounding tissue becomes markedly
edematous, but not particularly tender, distinguishing this infection from typical
cellulitis. This form of anthrax is quite amenable to therapy with a variety of
antibiotics and, with timely institution of treatment, is rarely fatal. In the 2001
outbreak, all 11 patients with cutaneous anthrax survived. The one pediatric
victim of the 2001 attack was a 7-month-old boy with cutaneous anthrax on his
arm, presumably contracted after a brief visit to a New York City television news
studio that had received contaminated mail (a similar lesion is pictured on the
face of a child in Fig. 132.2 ). Of note, he also developed hemolysis,
thrombocytopenia, and renal insufficiency, features not usually observed in
otherwise uncomplicated cases of cutaneous disease, thus raising the possibility
of a particular vulnerability in infancy.
FIGURE 132.2 Cutaneous anthrax on the eyelids of a young child. (Courtesy of Dr. Larry
Schwab. Reprinted from Ostler HB, Maibach HI, Hoke AW, et al., eds. Diseases of the Eye and
Skin: A Color Atlas . Philadelphia, PA: Lippincott Williams Wilkins, 2004. With permission.)
The finding of gram-positive rods in skin biopsy material (in the case of
cutaneous disease) or in blood smears, pleural fluid, or spinal fluid should suggest
anthrax. Chest radiographs demonstrating a widened mediastinum in the context
of fever and constitutional signs should also lead one to consider the diagnosis.
