Intensive Care Medicine

, Volume 38, Issue 7, pp 1092–1104

An overview of anthrax infection including the recently identified form of disease in injection drug users


  • Caitlin W. Hicks
    • Cleveland Clinic Lerner College of Medicine
    • Howard Hughes Medical Institute, National Institutes of Health Research Scholar, National Institutes of Health
  • Daniel A. Sweeney
    • Medical Intensivist ProgramWashington Hospital
  • Xizhong Cui
    • Critical Care Medicine Department, Clinical CenterNational Institutes of Health
  • Yan Li
    • Critical Care Medicine Department, Clinical CenterNational Institutes of Health
    • Critical Care Medicine Department, Clinical CenterNational Institutes of Health

DOI: 10.1007/s00134-012-2541-0

Cite this article as:
Hicks, C.W., Sweeney, D.A., Cui, X. et al. Intensive Care Med (2012) 38: 1092. doi:10.1007/s00134-012-2541-0



Bacillus anthracis infection (anthrax) can be highly lethal. Two recent outbreaks related to contaminated mail in the USA and heroin in the UK and Europe and its potential as a bioterrorist weapon have greatly increased concerns over anthrax in the developed world.


This review summarizes the microbiology, pathogenesis, diagnosis, and management of anthrax.

Results and conclusions

Anthrax, a gram-positive bacterium, has typically been associated with three forms of infection: cutaneous, gastrointestinal, and inhalational. However, the anthrax outbreak among injection drug users has emphasized the importance of what is now considered a fourth disease form (i.e., injectional anthrax) that is characterized by severe soft tissue infection. While cutaneous anthrax is most common, its early stages are distinct and prompt appropriate treatment commonly produces a good outcome. However, early symptoms with the other three disease forms can be nonspecific and mistaken for less lethal conditions. As a result, patients with gastrointestinal, inhalational, or injectional anthrax may have advanced infection at presentation that can be highly lethal. Once anthrax is suspected, the diagnosis can usually be made with gram stain and culture from blood or tissue followed by confirmatory testing (e.g., PCR). While antibiotics are the mainstay of anthrax treatment, use of adjunctive therapies such as anthrax toxin antagonists are a consideration. Prompt surgical therapy appears to be important for successful management of injectional anthrax.


Bacillus anthracisAnthraxPathogenesisDiagnosisTreatment

Copyright information

© Springer-Verlag (outside the USA) 2012