Gastrointestinal Anthrax
Incubation Period	Usually 1-7 days

Typical Signs/Symptoms	Initial phase Nausea, anorexia, vomiting, and fever progressing to severe abdominal pain, hematemesis, and diarrhea that is almost always bloody Acute abdomen picture with rebound tenderness may develop. Mesenteric adenopathy on computed tomography (CT) scan likely. Mediastinal widening on chest X-ray has been reported.	Subsequent phase 2-4 days after onset of symptoms, ascites develops as abdominal pain decreases. Shock, death within 2-5 days of onset
Laboratory	Coordinate all aspects of testing, packaging, and transporting with public health laboratory/LRN. Obtain specimens appropriate to system affected: blood (essential) ascitic fluid	Clues to diagnosis Gram-positive bacilli on unspun peripheral blood smear or ascitic fluid Pharyngeal swab for pharyngeal form Aerobic blood culture growth of large, gram-positive bacilli provides preliminary identification of Bacillus species.

Treatment (See Inhalational Anthrax Treatment Protocol for specific therapy)	Obtain specimens for culture BEFORE initiating antimicrobial therapy. Early (during initial phase) antimicrobial therapy is critical. Do NOT use extended-spectrum cephalosporins or trimethoprim/sulfamethoxazole because anthrax may be resistant to these drugs.
Precautions	Standard precautions