Inhalational Anthrax
Incubation Period	Usually less than 1 week; may be prolonged for weeks (up to 2 months)

Typical Signs/Symptoms (often biphasic, but symptoms may progress rapidly)	Initial phase Non-specific symptoms such as low-grade fever, nonproductive cough, malaise, fatigue, myalgias, profound sweats, chest discomfort (upper respiratory tract symptoms are rare) Maybe rhonchi on exam, otherwise normal Chest X-ray: mediastinal widening pleural effusion (often) infiltrates (rare)	Subsequent phase 1-5 days after onset of initial symptoms May be preceded by 1-3 days of improvement Abrupt onset of high fever and severe respiratory distress (dyspnea, stridor, cyanosis) Shock, death within 24-36 hours
Laboratory	Coordinate all aspects of testing, packaging, and transporting with public health laboratory/Laboratory Response Network (LRN). Obtain specimens appropriate to system affected: blood (essential) pleural fluid cerebral spinal fluid (CSF) skin lesion	Clues to diagnosis Gram-positive bacilli on unspun peripheral blood smear or CSF 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. Initiate antimicrobial therapy immediately upon suspicion. Do NOT use extended-spectrum cephalosporins or trimethoprim/sulfamethoxazole because anthrax may be resistant to these drugs. Supportive care including controlling pleural effusions
Precautions	Standard contact precautions