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Anthrax is a potentially lethal bacterial infection caused by Bacillus anthracis. It is endemic among animals, and is of great concern as the effect of biological warfare or bioterrorism using Bacillus anthracis as the pathogen. The most common presentation is as a skin disease, but the pneumonic form, a challenging diagnosis, can kill within hours once it is in the fulminant stage.

Its causative organism is listed in the Select Agent Program and is considered a high-risk biological weapon of CDC Bioterrorism Agents-Disease list Category A. While it was never used in combat, it was weaponized, under the code Agent N by the U.S. and U.K., and is the only spore-forming agent that will contaminate ground for significant periods of time. After a British open-air test, an area of Gruinard Island was dangerously contaminated from 1942 until a major decontamination in 1984.


General measures


Immunization is not recommended for the general population, although it is routinely given to military personnel, and to laboratory and clinical workers at high risk. There have been manufacturing and efficacy problems with the vaccine.


While the native agent is penicillin-sensitive, it is assumed that weaponized agents will be resistant. The first-choice prophylactic drug is ciprofloxacin, with doxycycline as a reasonable alternative.

Clinical Presentation

Forms of the disease

  • cutaneous
  • gastrontestinal
  • pneumonic

Differential diagnosis

Physical examination

Laboratory presentation

Treatment and prognosis

Significant outbreaks and cases

  • Sverdlovsk incident
  • African drum-makers