Professional Documents
Culture Documents
Anthrax
(ICD 10 Code: A22)
Name of DRU:
Type: RHU
Address:
Govt Laboratory
I. PATIENT
INFORMATION:
Patient Number:
Complete Address:
Sex:
Occupation:
Private Hospital
Private Laboratory
Middle Name
Male
Female
Last Name
MM
Date of
Birth:
Clinic
Airport/Seaport
DD
YY
Age:
Days
Months
Years
Name Workplace:
Address of Workplace:
II. CLINICAL
INFORMATION:
Signs and
Symptoms:
Admitted?
Yes No Unknown
Fever
Upset stomach (nausea)
Headache
Dry cough
Sore throat
Trouble swallowing
Trouble breathing
Date Admitted/
Seen/Consult
MM
DD
Stomach pain
Vomiting blood
Bloody diarrhea
Sweating excessively
Extreme tiredness
Pain or tightness in the chest
Sore muscles
YY
Date Onset of
Illness
MM
DD
YY
Neck pain
Itchy skin
Black scab on skin
Skin lesions
Describe lesion: ____________
_________________________
III. POTENTIAL RISK FACTORS IN THE 15-60 DAYS PRIOR TO ONSET OF SIGNS/SYMPTOMS
Y N U
Y N U
Y N U
Does the patient have occupational or other exposure to hides, wool, furs, bone meal or other animal products?
Y N U
Contact with live or dead animals? (cattle, sheep, goats, horses, pigs and other herbivores both livestock and wildlife)
Y N U
Does the patient have a history of travel beyond his/her usual place of residence/surroundings?
Y N U
Y N U
Y N U
Has the patient eaten undercooked meat? (cattle, sheep, goats, horses, pigs and other herbivores both livestock and wildlife)
Y N U
Did the patient receive unusual letters or packages? (e.g. containing threats or unusual messages)
Y N U
Y N U
Was the patient present or nearby when an envelope that contained any form of powder was opened?
CASE CLASSIFICATION
OUTCOME
Cutaneous
Gastrointestinal
Suspected Case
Alive
Pulmonary
Probable Case
Died,
Confirmed Case
Unknown
Meningeal
Unknown
V. LABORATORY TESTS:
Specify
Specimen
If YES, date
taken
MM
MM
DD
DD
Type of laboratory
test done
Results
N=Negative; I=Indeterminate; U-Unknown
YY
Positive for:
N I U
Positive for:
N I U
YY
Date result
MM
DD
YY
MM
DD
YY
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Anthrax
CASE DEFINITION/CLASSIFICATION:
Suspected case: A person with acute onset of illness characterized by several clinical forms as follows:
a. localized form:
1. cutaneous: skin lesion evolving over 1 to 6 days from a papular through a vesicular stage, to a depressed
black eschar invariably accompanied by edema that may be mild to extensive;
b. systemic forms:
1. gastro-intestinal: abdominal distress characterized by nausea, vomiting, anorexia and followed by fever;
2. pulmonary (inhalation): brief prodrome resembling acute viral respiratory illness, followed by rapid onset of
hypoxia, dyspnea and high temperature, with X-ray evidence of mediastinal widening;
3. meningeal: acute onset of high fever possibly with convulsions, loss of consciousness, meningeal signs and
symptoms; commonly noted in all systemic infections;
AND has an epidemiological link to a suspected or confirmed animal cases or contaminated animal products;
Probable case: A suspected case that has a positive reaction to allergic skin test (in non-vaccinated individuals);
LABORATORY CONFIRMATION:
Isolation of Bacillus anthracis from a clinical specimen (e.g., blood, lesions, discharges)
Demonstration of B. anthracis in a clinical specimen by microscopic examination of stained smears (vesicular fluid,
blood, cerebrospinal fluid, pleural fluid, stools)
Positive serology (ELISA, Western blot, toxin detection, chromatographic assay, fluorescent antibody test (FAT))