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NOTE: A surveillance case definition is a set of uniform criteria used to define a disease for public health surveillance. Surveillance case definitions enable public health officials to classify and count cases consistently across reporting jurisdictions. Surveillance case definitions are not intended to be used by healthcare providers for making a clinical diagnosis or determining how to meet an individual patient’s health needs.

Clinical Description

An illness with acute onset characterized by several distinct clinical forms including:

  • Cutaneous: a skin lesion evolving over 2 to 6 days from a papule, through a vesicular stage, to a depressed black eschar
  • Inhalation: a brief prodrome resembling a viral respiratory illness followed by development of hypoxia and dyspnea, with x-ray evidence of mediastinal widening
  • Intestinal: severe abdominal distress followed by fever and signs of septicemia
  • Oropharyngeal: mucosal lesion in the oral cavity or oropharynx, cervical adenopathy and edema, and fever

Laboratory Criteria For Diagnosis

  • Isolation of Bacillus anthracis from a clinical specimen, OR
  • Fourfold or greater rise in either the anthrax enzyme-linked immunosorbent assay (ELISA) or electrophoretic immunotransblot (EITB) titer between acute- and convalescent-phase serum specimens obtained greater than or equal to 2 weeks apart, OR
  • Anthrax ELISA titer greater than or equal to 64 or an EITB reaction to the protective antigen and/or lethal factor bands in one or more serum samples obtained after onset of symptoms, OR
  • Demonstration of B. anthracis in a clinical specimen by immunofluorescence

Case Classification


A clinically compatible illness that is laboratory confirmed

Related Case Definition(s)