Culture key to diagnosing cutaneous anthrax: may appear hours after exposure. (News).

Mailroom workers in high-profile office buildings now fit the occupational profile for people at risk for contracting cutaneous anthrax.

An estimated 95% of anthrax cases appear as cutaneous disease, limited until recently to cattlemen, butchers, and others who come in contact with infected animals or their hides. If a patient's occupational history and a history of the evolving skin rash make you suspect cutaneous anthrax, do a routine Gram's stain and culture or take a biopsy and culture to make the diagnosis, experts said in an interview.

Typically the disease starts out as a single erythematous papule or wheal that begins within hours or as long as 10-12 days after exposure to anthrax spores. The lesion may be asymptomatic or pruritic, appearing most often around the head and neck or on the arms in an area with a scratching abrasion or skin trauma, said Dr. Marc E. Grossman, who diagnosed a recent case in New York. Dr. Grossman is director of the dermatology consultation service at Columbia Presbyterian Medical Center in New York.

Once the inflammation starts, it develops rapidly over the next 24-36 hours. The papule becomes a bulla, frequently surrounded by intense edema and much infiltration so that it feels pretty thick. The bulla ruptures and may exude a ...