Clinical Presentation of Inhalational Anthrax Following Bioterrorism Exposure: Report of 2 Surviving Patients

• NCJ Number: 191693
• Journal: Journal of the American Medical Association Volume: 286 Issue: 20 Dated: November 28, 2001 Pages: 2549-2553
• Author(s): Thom A. Mayer M.D.; Susan Bersoff-Matcha M.D.; Cecele Murphy M.D.; James Earls M.D.; Scott Harper M.D.; Denis Pauze M.D.; Michael Nguyen M.D.; Jonathan Rosenthal M.D.; Donald Cerva, Jr. M.D.; Glenn Druckenbrod M.D.; Dan Hanfling M.D.; Naaz Fatteh M.D.; Anthony Napoli; Ashna Nayyar M.S.; Elise L. Berman M.D.
• Date Published: 2001
• Length: 5 pages
• Publication Format: Article
• Publication Type: Issue Overview
• Language: English
• Country: United States of America

Annotation

This paper describes the clinical presentation, the diagnosis and initial therapy of two patients with inhalational anthrax.

Abstract

The use of anthrax as a biological weapon has moved recently from a theory to reality. Clinical suspicion with abnormal findings on chest radiographs lead to presumptive diagnosis of inhalational anthrax in two recent anthrax cases. The last case of inhalational anthrax in the United States was in 1978. Current understanding of the disease is based on three sources: the unintentional anthrax exposure in Sverdlovsk in the former Soviet Union; scattered outbreaks among wool sorters or laboratory workers; and experimental animal models. Current literature on inhalational anthrax emphasized three features: syndromic surveillance could be an important component in raising clinical suspicion of the disease; the illness has a two-stage clinical course, with early nonspecific respiratory symptoms followed by the abrupt onset of fever, dyspnea, and respiratory distress; and radiographic findings of abnormal mediastinum have been considered pathognomonic of the disease. These cases suggest that early diagnosis and treatment may improve the prognosis of inhalational anthrax. Aggressive therapy produced positive results. Early diagnosis and intervention may have played a role in interrupting the two-stage cycle of the disease, in which mediastinal necrosis and hemorrhage progress to widespread toxin release and death. The authors found chest computed tomography (CT) useful. The high degree of clinical suspicion, diagnosis using CT, and an early intervention with antibiotics may reduce the previous mortality rate of 80 percent to 90 percent in inhalational anthrax. References