title: Clinical presentation of inhalational anthrax following bioterrorism exposure: report of 2 surviving patients.
abstract: The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in Washington, DC. This report details the clinical presentation, diagnostic workup, and initial therapy of 2 of these patients. The clinical course is in some ways different from what has been described as the classic pattern for inhalational anthrax. One patient developed low-grade fever, chills, cough, and malaise 3 days prior to admission, and then progressive dyspnea and cough productive of blood-tinged sputum on the day of admission. The other patient developed progressively worsening headache of 3 days' duration, along with nausea, chills, and night sweats, but no respiratory symptoms, on the day of admission. Both patients had abnormal findings on chest radiographs. Non-contrast-enhanced computed tomography of the chest showing mediastinal adenopathy led to a presumptive diagnosis of inhalational anthrax in both cases. The diagnoses were confirmed by blood cultures and polymerase chain reaction testing. Treatment with antibiotics, including intravenous ciprofloxacin, rifampin, and clindamycin, and supportive therapy appears to have slowed the progression of inhalational anthrax and has resulted to date in survival.
authors.affiliation: Department of Emergency Medicine, Inova Fairfax Hospital, 3300 Gallows Rd, Falls Church, VA 22042-3300, USA. thom.mayer@inova.com
authors.forename: T A
authors.initials: TA
authors.lastname: Mayer
authors.forename: S
authors.initials: S
authors.lastname: Bersoff-Matcha
authors.forename: C
authors.initials: C
authors.lastname: Murphy
authors.forename: J
authors.initials: J
authors.lastname: Earls
authors.forename: S
authors.initials: S
authors.lastname: Harper
authors.forename: D
authors.initials: D
authors.lastname: Pauze
authors.forename: M
authors.initials: M
authors.lastname: Nguyen
authors.forename: J
authors.initials: J
authors.lastname: Rosenthal
authors.forename: D
authors.initials: D
authors.lastname: Cerva
authors.forename: G
authors.initials: G
authors.lastname: Druckenbrod
authors.forename: D
authors.initials: D
authors.lastname: Hanfling
authors.forename: N
authors.initials: N
authors.lastname: Fatteh
authors.forename: A
authors.initials: A
authors.lastname: Napoli
authors.forename: A
authors.initials: A
authors.lastname: Nayyar
authors.forename: E L
authors.initials: EL
authors.lastname: Berman
mesh_terms: D000881:Anthrax / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001408:Bacillus anthracis / Q000302:isolation & purification*; D023482:Bioterrorism; D001769:Blood / Q000382:microbiology; D002939:Ciprofloxacin / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D004219:District of Columbia; D004417:Dyspnea / Q000150:complications; D005334:Fever / Q000150:complications; D006801:Humans; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging; D008297:Male; D008477:Mediastinal Diseases / Q000000981:diagnostic imaging*; D008875:Middle Aged; D016273:Occupational Exposure; D010996:Pleural Effusion / Q000000981:diagnostic imaging; D016133:Polymerase Chain Reaction; D011177:Postal Service; D013902:Radiography, Thoracic; D012141:Respiratory Tract Infections / Q000097:blood / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D012293:Rifampin / Q000627:therapeutic use; D013171:Spores, Bacterial / Q000302:isolation & purification*; D017741:Survivors; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D002939:Ciprofloxacin; D012293:Rifampin