title: Fatal inhalational anthrax with unknown source of exposure in a 61-year-old woman in New York City.
abstract: A 61-year-old woman who was a New York City hospital employee developed fatal inhalational anthrax, but with an unknown source of anthrax exposure. The patient presented with shortness of breath, malaise, and cough that had developed 3 days prior to admission. Within hours of presentation, she developed respiratory failure and septic shock and required mechanical ventilation and vasopressor therapy. Spiral contrast-enhanced computed tomography of the chest demonstrated large bilateral pleural effusions and hemorrhagic mediastinitis. Blood cultures, as well as DNA amplification by polymerase chain reaction of the blood, bronchial washings, and pleural fluid specimens, were positive for Bacillus anthracis. The clinical course was complicated by liver failure, renal failure, severe metabolic acidosis, disseminated intravascular coagulopathy, and cardiac tamponade, and the patient died on the fourth hospital day. The cause of death was inhalational anthrax. Despite epidemiologic investigation, including environmental samples from the patient's residence and workplace, no mechanism for anthrax exposure has been identified.
authors.affiliation: Section of Critical Care Medicine, Department of Medicine, Lenox Hill Hospital, 100 E 77th St, New York, NY 10021, USA. bmina@lenoxhill.net
authors.forename: Bushra
authors.initials: B
authors.lastname: Mina
authors.forename: J P
authors.initials: JP
authors.lastname: Dym
authors.forename: Frank
authors.initials: F
authors.lastname: Kuepper
authors.forename: Raymond
authors.initials: R
authors.lastname: Tso
authors.forename: Carmina
authors.initials: C
authors.lastname: Arrastia
authors.forename: Irina
authors.initials: I
authors.lastname: Kaplounova
authors.forename: Hasan
authors.initials: H
authors.lastname: Faraj
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Kwapniewski
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Krol
authors.forename: Mayer
authors.initials: M
authors.lastname: Grosser
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Glick
authors.forename: Steven
authors.initials: S
authors.lastname: Fochios
authors.forename: Athena
authors.initials: A
authors.lastname: Remolina
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Vasovic
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Moses
authors.forename: Thomas
authors.initials: T
authors.lastname: Robin
authors.forename: Maria
authors.initials: M
authors.lastname: DeVita
authors.forename: Michael L
authors.initials: ML
authors.lastname: Tapper
mesh_terms: D000784:Aortic Dissection / Q000175:diagnosis / Q000209:etiology; D000881:Anthrax / Q000175:diagnosis*; D001014:Aortic Aneurysm / Q000175:diagnosis; D001408:Bacillus anthracis / Q000235:genetics / Q000302:isolation & purification*; D023482:Bioterrorism; D004269:DNA, Bacterial / Q000032:analysis; D003937:Diagnosis, Differential; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D004781:Environmental Exposure; D017809:Fatal Outcome; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis; D006333:Heart Failure / Q000175:diagnosis; D006491:Hemothorax / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008480:Mediastinitis / Q000000981:diagnostic imaging / Q000209:etiology*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D009519:New York City; D010490:Pericardial Effusion / Q000175:diagnosis / Q000209:etiology*; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology*; D011014:Pneumonia / Q000175:diagnosis; D011859:Radiography; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012141:Respiratory Tract Infections / Q000175:diagnosis*; D013171:Spores, Bacterial
chemical_list: D004269:DNA, Bacterial