title: Fatal inhalational anthrax in a 94-year-old Connecticut woman.
abstract: We describe the 11th case of bioterrorism-related inhalational anthrax reported in the United States. The presenting clinical features of this 94-year-old woman were subtle and nondistinctive. The diagnosis was recognized because blood cultures were obtained prior to administration of antibiotics, emphasizing the importance of this diagnostic test in evaluating ill patients who have been exposed to Bacillus anthracis. The patient's clinical course was characterized by progression of respiratory insufficiency, pleural effusions and pulmonary edema, and, ultimately, death. Although her B anthracis bacteremia was rapidly sterilized after initiation of antibiotic therapy, viable B anthracis was present in postmortem mediastinal lymph node specimens. The source of exposure to B anthracis in this patient is not known. Exposure to mail that was cross-contaminated as it passed through postal facilities contaminated with B anthracis spores is one hypothesis under investigation.
authors.affiliation: Department of Infectious Diseases, Griffin Hospital, 130 Division St, Derby, CT 06418, USA.
authors.forename: Lydia A
authors.initials: LA
authors.lastname: Barakat
authors.forename: Howard L
authors.initials: HL
authors.lastname: Quentzel
authors.forename: John A
authors.initials: JA
authors.lastname: Jernigan
authors.forename: David L
authors.initials: DL
authors.lastname: Kirschke
authors.forename: Kevin
authors.initials: K
authors.lastname: Griffith
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Spear
authors.forename: Katherine
authors.initials: K
authors.lastname: Kelley
authors.forename: Diane
authors.initials: D
authors.lastname: Barden
authors.forename: Donald
authors.initials: D
authors.lastname: Mayo
authors.forename: David S
authors.initials: DS
authors.lastname: Stephens
authors.forename: Tanja
authors.initials: T
authors.lastname: Popovic
authors.forename: Chung
authors.initials: C
authors.lastname: Marston
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
authors.forename: Jeanette
authors.initials: J
authors.lastname: Guarner
authors.forename: Wun-Ju
authors.initials: WJ
authors.lastname: Shieh
authors.forename: H Wayne
authors.initials: HW
authors.lastname: Carver
authors.forename: Richard F
authors.initials: RF
authors.lastname: Meyer
authors.forename: David L
authors.initials: DL
authors.lastname: Swerdlow
authors.forename: Eric E
authors.initials: EE
authors.lastname: Mast
authors.forename: James L
authors.initials: JL
authors.lastname: Hadler
mesh_terms: D000368:Aged; D000881:Anthrax / Q000175:diagnosis*; D001344:Autopsy; D001408:Bacillus anthracis / Q000235:genetics / Q000302:isolation & purification*; D023482:Bioterrorism; D003237:Connecticut; D004269:DNA, Bacterial / Q000032:analysis; D004781:Environmental Exposure; D017809:Fatal Outcome; D005260:Female; D006470:Hemorrhage; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008477:Mediastinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D008482:Mediastinum; D009336:Necrosis; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology*; D011654:Pulmonary Edema / Q000209:etiology; D011859:Radiography; D012131:Respiratory Insufficiency / Q000209:etiology; D012141:Respiratory Tract Infections / Q000175:diagnosis*; D013171:Spores, Bacterial
chemical_list: D004269:DNA, Bacterial