Fatal inhalational anthrax in a 94-year-old Connecticut woman.
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.
Barakat
Lydia A
LA
Department of Infectious Diseases, Griffin Hospital, 130 Division St, Derby, CT 06418, USA.
Quentzel
Howard L
HL
Jernigan
John A
JA
Kirschke
David L
DL
Griffith
Kevin
K
Spear
Stephen M
SM
Kelley
Katherine
K
Barden
Diane
D
Mayo
Donald
D
Stephens
David S
DS
Popovic
Tanja
T
Marston
Chung
C
Zaki
Sherif R
SR
Guarner
Jeanette
J
Shieh
Wun-Ju
WJ
Carver
H Wayne
HW
Meyer
Richard F
RF
Swerdlow
David L
DL
Mast
Eric E
EE
Hadler
James L
JL
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
D004269:DNA, Bacterial