Clinical predictors of bioterrorism-related inhalational anthrax.
Limitation of a bioterrorist anthrax attack will require rapid and accurate recognition of the earliest victims. To identify clinical characteristics of inhalational anthrax, we compared 47 historical cases (including 11 cases of bioterrorism-related anthrax) with 376 controls with community-acquired pneumonia or influenza-like illness. Nausea, vomiting, pallor or cyanosis, diaphoresis, altered mental status, and raised haematocrit were more frequently recorded in the inhalational anthrax cases than in either the community-acquired pneumonia or influenza-like illness controls. The most accurate predictor of anthrax was mediastinal widening or pleural effusion on a chest radiograph. This finding was 100% sensitive (95% CI 84.6-100.0) for inhalational anthrax, 71.8% specific (64.8-78.1) compared with community-acquired pneumonia, and 95.6% specific (90.0-98.5) compared with influenza-like illness. Our findings represent preliminary efforts toward identifying clinical predictors of inhalational anthrax.
Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. dkyriacou@aol.com
Demetrios N
DN
Kyriacou
Adam C
AC
Stein
Paul R
PR
Yarnold
D Mark
DM
Courtney
Regina R
RR
Nelson
Gary A
GA
Noskin
Jonathan A
JA
Handler
Ralph R
RR
Frerichs
D000336:Aerosols; D000881:Anthrax / Q000175:diagnosis* / Q000635:transmission; D001408:Bacillus anthracis / Q000502:physiology; D023482:Bioterrorism; D003937:Diagnosis, Differential; D006801:Humans; D007251:Influenza, Human / Q000175:diagnosis; D011014:Pneumonia / Q000175:diagnosis; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000635:transmission; D013171:Spores, Bacterial
D000336:Aerosols