title: Inhalational, gastrointestinal, and cutaneous anthrax in children: a systematic review of cases: 1900 to 2005.
abstract: OBJECTIVE
  To systematically review all published case reports of children with anthrax to evaluate the predictors of disease progression and mortality.
  
  
  METHODS
  Fourteen selected journal indexes (1900-1966), MEDLINE (1966-2005), and the bibliographies of all retrieved articles.
  
  
  METHODS
  Case reports (any language) of anthrax in persons younger than 18 years published between January 1, 1900, and December 31, 2005. Main Exposures Cases with symptoms and culture or Gram stain or autopsy evidence of anthrax infection.
  
  
  METHODS
  Disease progression, treatment responses, and mortality.
  
  
  RESULTS
  Of 2499 potentially relevant articles, 73 case reports of pediatric anthrax (5 inhalational cases, 22 gastrointestinal cases, 37 cutaneous cases, 6 cases of primary meningoencephalitis, and 3 atypical cases) met the inclusion criteria. Only 10% of the patients were younger than 2 years, and 24% were girls. Of the few children with inhalational anthrax, none had nonheadache neurologic symptoms, a key finding that distinguishes adult inhalational anthrax from more common illnesses, such as influenza. Overall, observed mortality was 60% (3 of 5) for inhalational anthrax, 65% (13 of 20) for gastrointestinal anthrax, 14% (5 of 37) for cutaneous anthrax, and 100% (6 of 6) for primary meningoencephalitis. Nineteen of the 30 children (63%) who received penicillin-based antibiotics survived, and 9 of the 11 children (82%) who received anthrax antiserum survived.
  
  
  CONCLUSIONS
  The clinical presentation of children with anthrax is varied. The mortality rate is high in children with inhalational anthrax, gastrointestinal anthrax, and anthrax meningoencephalitis. Rapid diagnosis and effective treatment of anthrax in children requires recognition of the broad spectrum of clinical presentations of pediatric anthrax.
authors.affiliation: Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA 94305-6019, USA. dbravata@stanford.edu
authors.forename: Dena M
authors.initials: DM
authors.lastname: Bravata
authors.forename: Jon-Erik C
authors.initials: JE
authors.lastname: Holty
authors.forename: Ewen
authors.initials: E
authors.lastname: Wang
authors.forename: Robyn
authors.initials: R
authors.lastname: Lewis
authors.forename: Paul H
authors.initials: PH
authors.lastname: Wise
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: McDonald
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Owens
mesh_terms: D000293:Adolescent; D000881:Anthrax / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D014943:Global Health; D006801:Humans; D007223:Infant; D008171:Lung Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D008297:Male; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D016019:Survival Analysis