title: Confirmed Bacillus anthracis infection among persons who inject drugs, Scotland, 2009-2010.
abstract: In Scotland, the 2009 outbreak of Bacillus anthracis infection among persons who inject drugs resulted in a 28% death rate. To compare nonsurvivors and survivors, we obtained data on 11 nonsurvivors and 16 survivors. Time from B. anthracis exposure to symptoms or hospitalization and skin and limb findings at presentation did not differ between nonsurvivors and survivors. Proportionately more nonsurvivors had histories of excessive alcohol use (p = 0.05) and required vasopressors and/or mechanical ventilation (p≤0.01 for each individually). Nonsurvivors also had higher sequential organ failure assessment scores (mean ± SEM) (7.3 ± 0.9 vs. 1.2 ± 0.4, p<0.0001). Antibacterial drug administration, surgery, and anthrax polyclonal immune globulin treatments did not differ between nonsurvivors and survivors. Of the 14 patients who required vasopressors during hospitalization, 11 died. Sequential organ failure assessment score or vasopressor requirement during hospitalization might identify patients with injectional anthrax for whom limited adjunctive therapies might be beneficial.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Booth
authors.forename: Lindsay
authors.initials: L
authors.lastname: Donaldson
authors.forename: Xizhong
authors.initials: X
authors.lastname: Cui
authors.forename: Junfeng
authors.initials: J
authors.lastname: Sun
authors.forename: Stephen
authors.initials: S
authors.lastname: Cole
authors.forename: Susan
authors.initials: S
authors.lastname: Dailsey
authors.forename: Andrew
authors.initials: A
authors.lastname: Hart
authors.forename: Neil
authors.initials: N
authors.lastname: Johns
authors.forename: Paul
authors.initials: P
authors.lastname: McConnell
authors.forename: Tina
authors.initials: T
authors.lastname: McLennan
authors.forename: Benjamin
authors.initials: B
authors.lastname: Parcell
authors.forename: Henry
authors.initials: H
authors.lastname: Robb
authors.forename: Benjamin
authors.initials: B
authors.lastname: Shippey
authors.forename: Malcolm
authors.initials: M
authors.lastname: Sim
authors.forename: Charles
authors.initials: C
authors.lastname: Wallis
authors.forename: Peter Q
authors.initials: PQ
authors.lastname: Eichacker
mesh_terms: D000328:Adult; D000881:Anthrax / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000266:history / Q000635:transmission*; D001408:Bacillus anthracis; D004196:Disease Outbreaks; D055030:Drug Users; D049674:History, 21st Century; D006801:Humans; D007106:Immune Sera / Q000008:administration & dosage; D062486:Public Health Surveillance; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D007106:Immune Sera; D014662:Vasoconstrictor Agents