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JAMA-EXPRESS
Clinical Presentation of Inhalational Anthrax Following Bioterrorism Exposure
Report of 2 Surviving Patients
Thom A. Mayer, MD;
Susan Bersoff-Matcha, MD;
Cecele Murphy, MD;
James Earls, MD;
Scott Harper, MD;
Denis Pauze, MD;
Michael Nguyen, MD;
Jonathan Rosenthal, MD;
Donald Cerva, Jr, MD;
Glenn Druckenbrod, MD;
Dan Hanfling, MD;
Naaz Fatteh, MD;
Ashna Nayyar, MS,PA-C;
Elise L. Berman, MD
JAMA. 2001;286:2549-2553.
The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in Washington, DC. This report details the clinical presentation, diagnostic workup, and initial therapy of 2 of these patients. The clinical course is in some ways different from what has been described as the classic pattern for inhalational anthrax. One patient developed low-grade fever, chills, cough, and malaise 3 days prior to admission, and then progressive dyspnea and cough productive of blood-tinged sputum on the day of admission. The other patient developed progressively worsening headache of 3 days' duration, along with nausea, chills, and night sweats, but no respiratory symptoms, on the day of admission. Both patients had abnormal findings on chest radiographs. Non–contrast-enhanced computed tomography of the chest showing mediastinal adenopathy led to a presumptive diagnosis of inhalational anthrax in both cases. The diagnoses were confirmed by blood cultures and polymerase chain reaction testing. Treatment with antibiotics, including intravenous ciprofloxacin, rifampin, and clindamycin, and supportive therapy appears to have slowed the progression of inhalational anthrax and has resulted to date in survival.
Author Affiliations: Departments of Emergency Medicine (Drs Mayer, Murphy, Pauze, Druckenbrod, and Hanfling, Mr Napoli, and Ms Nayyar) and Radiology (Drs Earls, Cerva, and Berman), Inova Fairfax Hospital, Falls Church, Va; Departments of Infectious Disease (Drs Bersoff-Matcha, Rosenthal, and Fatteh) and Internal Medicine (Dr Nguyen), Mid-Atlantic Permanente Medical Group, Kaiser Permanente, Rockville, Md; and the Centers for Disease Control and Prevention, Atlanta, Ga (Dr Harper).
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