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Recognition and Treatment of Anthrax
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To the Editor: The Consensus Statement on anthrax as a biological weapon by Dr Inglesby and colleagues1 included much useful information, but the treatment section mentioned only antibiotics. In contrast, a clinical report2 of 1 of the few patients to survive intestinal anthrax contains important information about other aspects of effective management. This patient, who had purulent ascitic fluid, appeared to present with an acute abdomen, and had unnecessary surgery as a result. A gram-positive rod in the blood cultures was initially called a contaminant by the laboratory. The patient's course was complicated by pneumonitis, gastrointestinal hemorrhage with melena (probably from the site of primary intestinal infection), and focal cerebritis or meningitis. Prolonged antibiotic therapy was necessary to treat his disseminated infection, but he probably would not have survived without meticulous attention to water and electrolyte balance, prompt replacement of blood losses, and achievement of hemostasis.
David R. Nalin, MD
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RELATED ARTICLE
Anthrax as a Biological Weapon: Medical and Public Health Management
Thomas V. Inglesby, Donald A. Henderson, John G. Bartlett, Michael S. Ascher, Edward Eitzen, Arthur M. Friedlander, Jerome Hauer, Joseph McDade, Michael T. Osterholm, Tara O'Toole, Gerald Parker, Trish M. Perl, Philip K. Russell, Kevin Tonat, and for the Working Group on Civilian Biodefense
JAMA. 1999;281(18):1735-1745.
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