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To the Editor: Dr Borio and colleagues¹ described 2 patients who died of inhalation anthrax. Some factors in the first patient's case, however, raise concern that there was an initial gastrointestinal anthrax infection in addition to the inhalational illness, which became apparent later. The patient's prodrome consisted of nausea, vomiting, and abdominal pain, diagnosed by the patient himself as food poisoning. He did not complain of chest or respiratory symptoms on his first visit, and the symptom constellation prompted the initial treating physician to diagnose gastroenteritis. The postmortem examination confirmed a focal infection of the ileum, although mesenteric nodes were apparently unaffected.

Given the sequence of the patient's symptoms, it seems reasonable to suspect that this gastrointestinal infection developed with the inhalational illness and was not a subsequent metastatic event. If gastrointestinal anthrax as well as inhalational anthrax can be acquired through exposure to contaminated materials and work areas, it . . . [Full Text of this Article]

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Death Due to Bioterrorism-Related Inhalational Anthrax: Report of 2 Patients
Luciana Borio, Dennis Frank, Venkat Mani, Carlos Chiriboga, Michael Pollanen, Mary Ripple, Syed Ali, Constance DiAngelo, Jacqueline Lee, Jonathan Arden, Jack Titus, David Fowler, Tara O'Toole, Henry Masur, John Bartlett, and Thomas Inglesby
JAMA. 2001;286(20):2554-2559.
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