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Fatal Inhalational Anthrax With Unknown Source of Exposure in a 61-Year-Old Woman in New York City
Bushra Mina, MD;
J. P. Dym, MD;
Frank Kuepper;
Raymond Tso, MD;
Carmina Arrastia, MD;
Irina Kaplounova, MD;
Hasan Faraj, MD;
Agnieszka Kwapniewski, MD;
Christopher M. Krol, MD;
Mayer Grosser, MD;
Jeffrey Glick, MD;
Steven Fochios, MD;
Athena Remolina, MD;
Ljiljana Vasovic, MD;
Jeffrey Moses, MD;
Thomas Robin, M(ASCP);
Maria DeVita, MD;
Michael L. Tapper, MD
JAMA. 2002;287:858-862.
A 61-year-old woman who was a New York City hospital employee developed fatal inhalational anthrax, but with an unknown source of anthrax exposure. The patient presented with shortness of breath, malaise, and cough that had developed 3 days prior to admission. Within hours of presentation, she developed respiratory failure and septic shock and required mechanical ventilation and vasopressor therapy. Spiral contrast–enhanced computed tomography of the chest demonstrated large bilateral pleural effusions and hemorrhagic mediastinitis. Blood cultures, as well as DNA amplification by polymerase chain reaction of the blood, bronchial washings, and pleural fluid specimens, were positive for Bacillus anthracis. The clinical course was complicated by liver failure, renal failure, severe metabolic acidosis, disseminated intravascular coagulopathy, and cardiac tamponade, and the patient died on the fourth hospital day. The cause of death was inhalational anthrax. Despite epidemiologic investigation, including environmental samples from the patient's residence and workplace, no mechanism for anthrax exposure has been identified.
Author Affiliations: Section of Critical Care Medicine (Dr Mina), Department of Medicine (Drs Dym, Tso, Arrastia, Kaplounova, Faraj, Kwapniewski, Glick, and Fochios), Department of Radiology (Dr Krol), Section of Emergency Medicine (Dr Grosser), Section of Cardiology (Dr Remolina), Department of Pathology (Dr Vasovic), Section of Interventional Cardiology (Dr Moses), Microbiology Laboratory (Mr Robin), Section of Nephrology (Dr DeVita), and Section of Infectious Disease (Dr Tapper), Lenox Hill Hospital, New York, NY; and Charité of the Humboldt-University of Berlin, Germany (Mr Kuepper).
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