Clinical predictors of bioterrorism-related inhalational anthrax

Demetrios N. Kyriacou; Adam C. Stein; Paul R. Yarnold; D. Mark Courtney; Regina R. Nelson; Gary A. Noskin; Jonathan A. Handler; Ralph R. Frerichs

doi:10.1016/S0140-6736(04)16769-X

Clinical predictors of bioterrorism-related inhalational anthrax

Demetrios N. Kyriacou^*, Adam C. Stein, Paul R. Yarnold, D. Mark Courtney, Regina R. Nelson, Gary A. Noskin, Jonathan A. Handler, Ralph R. Frerichs

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

38 Scopus citations

Abstract

Limitation of a bioterrorist anthrax attack will require rapid and accurate recognition of the earliest victims. To identify clinical characteristics of inhalational anthrax, we compared 47 historical cases (including 11 cases of bioterrorism-related anthrax) with 376 controls with community-acquired pneumonia or influenza-like illness. Nausea, vomiting, pallor or cyanosis, diaphoresis, altered mental status, and raised haematocrit were more frequently recorded in the inhalational anthrax cases than in either the community-acquired pneumonia or influenza-like illness controls. The most accurate predictor of anthrax was mediastinal widening or pleural effusion on a chest radiograph. This finding was 100% sensitive (95% CI 84·6-100·0) for inhalational anthrax, 71·8% specific (64·8-78·1) compared with community-acquired pneumonia, and 95·6% specific (90·0- 98·5) compared with influenza-like illness. Our findings represent preliminary efforts toward identifying clinical predictors of inhalational anthrax.

Original language	English (US)
Pages (from-to)	449-452
Number of pages	4
Journal	Lancet
Volume	364
Issue number	9432
DOIs	https://doi.org/10.1016/S0140-6736(04)16769-X
State	Published - Jul 31 2004

Funding

This study was funded by an Excellence in Academic Medicine grant from the State of Illinois Department of Public Aid and Northwestern Memorial Hospital. All authors had access to the data and independence for interpretation of the findings.

ASJC Scopus subject areas

General Medicine

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10.1016/S0140-6736(04)16769-X

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title = "Clinical predictors of bioterrorism-related inhalational anthrax",

abstract = "Limitation of a bioterrorist anthrax attack will require rapid and accurate recognition of the earliest victims. To identify clinical characteristics of inhalational anthrax, we compared 47 historical cases (including 11 cases of bioterrorism-related anthrax) with 376 controls with community-acquired pneumonia or influenza-like illness. Nausea, vomiting, pallor or cyanosis, diaphoresis, altered mental status, and raised haematocrit were more frequently recorded in the inhalational anthrax cases than in either the community-acquired pneumonia or influenza-like illness controls. The most accurate predictor of anthrax was mediastinal widening or pleural effusion on a chest radiograph. This finding was 100% sensitive (95% CI 84·6-100·0) for inhalational anthrax, 71·8% specific (64·8-78·1) compared with community-acquired pneumonia, and 95·6% specific (90·0- 98·5) compared with influenza-like illness. Our findings represent preliminary efforts toward identifying clinical predictors of inhalational anthrax.",

author = "Kyriacou, {Demetrios N.} and Stein, {Adam C.} and Yarnold, {Paul R.} and {Mark Courtney}, D. and Nelson, {Regina R.} and Noskin, {Gary A.} and Handler, {Jonathan A.} and Frerichs, {Ralph R.}",

note = "Funding Information: This study was funded by an Excellence in Academic Medicine grant from the State of Illinois Department of Public Aid and Northwestern Memorial Hospital. All authors had access to the data and independence for interpretation of the findings.",

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AU - Kyriacou, Demetrios N.

AU - Stein, Adam C.

AU - Yarnold, Paul R.

AU - Mark Courtney, D.

AU - Nelson, Regina R.

AU - Noskin, Gary A.

AU - Handler, Jonathan A.

AU - Frerichs, Ralph R.

N1 - Funding Information: This study was funded by an Excellence in Academic Medicine grant from the State of Illinois Department of Public Aid and Northwestern Memorial Hospital. All authors had access to the data and independence for interpretation of the findings.

PY - 2004/7/31

Y1 - 2004/7/31

N2 - Limitation of a bioterrorist anthrax attack will require rapid and accurate recognition of the earliest victims. To identify clinical characteristics of inhalational anthrax, we compared 47 historical cases (including 11 cases of bioterrorism-related anthrax) with 376 controls with community-acquired pneumonia or influenza-like illness. Nausea, vomiting, pallor or cyanosis, diaphoresis, altered mental status, and raised haematocrit were more frequently recorded in the inhalational anthrax cases than in either the community-acquired pneumonia or influenza-like illness controls. The most accurate predictor of anthrax was mediastinal widening or pleural effusion on a chest radiograph. This finding was 100% sensitive (95% CI 84·6-100·0) for inhalational anthrax, 71·8% specific (64·8-78·1) compared with community-acquired pneumonia, and 95·6% specific (90·0- 98·5) compared with influenza-like illness. Our findings represent preliminary efforts toward identifying clinical predictors of inhalational anthrax.

AB - Limitation of a bioterrorist anthrax attack will require rapid and accurate recognition of the earliest victims. To identify clinical characteristics of inhalational anthrax, we compared 47 historical cases (including 11 cases of bioterrorism-related anthrax) with 376 controls with community-acquired pneumonia or influenza-like illness. Nausea, vomiting, pallor or cyanosis, diaphoresis, altered mental status, and raised haematocrit were more frequently recorded in the inhalational anthrax cases than in either the community-acquired pneumonia or influenza-like illness controls. The most accurate predictor of anthrax was mediastinal widening or pleural effusion on a chest radiograph. This finding was 100% sensitive (95% CI 84·6-100·0) for inhalational anthrax, 71·8% specific (64·8-78·1) compared with community-acquired pneumonia, and 95·6% specific (90·0- 98·5) compared with influenza-like illness. Our findings represent preliminary efforts toward identifying clinical predictors of inhalational anthrax.

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Clinical predictors of bioterrorism-related inhalational anthrax

Abstract

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