Death Due to Bioterrorism-Related Inhalational Anthrax: Report of 2 Patients

• NCJ Number: 191692
• Journal: Journal of American Medical Association Volume: 286 Issue: 20 Dated: November 28, 2001 Pages: 2554-2559
• Author(s): Luciana Borio M.D.; Dennis Frank M.D.; Venkat Mani M.D.; Carlos Chiriboga M.D.; Michael Pollanen M.D.; Mary Ripple M.D.; Syed Ali M.D.; Constance DiAngelo M.D.; Jacqueline Lee M.D.; Jonathan Arden M.D.; Jack Titus M.D.; David Fowler M.D.; Tara O'Toole M.D.; Henry Masur M.D.; John Bartlett M.D.; Thomas Inglesby M.D.
• Date Published: 2001
• Length: 6 pages
• Publication Format: Article
• Publication Type: Issue Overview
• Language: English
• Country: United States of America

Annotation

This paper follows two cases of inhalational anthrax.

Abstract

On October 9, 2001, a letter containing anthrax was mailed to a Senate office. Five postal workers, who were employed at the facility that processed that letter, had been hospitalized with inhalational anthrax as of October 30. Two of those patients died. The first patient, a 47-year-old male, first complained of abdominal pain and flulike symptoms. A working diagnosis on inhalational anthrax was made, based on news accounts of two postal workers had been hospitalized in the Washington, DC, area. Figure 1 shows chest X-rays of patient 1. Laboratory findings are listed in the table. Despite prompt therapy with a host of antibiotics, the patient later died on day seven. The death was certified as homicide. Patient 2 was a 55-year-old male postal worker who worked in the same office. His symptoms started as weakness and fever. He was diagnosed as having a viral syndrome and sent home. Five days into the illness, he went to the emergency room complaining of severe dsypnea, chest pressure, high fever, chills, a fever of 38.9°C, and other maladies. Because health care workers were aware of other anthrax cases, the patient was admitted with a diagnosis of suspected inhalational anthrax. Despite treatment with antibiotics, intubation, and cardiac resuscitation, the patient died. The death was certified as homicide. Inhalational anthrax causes nonspecific symptoms, making it difficult for physicians to diagnose. Media reports of anthrax prompted the true diagnosis, but only after several days of the onset of the disease. The two cases show that in the event of a serious outbreak, rapid communications are needed so that doctors can administer appropriate treatment. Most microbiological laboratories can make a diagnosis of anthrax readily. Rapid diagnostic tests to distinguish anthrax quickly should be made a priority on a national level to respond to the threat of bioterrorism. References