11/76. Update: Investigation of bioterrorism-related anthrax and interim guidelines for clinical evaluation of persons with possible anthrax.Since October 3, 2001, CDC and state and local public health authorities have been investigating cases of bioterrorism-related anthrax. This report updates findings as of October 31, and includes interim guidelines for the clinical evaluation of persons with possible anthrax. A total of 21 cases (16 confirmed and five suspected) of bioterrorism-related anthrax have been reported among persons who worked in the district of columbia, florida, new jersey, and new york city (Figure 1). Until the source of these intentional exposures is eliminated, clinicians and laboratorians should be alert for clinical evidence of bacillus anthracis infection. Epidemiologic investigation of these cases and surveillance to detect new cases of bioterrorism-associated anthrax continues.- - - - - - - - - - ranking = 1keywords = b (Clic here for more details about this article) |
12/76. Clinical presentation of inhalational anthrax following bioterrorism exposure: report of 2 surviving patients.The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in washington, DC. This report details the clinical presentation, diagnostic workup, and initial therapy of 2 of these patients. The clinical course is in some ways different from what has been described as the classic pattern for inhalational anthrax. One patient developed low-grade fever, chills, cough, and malaise 3 days prior to admission, and then progressive dyspnea and cough productive of blood-tinged sputum on the day of admission. The other patient developed progressively worsening headache of 3 days' duration, along with nausea, chills, and night sweats, but no respiratory symptoms, on the day of admission. Both patients had abnormal findings on chest radiographs. Non-contrast-enhanced computed tomography of the chest showing mediastinal adenopathy led to a presumptive diagnosis of inhalational anthrax in both cases. The diagnoses were confirmed by blood cultures and polymerase chain reaction testing. Treatment with antibiotics, including intravenous ciprofloxacin, rifampin, and clindamycin, and supportive therapy appears to have slowed the progression of inhalational anthrax and has resulted to date in survival.- - - - - - - - - - ranking = 0.75keywords = b (Clic here for more details about this article) |
13/76. death due to bioterrorism-related inhalational anthrax: report of 2 patients.On October 9, 2001, a letter containing anthrax spores was mailed from new jersey to washington, DC. The letter was processed at a major postal facility in washington, DC, and opened in the Senate's Hart Office Building on October 15. Between October 19 and October 26, there were 5 cases of inhalational anthrax among postal workers who were employed at that major facility or who handled bulk mail originating from that facility. The cases of 2 postal workers who died of inhalational anthrax are reported here. Both patients had nonspecific prodromal illnesses. One patient developed predominantly gastrointestinal symptoms, including nausea, vomiting, and abdominal pain. The other patient had a "flulike" illness associated with myalgias and malaise. Both patients ultimately developed dyspnea, retrosternal chest pressure, and respiratory failure requiring mechanical ventilation. leukocytosis and hemoconcentration were noted in both cases prior to death. Both patients had evidence of mediastinitis and extensive pulmonary infiltrates late in their course of illness. The durations of illness were 7 days and 5 days from onset of symptoms to death; both patients died within 24 hours of hospitalization. Without a clinician's high index of suspicion, the diagnosis of inhalational anthrax is difficult during nonspecific prodromal illness. Clinicians have an urgent need for prompt communication of vital epidemiologic information that could focus their diagnostic evaluation. Rapid diagnostic assays to distinguish more common infectious processes from agents of bioterrorism also could improve management strategies.- - - - - - - - - - ranking = 0.65keywords = b (Clic here for more details about this article) |
14/76. 'We're all working together.' New York-area hospitals redouble efforts in face of anthrax death.The death of a New York hospital worker from inhalation anthrax last week put new strains on an overburdened public health system. The fact that no source of the bacteria could be found only added to the difficulties. hospitals along the East Coast battled clinical, logistical and financial problems from the outbreak.- - - - - - - - - - ranking = 0.55keywords = b (Clic here for more details about this article) |
15/76. bioterrorism-related inhalational anthrax: the first 10 cases reported in the united states.From October 4 to November 2, 2001, the first 10 confirmed cases of inhalational anthrax caused by intentional release of bacillus anthracis were identified in the united states. Epidemiologic investigation indicated that the outbreak, in the district of columbia, florida, new jersey, and New York, resulted from intentional delivery of B. anthracis spores through mailed letters or packages. We describe the clinical presentation and course of these cases of bioterrorism-related inhalational anthrax. The median age of patients was 56 years (range 43 to 73 years), 70% were male, and except for one, all were known or believed to have processed, handled, or received letters containing B. anthracis spores. The median incubation period from the time of exposure to onset of symptoms, when known (n=6), was 4 days (range 4 to 6 days). Symptoms at initial presentation included fever or chills (n=10), sweats (n=7), fatigue or malaise (n=10), minimal or nonproductive cough (n=9), dyspnea (n=8), and nausea or vomiting (n=9). The median white blood cell count was 9.8 X 10(3)/mm(3) (range 7.5 to 13.3), often with increased neutrophils and band forms. Nine patients had elevated serum transaminase levels, and six were hypoxic. All 10 patients had abnormal chest x-rays; abnormalities included infiltrates (n=7), pleural effusion (n=8), and mediastinal widening (seven patients). Computed tomography of the chest was performed on eight patients, and mediastinal lymphadenopathy was present in seven. With multidrug antibiotic regimens and supportive care, survival of patients (60%) was markedly higher (<15%) than previously reported.- - - - - - - - - - ranking = 0.7keywords = b (Clic here for more details about this article) |
16/76. Update: Investigation of bioterrorism-related anthrax--connecticut, 2001.CDC and state and local health departments continue investigating cases of bioterrorism-related anthrax. This report revises the number of suspected cases and updates the investigation of a 94-year-old connecticut (CT) resident who died from inhalational anthrax.- - - - - - - - - - ranking = 0.3keywords = b (Clic here for more details about this article) |
17/76. Human anthrax associated with an epizootic among livestock--north dakota, 2000.On August 28, 2000, the north dakota Department of Health was notified by a local clinician of a patient with a cutaneous lesion suggestive of anthrax following exposure to an infected animal carcass. This report summarizes the investigation of this case, which was associated with an anthrax epizootic among livestock in north dakota, and emphasizes the importance of increased vigilance for human cases of anthrax during and following outbreaks of anthrax among livestock.- - - - - - - - - - ranking = 0.1keywords = b (Clic here for more details about this article) |
18/76. Update: investigation of bioterrorism-related inhalational anthrax--connecticut, 2001.Since October 3, 2001, CDC and state and local public health authorities have been investigating cases of bioterrorism-related anthrax. As of November 28, a total of 23 cases have been identified; 11 were confirmed as inhalational anthrax, and 12 (seven confirmed and five suspected) were cutaneous. Epidemiologic investigations to identify the source of exposure to bacillus anthracis continue for a case of inhalational anthrax in a hospital stockroom worker in new york city (NYC) and, most recently, a case of inhalational anthrax in an elderly woman in connecticut (CT). Antimicrobial prophylaxis is continuing in persons exposed to B. anthracis, and surveillance to detect new cases of bioterrorism-related anthrax is ongoing. This report summarizes the findings of the case investigation in CT.- - - - - - - - - - ranking = 0.6keywords = b (Clic here for more details about this article) |
19/76. Inhalational anthrax after bioterrorism exposure: spectrum of imaging findings in two surviving patients.The radiographic and computed tomographic (CT) findings in two patients with documented inhalational anthrax resulting from bioterrorism exposure are presented. Chest radiographs demonstrated mediastinal widening, adenopathy, pleural effusions, and air-space disease. Chest CT images revealed enlarged hyperattenuating mediastinal and hilar lymph nodes and edema of mediastinal fat. Chest CT findings are helpful for making the initial diagnosis. To the authors' knowledge, the spectrum and follow-up of CT findings have not been previously described.- - - - - - - - - - ranking = 1.5114958831439keywords = disease, b (Clic here for more details about this article) |
20/76. Symptoms associated with anthrax exposure: suspected "aborted" anthrax.anthrax is a naturally occurring organism with a low incidence of infection. There are no known cases of human-to-human transmission. bioterrorism-related anthrax in the united states has been seen in three high-risk groups: (1) postal workers, (2) politicians and their staffs, and (3) the press. It appears as though the bioterrorism-related anthrax cases of fall 2001 have been transmitted through the US postal service. The authors present a case in which a person at high risk for anthrax exposure was inadequately treated and had symptoms that do not fall into any specific category of disease. It emphasizes the need for someone who has been started on prophylaxis for anthrax to complete a full 60-day course of treatment. It also shows the effectiveness of antibiotic therapy, even in those with high exposure to weaponized anthrax. Further, we would like to suggest that there may exist a new clinical entity of "aborted anthrax infection."- - - - - - - - - - ranking = 1.6614958831439keywords = disease, b (Clic here for more details about this article) |
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