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What Distinguishes Anthrax from Viral Respiratory Disease?

A proposed screening protocol might help health care professionals cope with suspected bioterrorism.

If a bioterrorist attack with anthrax was suspected, how could practitioners who would be responsible for implementing mass screening distinguish patients with inhalational anthrax from those with vastly more common viral respiratory diseases? Because large prospective studies can't be performed to answer this question, researchers studied detailed reports of 28 anthrax cases in the medical literature and compared their clinical features with those noted in epidemiologic studies of influenza and noninfluenza viral respiratory illnesses and in a study of community-acquired pneumonia among ambulatory adults.

Among the anthrax patients, 96% had fever, chills, or cough on presentation; 81% had abnormalities on lung auscultation; 43% exhibited neurologic symptoms other than headache (confusion, blurry vision, dizziness); 18% had sore throat; and 14% had rhinorrhea. Nonheadache neurologic symptoms, dyspnea, nausea or vomiting, and abnormal auscultatory findings were significantly more common in anthrax patients than in patients with viral respiratory infection; rhinorrhea and sore throat were much less common in anthrax patients. No clinical features reliably distinguished anthrax from community-acquired pneumonia.

Comment: This analysis has 3 major problems. First, case reports do not contain unbiased, systematically collected data. Second, the characteristics of these few cases might differ from those found in an outbreak. And third, the studied comparison group might not be representative of people without anthrax who would present for screening if a publicized attack occurred. Nonetheless, these are the best currently available data and, should the health care system be faced with mass screening for anthrax, a screening protocol based on the identified signs and symptoms would be better than an uninformed approach. The authors propose a screening protocol, which is analyzed by an editorialist.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine September 23, 2003

Citation(s):

Hupert N et al. Accuracy of screening for inhalational anthrax after a bioterrorist attack. Ann Intern Med 2003 Sep 2; 139:337-45.

• Original article (Subscription may be required)
• Medline abstract (Free)

Sox HC. A triage algorithm for inhalational anthrax. Ann Intern Med 2003 Sep 2; 139:379-81.

• Original article (Subscription may be required)
• Medline abstract (Free)