Last Updated

07 Jan 2003

    Source: Jernigan JA et al. Bioterrorism-Related Inhalation Anthrax: The First 10 Cases Reported in the United States, Emerging Infectious Diseases 7(6), Nov.-Dec., 2001.

On October 16, a 56-year-old African-American male US Postal Service worker noted mild headache that was constant and global but not associated with visual changes, stiff neck, or other neurologic symptoms. Over the following 3 days, the headache worsened and was accompanied by lowgrade fever, chills, sore throat, myalgias, nausea, malaise, drenching sweats, intermittent blurred vision, and photophobia. A mild dry cough, dyspnea on exertion, and pleuritic chest pain developed.

b WBC = white blood cells; WNL = within normal limits; ND = not done; NA = not available; SGOT = serum glutamic oxalacetic transaminase; SGPT = serum glutamic pyruvic transaminase; FiO2 = fractional inspired 02; RA = room air; NRBR = nonrebreathing mask; RBC = red blood cells;LDH = lactate dehydrogenase c Pleural fluid studies were not performed at the time of the initial visit to a health-care provider.

 When he arrived at the hospital on October 20, he was afebrile and normotensive, pulse was 127/min, and respiratory rate 20/min. He was in no acute distress, and physical examination was unremarkable, except for decreased breath sounds at both bases. His past medical history was unremarkable, and he did not smoke. Admission laboratory results were normal, except for elevated bilirubin and hepatic enzymes, low albumin, and hypoxia (see Table - labeled Case 4 in article). A noncontrasted head CT was normal, and CSF exhibited 4 WBC/microL (all lymphocytes), 20 RBC/microL, with normal glucose and protein. No organisms were seen on Gram stain of the CSF, and CSF culture did not grow. An anteroposterior chest X-ray showed a widened mediastinum, bilateral hilar masses, right pleural effusion, and bilateral perihilar air space disease. A noncontrasted chest CT scan showed diffuse mediastinal edema; bilateral pleural effusions; bibasilar air space disease; and marked paratracheal, subcarinal, hilar, and azygo-esophageal recess adenopathy. Admission blood cultures grew B. anthracis within 15 hours. Ciprofloxacin, rifampin, and clindamycin were begun.

On October 22, signs of worsening respiratory distress developed, and on October 23, the patient underwent therapeutic thoracentesis, which yielded bloody pleural fluid, after which his condition improved. He also received systemic corticosteroids for bronchospasm.

He required a second thoracentesis and is being discharged from the hospital on November 9, 2001.

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