RESUMO
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.
Assuntos
Antraz/diagnóstico , Bacillus anthracis/isolamento & purificação , Bioterrorismo , Doenças do Mediastino/diagnóstico por imagem , Infecções Respiratórias/microbiologia , Esporos Bacterianos/isolamento & purificação , Antraz/sangue , Antraz/terapia , Antibacterianos/uso terapêutico , Sangue/microbiologia , Ciprofloxacina/uso terapêutico , Clindamicina/uso terapêutico , District of Columbia , Dispneia/complicações , Febre/complicações , Humanos , Doenças Linfáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Derrame Pleural/diagnóstico por imagem , Reação em Cadeia da Polimerase , Serviços Postais , Radiografia Torácica , Infecções Respiratórias/sangue , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/terapia , Rifampina/uso terapêutico , Sobreviventes , Tomografia Computadorizada por Raios XRESUMO
This article deals with the infectious entities, excluding acquired immunodeficiency syndrome and endocarditis, the physician is likely to encounter in the intravenous drug abuser on presentation to the Emergency Department. Multiple factors may suppress the usual diagnostic indicators. Awareness of the common infectious problems in this population and a high index of suspicion are needed to render quality care in the Emergency Department.