RESUMO
Eleven known cases of bioterrorism-related inhalational anthrax (IA) were treated in the United States during 2001. We retrospectively compared 2 methods that have been proposed to screen for IA. The 2 screening protocols for IA were applied to the emergency department charts of patients who presented with possible signs or symptoms of IA at Inova Fairfax Hospital (Falls Church, Virginia) from 20 October 2001 through 3 November 2001. The Mayer criteria would have screened 4 patients (0.4%; 95% CI, 0.1%-0.9%) and generated charges of 1900 dollars. If 29 patients (2.6%; 95% CI, 1.7%-3.7%) with >or=5 symptoms (but without fever and tachycardia) were screened, charges were 13,325 dollars. The Hupert criteria would have screened 273 patients (24%; 95% CI, 22%-27%) and generated charges of 126,025 dollars. In this outbreak of bioterrorism-related IA, applying the Mayer criteria would have identified both patients with IA and would have generated fewer charges than applying the Hupert criteria.
Assuntos
Antraz/diagnóstico , Bioterrorismo , Surtos de Doenças , Programas de Rastreamento , Adulto , Antraz/diagnóstico por imagem , Antraz/tratamento farmacológico , Antraz/economia , Antraz/epidemiologia , Guerra Biológica , Doxiciclina/uso terapêutico , Diagnóstico Precoce , Humanos , Inalação , Radiografia , Estudos Retrospectivos , VirginiaRESUMO
A panel of 10 physicians used the nominal group technique to assess the ability of the Centers for Disease Control and Prevention (CDC) interim guidelines for clinical evaluation of persons with possible inhalational anthrax (IA) to retrospectively identify the 11 patients with IA seen during the October 2001 bioterrorism outbreak. The guidelines would not have identified 10 of 11 of these patients, primarily because the guidelines were designed to address only those patients with a known history of exposure or clearly identified environmental or occupational risk. The panel suggested revisions to the guidelines, primarily consisting of broadening the criteria for evaluation to include either known exposure or environmental occupational risk, or to include clinical symptoms consistent with IA. These extensions of the guidelines retrospectively identified 8 of 11 of the patients with IA from October 2001.
Assuntos
Antraz/diagnóstico , Bacillus anthracis/isolamento & purificação , Bioterrorismo , Surtos de Doenças , Guias como Assunto , Antraz/epidemiologia , Guerra Biológica , Centers for Disease Control and Prevention, U.S./legislação & jurisprudência , Exposição Ambiental , Humanos , Exposição por Inalação , Prática de Saúde Pública , Infecções Respiratórias , Estudos Retrospectivos , Esporos Bacterianos , Estados Unidos/epidemiologiaRESUMO
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.