Details:

Alternative Title:
Clin Infect Dis
Personal Author:
Katharios-Lanwermeyer, Stefan ; Holty, Jon-Erik ; Person, Marissa ; Sejvar, James ; Haberling, Dana ; ... More +
Katharios-Lanwermeyer, Stefan ; Holty, Jon-Erik ; Person, Marissa ; Sejvar, James ; Haberling, Dana ; Tubbs, Heather ; Meaney-Delman, Dana ; Pillai, Satish K. ; Hupert, Nathaniel ; Bower, William A. ; Hendricks, Katherine Less -
Description:
BACKGROUND

Bacillus anthracis, the causative agent of anthrax, is a potential bioterrorism agent. Anthrax meningitis may be a manifestation of B. anthracis infection, has high mortality, and requires more aggressive treatment than anthrax without meningitis. Rapid identification and treatment of anthrax meningitis are essential for successful management of an anthrax mass casualty incident.

METHODS

Three hundred six published reports from 1880 through 2013 met pre-defined inclusion criteria. We calculated descriptive statistics for abstracted cases and conducted multivariable regression on separate derivation and validation cohorts to identify clinical diagnostic and prognostic factors for anthrax meningitis.

RESULTS

One hundred thirty-two of 363 (36%) cases with systemic anthrax met anthrax meningitis criteria. Severe headache, altered mental status, meningeal signs, and other neurological signs at presentation independently predicted meningitis in the derivation cohort and are proposed as a four-item screening tool for use during mass casualty incidents. Presence of any one factor on admission had a sensitivity for finding anthrax meningitis of 89% (83%) in the adult (pediatric) validation cohorts. Anthrax meningitis was unlikely in the absence of any of these signs or symptoms ([LR−]=0.12 [0.19] for adult [pediatric] cohorts), while presence of two or more factors made meningitis very likely ([LR+]=26.5 [29.2]). Survival of anthrax meningitis was predicted by treatment with a bactericidal agent (P=0.005) and use of multiple antimicrobials (P=0.012).

CONCLUSIONS

We developed an evidence-based triage tool for screening patients for meningitis during an anthrax mass casualty incident; its use could improve both patient outcomes and resource allocation in such an event.


Subject:
[+]
Anthrax
Article
Bacillus Anthracis
Mass Casualty Incident
Meningitis
Resource Allocation

Source:
Clin Infect Dis. 62(12):1537-1545.
Pubmed ID:
27025833
Pubmed Central ID:
PMC5034857
Document Type:
Journal Article
Funding:
CC999999/Intramural CDC HHS/United States
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:0446de88c82fd198ec94d4366c014ee58dedd3005a8718618f848a3a8559656d
File Type:

Supporting Files

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