Systematic Review of Systemic Anthrax Since 1880

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  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
• 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.
  
  
• Subjects:
  Adolescent Adult Anthrax Bacillus Anthracis Bioterrorism Child Child, Preschool Cognitive Dysfunction Female Headache Humans Male Mass Casualty Incidents Meningitis, Bacterial Middle Aged

  More +
• 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
• Volume:
  62
• Issue:
  12
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:0446de88c82fd198ec94d4366c014ee58dedd3005a8718618f848a3a8559656d
• Download URL:
  https://stacks.cdc.gov/view/cdc/41441/cdc_41441_DS1.pdf
• File Type:
  [PDF - 529.38 KB ]