Inhalational anthrax: Epidemiology, diagnosis, and management

Shirin Shafazand, Ramona Doyle, Stephen Ruoss, Ann Weinacker, Thomas A. Raffin

Research output: Contribution to journalArticle

125 Citations (Scopus)

Abstract

Anthrax, a disease of great historical interest, is once again making headlines as an agent of biological warfare. Bacillus anthracis, a rod- shaped, spore-forming bacterium, primarily infects herbivores. Humans can acquire anthrax by agricultural or industrial exposure to infected animals or animal products. More recently, the potential for intentional release of anthrax spores in the environment has caused much concern. The common clinical manifestations of anthrax are cutaneous disease, pulmonary disease from inhalation of anthrax spores, and GI disease. The course of inhalational anthrax is dramatic, from the insidious onset of nonspecific influenza-like symptoms to severe dyspnea, hypotension, and hemorrhage within days of exposure. A rapid decline, culminating in septic shock, respiratory distress, and death within 24 h is not uncommon. The high mortality seen in inhalational anthrax is in part due to delays in diagnosis. Classic findings on the chest radiograph include widening of the mediastinum as well as pleural effusions. Pneumonia is less common; key pathologic manifestations include severe hemorrhagic mediastinitis, diffuse hemorrhagic lymphadenitis, and edema. Diagnosis requires a high index of suspicion. Treatment involves supportive care in an intensive care facility and high doses of penicillin. Resistance to third-generation cephalosporins has been noted. Vaccines are currently available and have been shown to be effective against aerosolized exposure in animal studies.

Original languageEnglish
Pages (from-to)1369-1376
Number of pages8
JournalChest
Volume116
Issue number5
DOIs
StatePublished - Nov 25 1999
Externally publishedYes

Fingerprint

Anthrax
Epidemiology
Spores
Biological Warfare Agents
Mediastinitis
Bacillus anthracis
Lymphadenitis
Herbivory
Mediastinum
Pleural Effusion
Cephalosporins
Critical Care
Septic Shock
Skin Diseases
Penicillins
Dyspnea
Hypotension
Human Influenza
Lung Diseases
Edema

Keywords

  • Anthrax
  • Bacillus species
  • Inhalational anthrax
  • Mediastinal hemorrhage
  • Mediastinal widening

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Shafazand, S., Doyle, R., Ruoss, S., Weinacker, A., & Raffin, T. A. (1999). Inhalational anthrax: Epidemiology, diagnosis, and management. Chest, 116(5), 1369-1376. https://doi.org/10.1378/chest.116.5.1369

Inhalational anthrax : Epidemiology, diagnosis, and management. / Shafazand, Shirin; Doyle, Ramona; Ruoss, Stephen; Weinacker, Ann; Raffin, Thomas A.

In: Chest, Vol. 116, No. 5, 25.11.1999, p. 1369-1376.

Research output: Contribution to journalArticle

Shafazand, S, Doyle, R, Ruoss, S, Weinacker, A & Raffin, TA 1999, 'Inhalational anthrax: Epidemiology, diagnosis, and management', Chest, vol. 116, no. 5, pp. 1369-1376. https://doi.org/10.1378/chest.116.5.1369
Shafazand S, Doyle R, Ruoss S, Weinacker A, Raffin TA. Inhalational anthrax: Epidemiology, diagnosis, and management. Chest. 1999 Nov 25;116(5):1369-1376. https://doi.org/10.1378/chest.116.5.1369
Shafazand, Shirin ; Doyle, Ramona ; Ruoss, Stephen ; Weinacker, Ann ; Raffin, Thomas A. / Inhalational anthrax : Epidemiology, diagnosis, and management. In: Chest. 1999 ; Vol. 116, No. 5. pp. 1369-1376.
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