Clinical presentation of inhalational anthrax following bioterrorism exposure - Report of 2 surviving patients

The use of anthrax as a weapon of biological terrorism has moved from theor y to reality in recent weeks. Following processing of a letter containing a nthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal faci lity in Washington, DC. This report details the clinical presentation, diag nostic workup, and initial therapy of 2 of these patients. The clinical cou rse is in some ways different from what has been described as the classic p attern for inhalational anthrax. One patient developed low-grade fever, chi lls, cough, and malaise 3 days prior to admission, and then progressive dys pnea and cough productive of blood-tinged sputum on the day of admission. T he other patient developed progressively worsening headache of 3 days' dura tion, along with nausea, chills, and night sweats, but no respiratory sympt oms, 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 anth rax in both cases. The diagnoses were confirmed by blood cultures and polym erase chain reaction testing. Treatment with antibiotics, including intrave nous ciprofloxacin, rifampin, and clindamycin, and supportive therapy appea rs to have slowed the progression of inhalational anthrax and has resulted to date in survival.