Death due to bioterrorism-related inhalational anthrax - Report of 2 patients

On October 9, 2001, a letter containing anthrax spores was mailed from New Jersey to Washington, DC. The letter was processed at a major postal facili ty in Washington, DC, and opened in the Senate's Hart Office Building on Oc tober 15. Between October 19 and October 26, there were 5 cases of inhalati onal anthrax among postal workers who were employed at that major facility or who handled bulk mail originating from that facility. The cases of 2 pos tal workers who died of inhalational anthrax are reported here. Both patien ts had nonspecific prodromal illnesses. One patient developed predominantly gastrointestinal symptoms, including nausea, vomiting, and abdominal pain. The other patient had a "flulike" illness associated with myalgias and mal aise. Both patients ultimately developed dyspnea, retrosternal chest pressu re, and respiratory failure requiring mechanical ventilation. Leukocytosis and hemoconcentration were noted in both cases prior to death. Both patient s had evidence of mediastinitis and extensive pulmonary infiltrates late in their course of illness. The durations of illness were 7 days and 5 days f rom onset of symptoms to death; both patients died within 24 hours of hospi talization. Without a clinician's high index of suspicion, the diagnosis of inhalational anthrax is difficult during nonspecific prodromal illness. Cl inicians have an urgent need for prompt communication of vital epidemiologi c information that could focus their diagnostic evaluation. Rapid diagnosti c assays to distinguish more common infectious processes from agents of bio terrorism also could improve management strategies.