Clinical presentation of inhalational anthrax following bioterrorism exposure - Report of 2 surviving patients
Clinical presentation of inhalational anthrax following bioterrorism exposure - Report of 2 surviving patients
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DOI：
10.1001/jama.286.20.2549
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发表时间：
2001-11-28
影响因子：
120.7
通讯作者：
Berman, EL
中科院分区：
文献类型：
--
作者：
Mayer, TA;Bersoff-Matcha, S;Berman, EL
最近几周，利用炭疽热作为生物恐怖主义武器的说法已经从理论变成了现实。在处理寄给美国参议员的一封含有炭疽孢子的信件后，华盛顿特区一家主要邮政机构的邮政工作人员中发生了5例吸入性炭疽病例。本报告详细介绍了其中2例患者的临床表现、诊断检查和初始治疗。临床过程在某些方面不同于被描述为吸入性炭疽的经典模式。1例患者在入院前3天出现低烧、寒战、咳嗽和不适，入院当天出现进行性呼吸困难和咳嗽并伴有带血痰。另一位患者在入院当天出现持续3天的逐渐加重的头痛，并伴有恶心、寒战和盗汗，但无呼吸道症状。两例患者胸片均有异常表现。胸部非增强计算机断层扫描显示纵隔腺病导致两例吸入性炭疽的推定诊断。经血培养和聚合酶链反应试验确诊。抗生素治疗，包括静脉注射环丙沙星、利福平和克林霉素，以及支持治疗似乎减缓了吸入性炭疽的进展，并导致了迄今为止的生存。
The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in Washington, DC. This report details the clinical presentation, diagnostic workup, and initial therapy of 2 of these patients. The clinical course is in some ways different from what has been described as the classic pattern for inhalational anthrax. One patient developed low-grade fever, chills, cough, and malaise 3 days prior to admission, and then progressive dyspnea and cough productive of blood-tinged sputum on the day of admission. The other patient developed progressively worsening headache of 3 days' duration, along with nausea, chills, and night sweats, but no respiratory symptoms, 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 anthrax in both cases. The diagnoses were confirmed by blood cultures and polymerase chain reaction testing. Treatment with antibiotics, including intravenous ciprofloxacin, rifampin, and clindamycin, and supportive therapy appears to have slowed the progression of inhalational anthrax and has resulted to date in survival.