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Address for correspondence: John A. Jernigan, NCID, CDC, Mailstop E68, 1600 Clifton Road, N.E., Atlanta, GA 30333 USA; fax: 404-498-1244; e-mail: jjernigan@cdc.gov.

Members of the team who contributed to the work presented in this manuscript are J. Aguilar, M. Andre, K. Baggett, B. Bell, D. Bell, M. Bowen, G. Carlone, M. Cetron, S. Chamany, B. De, C. Elie, M. Fischer, A. Hoffmaster, K. Glynn, R. Gorwitz, C. Greene, R. Hajjeh, T. Hilger, J. Kelly, R. Khabbaz, A. Khan, P. Kozarsky, M. Kuehnert, J. Lingappa, C. Marston, J. Nicholson, S. Ostroff, T. Parker, L. Petersen, R. Pinner, N. Rosenstein, A. Schuchat, V. Semenova, S. Steiner, F. Tenover, B. Tierney, T. Uyeki, S. Vong, D. Warnock, C. Spak, D. Jernigan, C. Friedman, M. Ripple, D. Patel, S. Pillai, S. Wiersma, R. Labinson, L. Kamal, E. Bresnitz, M. Layton, G. DiFerdinando, S. Kumar, P. Lurie, K. Nalluswami, L. Hathcock, L. Siegel, S. Adams, I. Walks, J. Davies-Coles, M. Richardson, K. Berry, E. Peterson, R. Stroube, H. Hochman, M. Pomeranz, A. Friedman-Kien, D. Frank, S. Bersoff-Matcha, J. Rosenthal, N. Fatteh, A. Gurtman, R. Brechne r, C. Chiriboga, J. Eisold, G. Martin, K. Cahill, R. Fried, M. Grossman, and W. Borkowsky .

We thank Sherrie Bruce, Rebecca Dixon, Anexis Lopez, Pat McConnon, Carmen Resurreccion, Kay Vydareny, the laboratories of the National Center for Infectious Diseases, the laboratories of affected states, the U.S. Department of Defense, and Epidemic Intelligence Service Officers for their assistance in preparing this article.

Dr. Jernigan is a medical epidemiologist with the National Center for Infectious Diseases, Centers for Disease Control and Prevention, and assistant professor of medicine with Emory University School of Medicine.

He has been extensively involved in the clinical evaluation of the anthrax cases associated with this outbreak.

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Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Immunology
  • Infectious Diseases
  • OUTBREAK

Bioterrorism-related inhalational anthrax: The first 10 cases reported in the United States

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Journal Title:

Emerging Infectious Disease

Volume:

Volume 7, Number 6

Publisher:

, Pages 933-944

Type of Work:

Article | Final Publisher PDF

Abstract:

From October 4 to November 2, 2001, the first 10 confirmed cases of inhalational anthrax caused by intentional release of Bacillus anthracis were identified in the United States. Epidemiologic investigation indicated that the outbreak, in the District of Columbia, Florida, New Jersey, and New York, resulted from intentional delivery of B. anthracis spores through mailed letters or packages. We describe the clinical presentation and course of these cases of bioterrorism-related inhalational anthrax. The median age of patients was 56 years (range 43 to 73 years), 70% were male, and except for one, all were known or believed to have processed, handled, or received letters containing B. anthracis spores. The median incubation period from the time of exposure to onset of symptoms, when known (n=6), was 4 days (range 4-6 days). Symptoms at initial presentation included fever or chills (n=10), sweats (n=7), fatigue or malaise (n=10), minimal or nonproductive cough (n=9), dyspnea (n=8), and nausea or vomiting (n=9). The median white blood cell count was 9.8 × 10 3 /mm 3 (range 7.5 to 13.3), often with increased neutrophils and band forms. Nine patients had elevated serum transaminase levels, and six were hypoxic. All 10 patients had abnormal chest X-rays; abnormalities included infiltrates (n=7), pleural effusion (n=8), and mediastinal widening (seven patients). Computed tomography of the chest was performed on eight patients, and mediastinal lymphadenopathy was present in seven. With multidrug antibiotic regimens and supportive care, survival of patients (60%) was markedly higher ( < 15%) than previously reported.

Copyright information:

Emerging Infectious Diseases is an open access journal published monthly by the Centers for Disease Control and Prevention (CDC).

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