Rapid detection of anthrax inhalation

Authors of a research letter in this week’s issue of THE LANCET outline progress in the ability to rapidly detect anthrax inhalation in the event of bioterrorist attacks.

Limiting the effects of a bioterrorist anthrax attack will require the rapid and accurate recognition of symptoms among the earliest victims. Central to this will be the ability to distinguish between the specific effects of anthrax inhalation from other respiratory illness such as pneumonia or influenza.

Demetrios Kyriacou (Northwestern Hospital, Chicago, USA) and colleagues compared 47 historical cases (including 11 cases of bioterrorism-related anthrax) with 376 controls who had either community-acquired pneumonia or influenza-like illness. The investigators found that specific features—including Nausea, vomiting, and altered mental status—were more frequently recorded in the inhalational anthrax cases than in either the community-acquired pneumonia or influenza-like illness controls. The most accurate predictor of anthrax was mediastinal widening (when mid-chest tissue appears swollen from enlarged lymph nodes in response to infection and inflammation in the lung) or pleural effusion (fluid shadow) on a chest X-ray.

Dr Kyriacou comments: “Our findings represent preliminary efforts toward identifying clinical predictors of inhalational anthrax…Studies using prospectively collected information from controls should be done to corroborate, modify, or refute our findings.”

In an accompanying Commentary (p 393), Jeremy Mogridge (University of Toronto, Canada) adds: “Without widespread vaccinations against anthrax, the ability to respond effectively to a bioterrorist attack is vital. The development of new antibacterial drugs and antitoxins will enhance our ability to treat patients who have become infected. We should also keep in mind that a strong health-care system with a capacity to absorb a sudden surge of patients will dramatically reduce the impact of an attack.”